严重脓毒症及脓毒症休克阴阳辨证与炎症指标的相关性研究

Correlation between syndrome differentiation of yin-yang and inflammatory markers in patients with severe sepsis and septic shock

目的探讨严重脓毒症及脓毒症休克阴阳辨证的分布规律,并分析其与炎症指标的相关性。方法选择208例严重脓毒症及脓毒症休克患者,根据中医辨证分为阴证98例,阳证110例,记录患者急性生理与慢性健康状况评分(APACHEⅡ评分)和全身炎症反应综合征评分(SIRS评分),同时检测患者的乳酸(LAC)、白细胞计数(WBC)、中性粒细胞百分比(NE%)、C反应蛋白(CRP)、降钙素原(PCT)各炎症指标水平,并统计两组患者28天死亡率。结果阴证患者比阳证患者SIRS评分明显降低(P<0.05),而阴证患者PCT水平显著高于阳证患者(P<0.05)。两组的APACHEⅡ评分、WBC、NE%及CRP比较,差异无统计学意义(P>0.05)。阴证患者存活组与死亡组比较,NE%值以及APACHEⅡ评分差异有统计学意义(P<0.05)。阳证患者死亡组PCT水平、APACHEⅡ评分明显高于存活组(P<0.05)。结论中医阴阳辨证对严重脓毒症及脓毒症休克炎症状态判断有一定的预测价值。

Objective To investigate the distribution of syndrome differentiation of yin-yang in severe sepsis and septic shock patients, and to study correlation between yin syndrome or yang syndrome with inflammatory markers. Methods Based on the principles of TCM syndrome differentiation, 98 of 208 patients with severe sepsis and septic shock were diagnosed as yin syndrome, and 110 patients as yang syndrome. Acute physiology and chronic health evaluation 11 （APACHE 11 ） score and systemic inflammatory response syndrome （SIRS） score were recorded, as well as 28 d mortality. Lactic acid （ LAC）, WBC, percentage of neutrophils （ NE% ）, C-reactive protein （CRP） and procalcitonin （PCT） were determined. Results Yin syndrome patients with mean SIRS score 2.51 ±0.62 were significantly lower than yang syndrome patients with 3.06 ± 0.80 （ P 〈 0.05 ）. However, PCT in yin syndrome patients were significantly higher than those in yang syndrome patients （ P 〈 0.05 ）. No statistically differences were showed in APACHE Ⅱ score, WBC, NE% and CRT. In yin syndrome patients, 72 of 98 were survival （survival group）and 26 were dead（ death group）. APACHE Ⅱ score and NE% in survival group with yin syndrome were significantly lower than death group （ P 〈 0.05 ）. APACHE Ⅱ score and PCT in survival group （ n = 81 ） with yang syndrome were significantly lower than death group （ n = 29 ） （ P 〈 0. 05 ）. Conclusion Syndrome differentiation of yin-yang can be used in predicting the inflammatory state and prognosis in patients with severe sepsis and septic shock.