不同中医证型脓毒症患者免疫功能、肠道微生态及预后分析

Analysis of immune function,intestinal microecology and prognosis in sepsis patients with different TCM syn-dromes

目的:分析不同中医证型脓毒症患者免疫功能、肠道微生态及预后。方法:选取2019年11月~2021年11月于本院收治的97例脓毒症患者,根据不同中医证型分为毒热证组、痰热证组和瘀毒证组,另选30例体检健康者作为健康组,比较不同中医证型脓毒症患者与健康组的免疫功能[免疫球蛋白A(IgA)、IgG、IgM]、肠道菌群(双歧杆菌、酵母菌、肠杆菌、肠球菌)数量和肠道菌群多样性(Chao1、Shannon、Simpson指数),随访1月,比较不同中医证型脓毒症患者的预后。结果:不同中医证型脓毒症患者的IgA、IgG、IgM水平和双歧杆菌水平以及Shannon指数、Simpson指数均低于健康组,酵母菌、肠杆菌水平高于健康组(P<0.05);毒热证组患者的APACHE II评分、酵母菌、肠杆菌水平高于痰热证组、瘀毒证组与健康组,IgA、IgG、IgM水平和双歧杆菌水平以及Shannon指数、Simpson指数低于痰热证组、瘀毒证组与健康组(P<0.05),毒热证组患者的死亡率高于瘀毒证组(P<0.05)。结论:脓毒症患者免疫功能降低,肠道微生态紊乱,以毒热证表现尤为明显,该证型患者预后较差。

Objective:To analyze the immune function,intestinal microecology and prognosis of sepsis patients with different TCM syndromes.Methods:A total of 97patients with sepsis admitted to our hospital were enrolled between November 2019and No-vember 2021.According to different TCM syndromes,they were divided into toxin-heat syndrome group,phlegm-heat syndrome group and stasis-toxin syndrome group.A total of 3Ohealthy controls were enrolled as healthy group.The immune function indexes[immunoglobulin A(IgA),IgG,IgM],counts of intestinal floras(Bifidobacteria,Yeast,Enterobacteriaceae,Enterococcus)and diversities of intestinal floras(Chaol,Shannon,Simpson index)between sepsis patients with different TCM syndromes and healthy controls were compared.All patients were followed up for lmonth to compare the prognosis of sepsis patients with different TCM syndromes.Results:The levels of IgA,IgG and IgM,Bifidobacteria count,Shannon index and Simpson index in sepsis pa-tients with different TCM syndromes were lower than those in the healthy group,while counts of Yeast and Enterobacteriaceae were higher than those in the healthy group(P<0.05).The score of Acute Physiology and Chronic Health Scoring System(A-PACHE II),counts of Yeast and Enterobacteriaceae in toxin-heat syndrome groups were higher than those in phlegm-heat syn-drome group,stasis-toxin syndrome group and healthy group,while levels of IgA,IgG and IgM,Bifidobacteria count,Shannon index and Simpson index were lower than those in the three groups(P<0.05).The mortality rate in toxin-heat syndrome group was higher than that in stasis-toxin syndrome group(P<0.05).Conclusion:Patients with sepsis have reduced immune function and disturbances in intestinal microecology,and the prognosis for patients with this evidence is poor.