脓毒症合并急性肾衰竭患者中医证候特征及28 d死亡的危险因素分析  

Analysis of TCM syndrome characteristics and risk factors for 28-day mortality in patients with sepsis and acute renal failure

作　　者：黎雾峰 王晶[2] 王毅[1] 张莉芬[1] 张丽葳 徐震宇 LI Wufeng;WANG Jing;WANG Yi;ZHANG Lifen;ZHANG Liwei;XU Zhenyu(The Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China;Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China)

机构地区：[1]上海中医药大学附属第七人民医院,上海200137 [2]上海中医药大学附属市中医医院,上海200071

出　　处：《现代中西医结合杂志》2023年第3期302-307,314,共7页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：上海市浦东新区卫健委学科建设项目(PWZzk2022-15);上海市卫健委科研课题(202040143)。

摘　　要：目的 探究脓毒症合并急性肾衰竭(AKI)患者的中医证候特征及其28 d死亡的危险因素。方法 选取2018年3月-2021年5月上海中医药大学附属第七人民医院收治的224例脓毒症患者为研究对象,根据患者是否发生AKI分为脓毒症AKI组(118例)和脓毒症非AKI组(106例),并根据脓毒症AKI患者28 d死亡情况分为死亡组(65例)和存活组(53例)。收集所有患者临床资料,比较脓毒症AKI组和脓毒症非AKI组患者中医症状、证型、证素差异。采用单因素分析和多因素Logistic回归分析脓毒症AKI患者28 d死亡的独立影响因素。利用多因素分析结果构建列线图预测模型,采用受试者工作曲线(ROC曲线)和校准曲线评价模型的区分度和一致性。结果 脓毒症AKI患者中医症状方面常见咳喘、头晕、恶寒战栗的表现,较脓毒症非AKI患者更易出现四末不温、小便不利、水肿症状(P均<0.05);证型以虚实夹杂证最为常见,单纯实证最为少见;病位证素以肾、脾分布最广,病性证素中热毒、气虚分布占一半以上,且脓毒症AKI患者更易出现阴虚、湿热、血虚、腑实证素。118例脓毒症AKI患者28 d病死率为55.08%(65/118)。多因素Logistic回归分析显示,年龄、胱抑素C(CysC)、AKI分期、序贯器官衰竭评分量表(SOFA)评分、APACHEⅡ评分、血乳酸(Lac)是脓毒症AKI患者28 d死亡的独立危险因素(P均<0.05)。所构建的列线图模型拟合效果良好,区分度和一致性较高。结论 脓毒症AKI患者中医证候方面,以咳喘、头晕、恶寒战栗症状和虚实夹杂证证型最常见,其中肾、脾病位和热毒、气虚病性分布最多。年龄、CysC、AKI分期、SOFA评分、APACHEⅡ评分、Lac是脓毒症AKI患者28 d死亡的独立危险因素。Objective It is to explore the characteristics of traditional Chinese medicine(TCM)syndromes in patients with sepsis and acute kidney injury(AKI)and the risk factors for 28-day mortality.Methods A total of 224 patients with sepsis admitted to the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine from March 2018 to May 2021 were selected as the study subjects.They were divided into sepsis AKI group(118 cases)and sepsis non-AKI group(106 cases)according to whether they had AKI or not,and the patients with sepsis and AKI were divided into death group(65 cases)and survival group(53 cases)according to their death or not within 28 days.The clinical data of all patients were collected,and the differences in TCM symptoms,syndrome types,and syndrome elements between the sepsis AKI group and the sepsis non-AKI group.The independent influencing factors for death in AKI patients with sepsis within 28 days were analyzed by univariate analysis and multifactorial Logistic regression,the results of multifactor analysis were used to construct a column line graph prediction model,and the discrimination and consistency of the model were evaluated by receiver operaing characteristic curves(ROC)and calibration curves.Results Cough and asthma,dizziness,and shaking chills were common in the TCM symptoms of patients with sepsis AKI,and they were more likely to have the symptoms of non-warm limbs,difficult urination and edema compared with non sepsis AKI patients(all P<0.05).The most common type of syndrome was syndrome of intermingled deficiency and excess,and the most rare was simple excess syndrome.The kidney and spleen were the most widely distributed in disease location syndrome elements,while the heat toxicity and Qi deficiency accounting for more than half of the disease character syndrome elements,furthermore,the patients with sepsis and AKI were more prone to had syndrome elements like Yin deficiency,damp heat,blood deficiency and viscera excess.The 28 day mortality rate of 118 patients with seps

关 键 词：脓毒症 急性肾损伤 中医证候 28 d死亡 危险因素 

分 类 号：R692.5[医药卫生—泌尿科学]