清热养阴法阻断社区获得性肺炎转化重症的回顾性分析

A Retrospective Analysis of Qingre Yangyin Decoction in Blocking the Conversion of Community-acquired Pneumonia to Severe Pneumonia

目的总结非重症社区获得性肺炎(CAP)院内发生重症肺炎(SP)的相关因素,同时探究早期运用清热养阴方对减少SP发生及相关预后的影响。方法采取回顾性研究的方法,收集符合标准的2018年6月至2023年3月间江苏省中医院急诊科病房收治的CAP病例资料,分析院内SP的发生情况,以及影响SP发生的因素,并根据住院前5 d完整运用清热养阴方中药参与治疗,定义为中药组,其余为对照组,分析中药治疗对减少SP发生与临床疗效的影响。结果共纳入研究病例1235例,其中院内14 d内发生SP 79例,其中,年龄≥65(OR=3.673)、中药治疗(OR=2.683)、低氧血症(OR=5.788)、白细胞(OR=1.592)、降钙素原(OR=0.491)、胆碱酯酶(OR=0.998)为影响中低危CAP院内发生SP的因素;中药组680例,对照组555例,在倾向性匹配后,各497例纳入分析,中药组院内SP发生率低于对照组(P=0.041),临床有效率优于对照组(P=0.025)。结论中低危CAP病患中,年龄≥65岁,PSI评分、白细胞计数、降钙素原高,胆碱酯酶低,合并低氧血症可增加院内发生SP的风险,同时清热养阴方早期运用可减少重症的发生,并对预后有积极意义。

Objective:To summarize the factors associated with the in-hospital occurrence of severe pneumonia(SP)in non-serious community-acquired pneumonia(CAP),and to explore the impact of the early application of Qingre Yangyin Decotion on the reduction of the occurrence of SP and the related prognosis.Methods:A retrospective study method was adopted to collect the data of CAP cases admitted to the emergency department ward of Jiangsu Provincial Hospital of Traditional Chinese Medicine between June 2018 and March 2023 that met the criteria.Statistical analysis was conducted for the occurrence of SP in the hospital and the factors affecting the occur-rence of SP.Qingre Yangyin Decotion group was defined with those who completed applied this decoction in the first 5 days of hospitalization,and the rest as the control group.The effect of Qingre Yangyin Decotion on reducing the occurrence of SP and clinical efficacy was analyzed.Results:A total of 1235 cases were included in the study,of which 79 cases of SP occurred in the hospital.Among them,age≥65(OR=3.673),traditional Chinese medicine(TCM)treatment(OR=2.683),hypoxaemia(OR=5.788),leukocyte count(OR=1.592),calcitoninogen(OR=0.491),and cholinesterase(OR=0.998)were the main factors influencing the occurrence of low and medi-umrisk CAP in-hospital occurrence of SP.Among all cases,680 cases were in the TCM group and 555 cases were in the control group;after propensity matching,497 cases in the TCM group and the control group were in-cluded in further analyses,which showed that the incidence of in-hospital SP in the TCM group was lower than that in the control group(P=0.041),and the final clinical effectiveness rate was better than that in the control group(P=0.025).Conclusion:In patients with low to medium risk CAP,factors of age≥65 years old,high PSI score,white blood cell count,calcitoninogen,low cholinesterase,and combined hypoxaemia can increase the risk of in-hospital SP,while early application of Qingre Yangyin Decotion can reduce the incidence of converting to SP,and has a positive significance on clinical prognosis.