脓毒症患者同型半胱氨酸、凝血功能与中医辨证分型的关系研究

Study on the relationship between homocysteine,coagulation function and TCM syndrome differentiation in sepsis patients

目的:分析脓毒症患者同型半胱氨酸、凝血功能、中医辨证分型之间的关系,为脓毒症的诊治提供新的依据。方法:将62例诊断为脓毒症患者进行同型半胱氨酸、凝血检测及中医辨证分型,观察脓毒症中医证型的分布概况、不同证型间同型半胱氨酸的差异及同型半胱氨酸与凝血指标之间的相关性。结果:脓毒症患者的中医证型以热毒炽盛证、瘀毒内阻证、阳气暴脱证居多;"热、瘀、虚"三大证型之间同型半胱氨酸的差异有统计学意义(P <0.05);气阴耗竭证、阳气暴脱证及邪毒内蕴、败血损络证三个证型之间同型半胱氨酸的差异无统计学意义(P> 0.05),与其他证型同型半胱氨酸的差异有统计学意义(P <0.05);脓毒症患者同型半胱氨酸与正常人相比处于较高水平,与凝血酶原时间、部分凝血酶原时间、D二聚体成正相关,差异具有统计学意义(P <0.05),与纤维蛋白原之间无显著相关性(P> 0.05)。结论:脓毒症患者的同型半胱氨酸可出现不同程度升高,并且参与凝血功能障碍的发生,与中医证型气阴耗竭证、阳气暴脱证有密切关系,对其进行监测对脓毒症的中西医诊治过程有一定的意义。

Objective:To analyze the relationship between Hcy,coagulation function and TCM syndrome differentiation in patients with sepsis,and to provide a new basis for the diagnosis and treatment of sepsis.Methods:Sixty-two patients diagnosed with sepsis were tested for Hcy and coagulation,and identifyed TCM syndromes.The distribution of TCM syndromes of sepsis,the difference of Hcy among different syndromes and the correlation between Hcy and coagulation indexes were observed.Results:The TCM syndromes of patients with sepsis were in the majority with the Redu Chisheng syndrome(热毒炽盛证),the Yudu Neizu syndrome(瘀毒内阻证) and the Yangqi Baotuo syndrome(阳气暴脱证).There was statistically significant difference in Hcy among the heat syndrome,the stasis syndrome and the deficiency syndrome,P<0.05.There was no statistical significance in Hcy among the Qiyin Haojie syndrome(气阴耗竭证),the Yangqi Baotuo syndrome and the Xiedu Neiyun syndrome(邪毒内蕴证),the Baixue Sunluo syndrome(败血损络证),P>0.05.However,there was astatistically significant difference in Hcy between these three syndromes and other syndromes(P<0.05).Patients with sepsis have higher levels of Hcy than healthy people.Hcy was positively correlated with PT,APTT and D-D(P<0.05),but had no significant correlation with FIB(P>0.05).Conclusion:Hcy in patients with sepsis may increase to varying degrees and participate in the occurrence of coagulation dysfunction,which is closely related to the Qiyin Haojie syndrome and the Yangqi Baotuo syndrome.Monitoring of Hcy is of certain significance for the diagnosis and treatment of sepsis in TCM and western medicine.