细菌性肝脓肿中期热毒炽盛证患者血脂水平与病情变化的相关性研究  

Study on the correlation between blood lipid level and condition changes in the middle stage of bacterial liver abscess with severe heat poisoning syndrome

作　　者：陈頔 陈明 CHEN Di;CHEN Ming(Tianjin University of Traditional Chinese Medicine,Tianjin 300100,China)

机构地区：[1]天津中医药大学,天津300193 [2]天津中医药大学,天津市中西医结合医院,天津300100

出　　处：《中国中西医结合外科杂志》2025年第1期98-104,共7页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

摘　　要：目的:研究细菌性肝脓肿中期热毒炽盛证患者血脂水平与炎症水平、病情评分的相关性,以及采用不同治疗方案后其变化情况。方法:回顾性选择天津市中西医结合医院收治的细菌性肝脓肿中期热毒炽盛证患者121例,根据治疗前是否存在脓毒症及脓毒性休克分为非脓毒症组27例、脓毒症(非脓毒性休克)组73例、脓毒症(脓毒性休克)组21例,并按治疗方案分为西医治疗组38例、中西医结合治疗组83例,对其血脂水平、炎症水平、器官衰竭(SOFA)评分、急性生理学与慢性健康状况评价系统Ⅱ(APACHEⅡ)评分、脓毒症危险因素,以及西医治疗和中西医结合治疗后指标的变化等进行分析。结果:121例细菌性肝脓肿中期热毒炽盛证患者治疗前的高密度脂蛋白(HDL)、低密度脂蛋白(LDL)与中性粒细胞百分比(Leukocyte N%)、C反应蛋白(CRP)、降钙来原(PCT)、SOFA评分及APACHEⅡ评分均呈负相关性,多因素Logistic回归分析显示,HDL、PCT以及APACHEⅡ评分是脓毒症的危险因素;LDL、PCT以及APACHEⅡ评分是脓毒性休克的危险因素。继续进行治疗分组研究显示,中西医结合治疗组患者治疗前后ΔHDL、ΔCRP的绝对值[(+0.54±0.18)mmol/L、(-164.10±75.50)mg/L vs(+0.12±0.14)mmol/L、(-95.94±68.98)mg/L]大于西医治疗组,差异有统计学意义(P<0.05)。结论:细菌性肝脓肿中期热毒炽盛证患者的血脂水平变化对病情严重程度有提示作用,且中西医结合治疗该类患者有加速炎症恢复、促进病情痊愈、缩短病程时间、减少住院花费的明显优势。Objective To study the correlation between blood lipid level,inflammation level and disease score in patients in the middle stage of bacterial liver abscess with severe heat poisoning syndrome,and the changes of blood lipid level after different treatment schemes.Methods A retrospective study was carried out on 121 patients in the middle stage of bacterial liver abscess with severe heat poisoning syndrome who were hospitalized in Tianjin Hospital of ITCWM Hospital.Based on the presence of sepsis and septic shock prior to treatment,the patients were divided into three groups:the non-septic group(27 cases),the septic group(nonseptic shock)(73 cases),and the septic group(septic shock)(21 cases).Furthermore,patients were categorized by treatment regimen into a Western medicine treatment group(38 cases) and a integrated traditional Chinese and Western medicine treatment group(83 cases).Then analyze their blood lipid level,inflammation level,SOFA score,APACHE Ⅱ score,risk factors of sepsis and changes of indicators after western medicine treatment and integrated traditional Chinese and western medicine treatment.Results Before treatment,HDL and LDL was negatively correlated with Leukocyte N%,CRP,PCT,SOFA score and APACHE Ⅱ score.Multivariate Logistic regression analysis showed that HDL,PCT and APACHE Ⅱ scores were risk factors for sepsis.LDL,PCT,APACHE Ⅱ scores were risk factors for septic shock.The further study of treatment groups showed that the absolute values of ΔHDL and ΔCRP in the treatment group of ITCWM before and after treatment was higher than that of the Western medicine treatment group [(+0.54 ±0.18)mmol/L,(-164.10 ±75.50)mg/L vs (+0.12 ±0.14)mmol/L,(-95.94 ±68.98)mg/L],and the difference was statistically significant(P <0.05).Conclusion The change of blood lipid level in patients in the middle stage of bacterial liver abscess with severe heat poisoning syndrome can prompt the severity of the disease,and the treatment of this kind of patients with ITCWM has obvious advantages in accelerating

关 键 词：细菌性肝脓肿 中医分期辨证 血脂 脓毒症 

分 类 号：R575.4[医药卫生—消化系统]