脓毒症患者六经辨证与HLA-DR、T淋巴细胞亚群的相关性研究

Correlation between Syndrome Differentiation of Six Meridians and HLA-DR, T Lymphocyte Subsets in Patients with Sepsis

目的:探讨脓毒症患者六经辨证分型与CD+14单核细胞人白细胞DR抗原(HLA-DR)、T淋巴细胞亚群(CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+))的相关性及规律性。方法:将2019年1月—2021年12月北京中医药大学深圳医院(龙岗)重症医学科(ICU)收治的88例脓毒症患者按六经辨证分型,分为太阳病组20例、阳明病组12例、少阳病组17例、太阴病组11例,少阴病组25例、厥阴病组3例;入组24 h内检测免疫指标、降钙素原(PCT)、氧合指数(PaO_(2)/FiO_(2))、血乳酸(LAC)水平;对比各组急性生理及慢性健康评分(APACHE II)、序贯性脏器衰竭评分(SOFA)、28 d死亡率、机械通气时间,ICU和总住院时间。结果:三阳病(太阳、阳明、少阳)各组间HLA-DR、T细胞亚群、PCT、PaO_(2)/FiO_(2)、LAC、APACHE II评分、SOFA评分、28 d死亡率、机械通气时间、ICU和住院时间等对比无统计学差异(P>0.05);与太阳病组比较,太阴病组CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)、HLA-DR、IgG、IgM明显降低,CD_(8)^(+)、年龄、机械通气时间、ICU和住院时间明显上升或延长(P<0.05,P<0.01);少阴病组与三阳病组间上述免疫指标、年龄、机械通气时间、ICU和住院时间比较均有统计学意义(P<0.05,P<0.01);从太阳病到少阴病,APACHE II、SOFA评分、PCT、LAC逐渐增高,PaO_(2)/FiO_(2)逐渐降低,其中太阴病组与太阳病、阳明病组上述指标比较有统计学意义(P<0.05,P<0.01),少阴病组与三阳病组间比较亦有统计学意义(P<0.05,P<0.01);少阴病组28 d死亡率显著高于太阳病组[52.00%(13/25)比20.00%(4/20),P<0.05]。结论:脓毒症患者HLA-DR、T淋巴细胞亚群百分比的表达与六经传变存在对应的关系。六经辨证分型有助于评估脓毒症患者的免疫功能、病情严重程度及转归。

Objective:To explore the correlation and regularity between six meridians syndrome differentiation and CD+14 monocyte human leukocyte DR antigen(HLA-DR)and T lymphocyte subsets(CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+))in patients with sepsis.Methods:From January 2019 to December 2021,88 patients with sepsis treated in the Department of critical medicine(ICU)of Shenzhen Hospital(Longgang)of Beijing University of Chinese medicine were divided into Taiyang disease group(20 cases),Yangming disease group(12 cases),Shaoyang disease group(17 cases),Taiyin disease group(11 cases),Shaoyin disease group(25 cases)and Jueyin disease group(3 cases).The immune indexes,procalcitonin(PCT),oxygenation index(PaO_(2)/FiO_(2))and blood lactic acid(LAC)were measured within 24 hours;The acute physiology and chronic health score(APACHE II),sequential organ failure score(sofa),28 day mortality,mechanical ventilation time,ICU and total hospital stay were compared.Results:There was no significant difference in HLA-DR,T lymphocytsubsets,PCT,PaO_(2)/FiO_(2),LAC,APACHE II score,SOFA score,28 day mortality,mechanical ventilation time,ICU and hospitalization time among the three Yang diseases(Taiyang,Yangming and Shaoyang)(P>0.05);Compared with Taiyang disease group,CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+),HLA-DR,IgG and IgM in Taiyin disease group decreased significantly,while CD_(8)^(+),age,mechanical ventilation time,ICU and hospitalization time increased or prolonged significantly(P<0.05,P<0.01);The above immune indexes,age,mechanical ventilation time,ICU and hospitalization time between Shaoyin disease group and Sanyang disease group were statistically significant(P<0.05,P<0.01);From Taiyang disease to Shaoyin disease,APACHE II,SOFA score,PCT and lac increased gradually,and PaO_(2)/FiO_(2) decreased gradually.The above indexes in Taiyin disease group were statistically significant compared with Taiyang disease and Yangming disease group(P<0.05,P<0.01),and there was also statistical significance between Shaoyin disease group and Sanyang disease group(P<0.05,P<0.01);The 28 day mortality in Shaoyin disease group was significantly higher than that in Taiyang disease group[52.0%(13/25)vs 20.0%(4/20),P<0.05)].Conclusion:There is a corresponding relationship between the expression of HLA-DR and T cell subsets in patients with sepsis and the transmission of six meridians.The syndrome differentiation of six meridians is helpful to evaluate the immune function,severity and prognosis of patients with sepsis.