脓毒症相关急性肾损伤的中医证型与预后的相关性研究  

Correlation Study on the Chinese Medicine Syndrome Characteristics and Prognosis in Patients with Sepsis-associated Acute Kidney Injury

作　　者：曾瑞峰 赖芳 高益锐 陈瑞 陈国聪 杨苏仪 黄威 李俊 Zeng Ruifeng;Lai Fang;Gao Yirui;Chen Rui;Chen Guocong;Yang Suyi;Huang Wei;Li Jun(The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangdong Provincial Hospital of Chinese Medicine,Guangdong Provincial Key Laboratory of Research on Emergency in TCM,Guangdong,Guangzhou 510120,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,广东省中医急症研究重点实验室,广东广州510120 [2]广州中医药大学,广东广州510006 [3]广州中医药大学第一附属医院,广东广州510405

出　　处：《中国中医急症》2024年第1期32-35,44,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：广东省自然科学基金面上项目(2020A1515010512);广东省中医院中医药科学技术研究专项资助(YN2018ZD03);广东省中医院临床研究专项(YN10101908);广东省中医院“优势病种”突破专项(脓毒症优势病种);广东省中医药局科研专项课题(20213007);广东省中医急症研究重点实验室(2023B1212060062)。

摘　　要：目的探讨脓毒症相关急性肾损伤(SA-AKI)患者的中医证型与预后的关系。方法对广东省中医院急诊病区住院患者进行回顾性分析,选择2018年6月至2023年5月的SA-AKI患者为研究对象,根据纳入排除标准筛选出160例。收集患者纳入当时的一般情况、中医临床四诊信息、实验室指标、危重症评分、基础疾病、感染部位及28 d死亡率等。结果单变量回归分析提示持续性SA-AKI相对于短暂性SA-AKI患者死亡风险增加[OR=2.070,95%CI(1.042-4.109)];急性虚证患者[OR=2.047,95%CI(1.065-3.935)]、改善全球肾脏病预后组织(KDIGO)分期[2期OR=2.575,95%CI(1.114-5.952);3期OR=2.853,95%CI(1.034-7.875)]患者发生死亡的风险增加。纳入年龄、性别、SA-AKI分型、KDIGO分期、急性虚证的COX生存回归分析方程具有统计学意义(χ^(2)=13.305,P=0.038),且提示急性虚证为独立危险因素[OR=0.558,95%CI(0.347-0.995),P=0.048]。结论正虚是SA-AKI的重要病机,SA-AKI的中西医结合治疗中需注重早期扶正、全程扶正,并辅以活血化瘀、行气通腑,以减少向持续性SA-AKI发展的比例,降低死亡率。Objective:To investigate the correlation between Chinese medicine syndrome differentiation and prognosis in patients with sepsis-associated acute kidney injury(SA-AKI).Methods:A retrospective study was conducted on patients who were admitted to the emergency ward of Guangdong Provincial Hospital of Chinese Medicine.SA-AKI patients from June 2018 to May 2023 were screened and a total of 160 SA-AKI patients were selected based on the inclusion and exclusion criteria.The general information,clinical diagnosis details,laboratory test results,Sequential Organ Failure Assessment(SOFA)scores,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores,underlying conditions,infection sites on the day of admission,and 28 day mortality were collected.Results:Univariate regression analysis indicated that for patients with transient SA-AKI[OR=2.070,95%CI(1.042-4.109)],patients with acute deficiency syndrome[OR=2.047,95%CI(1.065-3.935)],and patients in Kidney Disease:Improving Global Outcomes(KDIGO)stage[stage 2 OR=2.575,95%CI(1.114-5.952);stage 3 OR=2.853,95%CI(1.034-7.875)],persistent SA-AKI had an increased risk of death.The COX regression analysis,including age,gender,SA-AKI type,KDIGO stage,and acute deficiency syndrome,was statistically significant(χ^(2)=13.305,P=0.038),acute deficiency syndrome had independent risk factors[OR=0.558,95%CI(0.347-0.995),P=0.048].Conclusion:The root cause of SA-AKI is typically attributed to a deficiency of qi.To effectively treat this condition,a blend of western medicine and traditional Chinese practices is suggested.It is crucial to pay attention to reinforcing the healthy qi early and wholly,while also activating blood and resolving stasis,moving qi and relaxing the bowels to prevent persistent SA-AKI and minimize the risk of mortality.

关 键 词：脓毒症 脓毒症相关急性肾损伤 急性虚证 证候分析 生存分析 

分 类 号：R631[医药卫生—外科学]