脓毒症中医阴阳证型分布特点与免疫功能障碍的相关性研究  

Correlation study on the distribution characteristics and immune dysfunction in severe sepsis of yin and yang syndrome in Chinese medicine

作　　者：赖芳[1,2] 郑义 曾瑞峰 袁金霞[4] 廖继旸 周敏莹 李芷瑛 蓝嘉欣 韩云 李俊[1] LAI Fang;ZHENG Yi;ZENG Rui-feng;YUAN Jin-xia;LIAO Ji-yang;ZHOU Min-ying;LI Zhi-ying;LAN Jia-xin;HAN Yun;LI Jun(The Second Affiliated Hospital of Guangzhou University of Chinese Medicine(Guangdong Provincial Hospital of Chinese Medicine),Guangzhou 510120,China;The Second Clinical College of Guangzhou University of Chinese Medicine,Guangzhou 510006,China;Foshan Hospital of TCM,Foshan 528000,China;Hubei Provincial Hospital of Integrated Chinese and Western Medicine,Wuhan 430015,China;Shenzhen Affiliated Hospital of Guangzhou University of Chinese Medicine,Shenzhen 518033,China)

机构地区：[1]广州中医药大学第二附属医院(广东省中医院),广州510120 [2]广州中医药大学第二临床医学院,广州510006 [3]佛山市中医院,佛山528000 [4]湖北省中西医结合医院,武汉430015 [5]广州中医药大学深圳医院,深圳518033

出　　处：《中华中医药杂志》2020年第8期4159-4164,共6页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金项目(N o.81703856);广东省科技厅项目(N o.2014A020212280,No.2016A020215196);广东省中医急症研究重点实验室(No.2017B030314176);广东省中医院中医药科学技术研究专项(No.YN2018ZD03);广东省中医院“优势病种”突破专项:脓毒症优势病种;广东省中医院名中医药专家传承工作建设项目:晁恩祥名中医药专家传承工作室。

摘　　要：目的:探讨阴证及阳证严重脓毒症患者的中医证型分布规律、免疫功能与预后的相关性。方法:依照纳入排除标准,共纳入2016年5月至2018年11月广东省中医院收治的严重脓毒症患者155例,其中阴证85例,阳证70例。收集患者一般资料、纳入24h内炎症指标、血乳酸水平、免疫指标及28d病死率等。结果:采用二分类Logistic回归评估各指标与脓毒症阴阳分型的相关性,纳入年龄、性别、APACHEⅡ评分≥15、氧合指数>400、TBIL≤32、肌酐(Cr)≤170、血清总补体(CH50)共7项自变量的模型具有统计学意义(χ2=9.105,P=0.011),其中氧合指数>400(OR=3.153,95%CI[1.218,8.164]),CH50(OR=1.026,95%CI[1.001,1.052])与脓毒症阳证成独立正相关。回归模型评估严重脓毒症患者病死率,校正后的模型显示白介素-6(OR=1.001,95%CI[1.000,1.001])以及心率(OR=1.031,95%CI[1.006,1.058])升高与最终死亡的风险增加正相关(χ2=14.973,P=0.001)。结论:脓毒症患者中阴证较阳证存在更差的呼吸及免疫失衡;脓毒症早期的炎症反应和心功能可能与病死率有关系。Objective:To investigate the distribution,characteristics,and the correlation between the immune dysfunction and prognosis of patients with severe sepsis of yin and yang syndrome.Methods:155 patients with severe sepsis admitted to the Department of Critical Care Medicine(ICU)of Guangdong Provincial Hospital of Chinese Medicine from May 2016 to November 2018 were enrolled,including 85 patients with yin syndrome and 70 with yang syndrome,according to the inclusion and exclusion criteria.General data,inflammatory markers,lactate,immune indicators were collected within 24 hours after admitted,28-day mortality and health economics indicators as the same.Results:Binary Logistic regression was used to evaluate the relationship between each index in sepsis of yin and yang syndrome.A model with 7 independent variables,including age,gender,APACHEⅡscore≥15,oxygenation index>400,total bilirubin≤32,creatinine≤170,and serum total Complement(CH50),was statistically significant(χ~2=9.105,P=0.011).Oxygenation index>400(OR=3.153,95%CI[1.218,8.164]),CH50(OR=1.026,95%CI[1.001,1.052])was independently and positively correlated with yang syndrome.Adjusted Logistic regression model was used to assess mortality in patients with severe sepsis.The model showed interleukin-6(OR=1.001,95%CI[1.000,1.001])and heart rate(OR=1.031,95%CI[1.006,1.058])were positively associated with an increased risk of mortality(χ~2=14.973,P=0.001).Conclusion:Compared with yang syndrome,there was worse respiratory function and more immune severe imbalance in severe sepsis of yin syndrome.The degree of inflammatory reaction and cardiac function in the early stage of sepsis may have a specific relationship with mortality.

关 键 词：脓毒症 阴证 阳证 免疫障碍 横断面研究 

分 类 号：R459.7[医药卫生—急诊医学]