脓毒症相关急性肾损伤的疾病分型与中医辨证要素的回顾性研究  

A Retrospective Study on the Disease Classification of Sepsis-associated Acute Kidney Injury and the Elements of TCM Syndrome Differentiation

作　　者：曾瑞峰 赖芳 杨苏仪 陈国聪 邓雅文 黄威 陈瑞 李俊 Zeng Ruifeng;Lai Fang;Yang Suyi;Chen Guocong;Deng Yawen;Huang Wei;Chen Rui;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2期227-230,255,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);广东省中医药局科研专项课题(20213007);广东省中医急症研究重点实验室(2023B1212060062);广东省中医院“优势病种”突破专项(脓毒症优势病种)。

摘　　要：目的探寻脓毒症相关急性肾损伤(SA-AKI)患者疾病分型与中医辨证要素之间的关系。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为研究对象,根据纳入排除标准筛选出160例SA-AKI患者,按诊断标准分为短暂性SA-AKI和持续性SA-AKI。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、感染部位等。结果短暂性SA-AKI和持续性SA-AKI比较,年龄[(69.48±15.72)vs.(75.90±12.03),P=0.007]、肌酐[137.70μmol/L(115.50,197.25)vs.156.20μmol/L(133.00,238.25),P=0.031]之间差异存在统计学意义。证候分型方面,急性虚证占比最多(50.63%),其次为毒热证(18.75%)、腑实证(16.88%)、血瘀证(13.75%),短暂性SA-AKI与持续性SA-AKI在不同证型占比之间不具有统计学差异(P>0.05)。急性虚证患者与非急性虚证患者比较,SOFA评分[5.00(3.00,9.00)vs.4.00(3.00,6.00),P=0.044]更高。结论SA-AKI的早期理化特征无法预测患者的AKI分型。证型方面急性虚证占比最多,且疾病严重程度及预后更差。病机方面,短暂性SA-AKI以邪盛正虚为主,持续性SA-AKI以正虚受邪为主。Objective:To investigate the correlation between traditional Chinese medicine(TCM)syndrome differentiation factors and disease classification in patients with sepsis-associated acute kidney injury(SA-AKI).Methods:A retrospective analysis was conducted on in-patients in the Guangdong Provincial Hospital of Chinese Medicine emergency ward.SA-AKI patients from June 2018 to May 2023 were selected as the research subjects.According to the inclusion and exclusion criteria,160 SA-AKI patients were screened out and divided into transient SA-AKI and persistent SA-AKI.The general conditions,TCM clinical diagnosis information,laboratory indi-cators,Sequential Organ Failure Assessment(SOFA)scores,Acute Physiology and Chronic Health Evaluation II(APACHEII)scores,underlying diseases,and infection sites were collected on the day of admission,and 28-day mortality were followed.Results:Compared between transient SA-AKI and persistent SA-AKI,the differences of age[(69.48±15.72)us.(75.90±12.03),P=0.007],creatinine[137.70μmol/L(115.50,197.25)vs.156.20μmol/L(133.00,238.25),P=0.031]were statistically significant.In terms of syndrome dfferentiation,acute deficiency syndrome accounted for the most critical proportion(50.63%),followed by toxic heat syndrome(18.75%),bowel excess syndrome(16.88%),and blood stasis syndrome(13.75%).No statistical difference existed between the proportion of different syndromes in transient and persistent SA-AKI(P>0.05).Compared with patients with non-acute deficiency syndrome,S0FA score[5.00(3.00,9.00)us.4.00(3.00,6.00),P=0.044]was higher.Conclusion:Based on the early physicochemical characteristics of SA-AKI,it is not possible to predict a patient's AKI classification.Acute deficiency syndrome is the most prevalent type of syndrome with worse disease severity and progno-sis.Transient SA-AKI is caused by an excess of pathogens and a deficiency of qi,while persistent SA-AKI is characterized by a deficiency of qi and affected by pathogens.

关 键 词：脓毒症脓 毒症相关急性肾损伤 急性虚证证候分析 回顾性研究 

分 类 号：R631[医药卫生—外科学]