社区获得性肺炎中医证型与白细胞、肿瘤坏死因子关系探讨

Relationship between White Blood Cell,Tumor Necrosis Factor-α and TCM Syndromes of Community-acquired Pneumonia

目的研究社区获得性肺炎(CAP)中医证型与白细胞、TNF-α关系,探求炎性指标在CAP中医证型的分布规律。方法选取CAP风热犯肺、痰热壅肺、肺胃热盛、热闭心包、气阴两虚病例各20例,正常对照组20例,检测各证型WBC、GR%、TNF-α,分析各中医证型炎性指标的异同性。结果CAP患者与正常人相比较,WBC、GR%、TNF-α均有显著性差异(P<0.01)。WBC水平按风热犯肺→痰热壅肺→肺胃热盛→热闭心包增高,病情由轻向重发展,气阴两虚型又恢复正常;GR%有类似的表达;TNF-α在实证与虚证之间有显著性差异,故TNF-α可用为肺热病虚实证的参考指标。结论CAP不同的中医证型,其炎症指标有一定的变化规律,联合检测这些指标可以作为CAP辩证分型的客观依据。

Objective To study the relationship between white blood cell （WBC）, tumor necrosis factor-α （TNF-α） and TCM syndromes of community-acquired pneumonia （CAP） and explore the distribution rule of inflammatory indexes in TCM syndromes of CAP. Methods CAP patients were divided into five groups according to the TCM differentiation, ie. syndrome of wind-heat invading the lung, syndrome of accumulation of phlegm-heat in the lung, syndrome of excessive heat in the lung and stomach, syndrome of retention of heat in the theca cordis and syndrome of deficiency of both Qi and Yin. 20 cases for each group and 20 healthy cases as control group, and the levels of WBC, TNF-α and percentage of heterophil granulocyte （GR%） in each group were detected, then the differences and similarities of the inflammatory indexes were analyzed. Results The level of WBC, GR% and TNF-α had significant differences between CAP patients and normals. The level of WBC in syndrome of wind-heat invading the lung, syndrome of accumulation of phlegm-heat in the lung, syndrome of excessive heat in the lung and stomach, syndrome of retention of heat in the theca cordis was gradually increased, and was normal in syndrome of deficiency of both Qi and Yin. The expression of GR% was similar with WBC. The level of TNF-α had significant differences between sthenia syndromes and deficient syndrome. Conclusion The changes of inflammatory indexes have some rules in different TCM syndromes, and combined determination of the indexes could be as the objective basis for syndrome differentiation of CAP.