基于中医证候要素的脓毒症预后因素多元Cox模型分析  

Multivariate Cox Model Analysis of Prognosis Factors of Sepsis Based on TCM Syndrome Elements

作　　者：李思耐[1] 杨思雯[1] 夏非[1] 张羽[1] 张鑫 王旭升[1] 刘清泉[1] 宋麦芬[1] Li Sinai;Yang Siwen;Xia Fei;Zhang Yu;Zhang Xin;Wang Xusheng;Liu Qingquan;Song Maifen(Beijing Hospital of Traditional Chinese Medicine,Bejing Institute of Traditional Chinese Medicine,Bejing 100010,China.)

机构地区：[1]首都医科大学附属北京中医医院,北京100010

出　　处：《中国中医急症》2020年第7期1135-1139,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：国家自然科学基金资助项目(81703850)

摘　　要：目的应用多元Cox回归模型分析影响脓毒症患者预后的中医证候要素(证素)和危险因素。方法选取在ICU住院治疗的364例脓毒症患者为研究对象,记录其入院时中医证素、临床指标以及住院30 d的临床结局,分析脓毒症患者中医证候特征及其与预后的相关性,应用多元Cox回归模型分析影响脓毒症患者预后的中医证素和其他危险因素,并构建判断脓毒症患者死亡危险的函数模型。结果 364例患者住院30 d时死亡率29.4%(107/364);中医证素分析发现,脓毒症患者常见中医病位在肺,所占比例为67.3%,痰浊和气虚是脓毒症患者最常见的病理证素,所占比例分别为56.9%和44.2%;单因素分析显示,影响脓毒症预后的中医证素为心(P<0.05)、肾(P<0.05)、阳虚(P<0.01)、实热(P<0.05);影响脓毒症预后的危险因素为GCS评分(P<0.01)、RBC(P<0.01)、Hgb(P<0.05)、PLT(P<0.01)、氧合指数(P<0.05)、使用机械通气(P<0.01)、心率(P<0.01)、WBC(P<0.01)及肌酐(P<0.01);多元Cox回归模型分析结果发现证素心(OR=1.716,95%CI:1.090~2.703,P<0.05)、WBC水平(OR=1.027,95%CI:1.001~1.053,P<0.05)与脓毒症死亡率呈正相关,证素实热(OR=0.397,95%CI:0.224~0.703,P<0.01)、PLT(OR=0.998,95%CI:0.996~1.000,P<0.05)与脓毒症死亡率呈负相关。结论脓毒症早期出现心、肾、阳虚证素的脓毒症患者预后较差,而实热证素与脓毒症死亡率呈负相关。Objective:To analyze TCM syndrome elements and risk factors affecting the prognosis of sepsis patients with a multivariate Cox regression model. Methods:364 sepsis patients were enrolled in this study. TCM syndrome elements,clinical indices and clinical outcome following 30 days of hospitalization were recorded to analyze TCM syndrome characteristics of sepsis patients and its correlation with prognosis. Multivariate Cox regression models were built to analyze TCM syndrome elements and risk factors affecting the prognosis of sepsis patients,and to build a functional model to judge the death risk of sepsis patients. Results:The mortality rate of 364 patients was 29.4%(107/364)after 30 days of hospitalization. According to the analysis of TCM syndrome elements,the most common disease position in TCM among sepsis patients was"lung",with a proportion of 67.3%. The most common pathological syndrome elements in sepsis patients were"phlegm"and"Qi deficiency",with proportions of 56.9% and 44.2%,respectively. Univariate analysis showed that TCM syndrome element"heart"(P<0.05),"kidney"(P< 0.05),"Yang-deficiency"(P< 0.01)and"excess-heat"(P< 0.05)were important factors affecting the prognosis of sepsis patients. The risk factors affecting prognosis included GCS(P<0.01),RBC(P<0.01),Hgb(P< 0.05),PLT(P< 0.01),oxygenation index(P< 0.05),mechanical ventilation(P< 0.01),heart rate(P< 0.01),WBC(P< 0.01)and creatinine(P< 0.01). In the multivariate Cox regression model,TCM syndrome element"heart"(OR=1.716,95%CI:1.090~2.703,P< 0.05)and WBC(OR=1.027,95%CI:1.001~1.053,P< 0.05)positively associated with sepsis mortality,and TCM syndrome element"excess-heat"(OR=0.397,95%CI:0.224~0.703,P< 0.01)and PLT(OR=0.998,95%CI:0.996~1.000,P< 0.05)negatively associated with sepsis mortality.Conclusion:TCM syndrome elements of"heart","kidney"and"Yang-deficiency"are indicative of poor prognosis in sepsis patients,but the element of"excess-heat"is negatively correlated with the mortality of sepsis.

关 键 词：脓毒症 中医证候要素 COX模型 预后 

分 类 号：R631[医药卫生—外科学]