社区获得性肺炎合并脓毒症中医证型分布及其与C反应蛋白、降钙素原、D-二聚体关系的研究

Study on Chinese medicine syndrome types and correlative indicators in community-acquired pneumonia with sepsis

目的研究社区获得性肺炎合并脓毒症中医证型分布规律及其与C反应蛋白(CRP)、降钙素原(PCT)、D-二聚体(D-Di)之间的关系。方法选取社区获得性肺炎合并脓毒症患者186例,调查其中医证型分布情况,并检测血清CRP、PCT、D-Di水平。结果 1中医证型以热入营血证(27.96%)、瘀毒内阻证(26.89%)、热毒炽盛证(22.58%)多见。2热入营血证CRP水平最高,热毒炽盛证、瘀毒内阻证、气阴两虚证CRP水平与其相近(P>0.05),均明显高于邪毒袭肺证(P<0.01);各组CRP均值由高到低顺序为热入营血证>瘀毒内阻证>热毒炽盛证>气阴两虚证>邪毒袭肺证。3热入营血证、瘀毒内阻证、热毒炽盛证、气阴两虚证PCT水平明显高于邪毒袭肺证(P<0.01),其中瘀毒内阻证、热入营血证高于气阴两虚证及热毒炽盛证(P<0.01);各组PCT均值由高到低顺序为瘀毒内阻证>热入营血证>热毒炽盛证>气阴两虚证>邪毒袭肺证。4瘀毒内阻证、热入营血证的D-Di水平均高于其他各证(P<0.01),瘀毒内阻证D-Di水平明显高于热入营血证(P<0.01);各组D-Di均值由高到低顺序为瘀毒内阻证>热入营血证>热毒炽盛证>气阴两虚证>邪毒袭肺证。结论社区获得性肺炎合并脓毒症中医证型以热入营血证、瘀毒内阻证、热毒炽盛证多见;联合检测CRP、PCT、D-Di,对中医辨证分型有一定的参考价值。

Objective To study the relation between the syndrome of TCM of community-acquired pneumonia（ CAP） combined sepsis with CRP,PCT,D-Di and to analyze the regularities of distribution of indexes among the syndrome of TCM. Methods One hundred and eighty-six CAP patients combined with sepsis were selected to investigate distribution of TCM syndrome,and the levels of CRP,PCT and D-Di were detected. Results 1 In the compare of constituent ratio of syndrome of TCM,the syndrome of toxic heat flourishing（ 22. 58%）,heat the ying blood（ 27. 96%）,stasis poison resistance（ 26. 89%） is common. 2 The CRP level in evil poison attack the lung group is lower than other groups（ P 〈 0. 01）,and there is no statistically significant difference among the syndrome of toxic heat flourishing,heat the ying blood,stasis poison resistance groups. The PCT of deficiency of both qi and yin group and toxic heat flourishing group is higher than evil poison attack the lung group（ P 〈 0. 01） and is lower than heat the ying blood,stasis poison resistance groups（ P 〈 0. 01）. The D-Di of heat the ying blood,stasis poison resistance groups is higher than other groups significantly（ P 〈 0. 01）,and the stasis poison resistance group is highest. It is statistically significant difference compared with heat the ying blood group（ P 〈 0. 01）. Conclusion Combined detection of PCT,D-Di for syndrome differentiation of TCM of CAP with sepsis patients has a certain reference value.