社区获得性肺炎合并低蛋白血症的中医证候、死亡因素与中药治疗的回顾性分析

A Retrospective Analysis of TCM Syndromes,Death Factors and TCM Treatment Intervention of CAP Combined with Hypoproteinemia

目的总结社区获得性肺炎(CAP)合并低蛋白血症的中医证候、相关死亡因素,同时探究清热化痰健脾法对预后的影响。方法采取回顾性研究的方法,收集2016年6月至2019年11月间江苏省中医院急诊病区收治的CAP合并低蛋白症病例资料,统计分析并比较中医证候资料,分析影响28 d死亡率的因素。并根据住院期间是否口服中药≥7 d参与治疗,定义为中药组,其余为对照组,分析中药治疗对于蛋白指标、感染与预后的影响。结果共纳入研究病例224例,其中死亡52例,生存172例,中医病邪以痰邪、湿邪为主,痰热证为首;其中,年龄(HR=1.037)、急性生理与慢性健康情况评分Ⅱ(APACHEⅡ)(HR=1.120)、重症肺炎(HR=2.391)、恶性肿瘤病史(HR=4.832)、呼吸衰竭(HR=4.829)、慢性肾衰竭(HR=6.350)、中药治疗(HR=0.288)为影响CAP合并低蛋白血症死亡的因素(P<0.05);中药组144例,对照组80例,在倾向性匹配与基线对比后,分析显示中药组28 d死亡率低于对照组(P<0.01),组内比较时,中药治疗可提高前后白蛋白、前白蛋白、总白蛋白含量(P<0.05),降低中性粒细胞百分比(NEUT%)、C反应蛋白(CRP)(P<0.05);两组组间比较无明显统计学差异(P>0.05)。结论痰热病邪是导致CAP合并低蛋白血症的主要病邪。其中恶性肿瘤、呼吸衰竭、重症肺炎、慢性肾衰竭等疾病可增加CAP合并低蛋白血症病患死亡的风险,中药干预治疗可改善低蛋白状态与降低死亡风险,对预后有着积极的意义。

Objective:To summarize the traditional Chinese medicine symptoms and related death factors of community acquired pneumonia(CAP)complicated with hypoproteinemia,and to explore the influence of heatclearing,phlegm-clearing and spleen-invigorating method on the prognosis.Methods:Retrospective study was conducted to collect the data of CAP patients admitted to the emergency ward of Jiangsu Hospital of Traditional Chinese Medicine from June 2016 to November 2019.The data of TCM syndromes were statistically analyzed and compared,and the factors affecting 28d mortality were analyzed.In addition,the group was defined as the TCM group and the rest were the control group according to whether the TCM was taken orally for no less than 7 days during the hospitalization period.The effects of traditional Chinese medicine treatment on protein indicators,infec⁃tion and prognosis were analyzed.Results:A total of 224 cases were included,among which 52 died and 172 sur⁃vived.The pathogenic factors of TCM were mainly phlegm and dampness,with phlegm heat syndrome as the lead⁃ing cause.Among them,age(HR=1.037),APACHEII(HR=1.120),severe pneumonia(HR=2.391),history of malig⁃nant tumor(HR=4.832),respiratory failure(HR=4.829),chronic renal failure(HR=6.350),and Chinese medicine treatment(HR=0.288)were the factors influencing death of CAP with hypoproteinemia(P<0.05);among all the cases,144 were in the TCM group and 80 were in the control group.After propensity matching and baseline com⁃parison,the analysis showed that the mortality rate of the TCM group on 28 days was lower than that of the control group(P<0.01).When compared within the group,the content of albumin,prealbumin and total albumin before and after the TCM treatment was increased(P<0.05),the percentage of neutrophils and the hypersensitive C-reactive protein(P<0.05);there was no statistically significant difference between the two groups(P>0.05).Conclu⁃sion:Sputum fever is the main pathogenic factor of cap-associated hypoproteinemia.Among them,malignant tu⁃mor,respiratory failure,severe pneumonia,chronic renal failure and other diseases can increase the risk of death in patients with CAP complicated with hypoproteinemia,and TCM intervention can improve the state of hypopro⁃teinemia and reduce the risk of death,which has a positive significance for the prognosis.