脓毒症中医证型分布、死亡因素分析及AT-Ⅲ联合NT-proBNP、SOFA评分对预后的评估价值

Analysis of Distribution of Traditional Chinese Medicine Syndrome Types and Death Factors of Sepsis and Value of AT-Ⅲ Combined with NT-proBNP and SOFA Score in Evaluation of Its Prognosis

目的:探讨脓毒症中医证型分布规律及影响脓毒症患者预后的因素,并分析抗凝血酶原-Ⅲ(AT-Ⅲ)、N-末端脑钠肽前体(NT-proBNP)及序贯性器官衰竭(SOFA)评分对脓毒症患者预后的评估价值。方法:选取148例脓毒症患者作为研究对象,总结中医证型分布规律。根据预后情况分为存活组115例及死亡组33例。通过单因素及多因素逻辑(logistic)回归分析影响脓毒症患者预后的相关因素。绘制受试者工作特征(ROC)曲线评价AT-Ⅲ、NT-proBNP及SOFA评分对其预后的评估价值。结果:148例脓毒症患者的中医证型分布按频次从高到低排序依次为急性虚证64例(43.24%)、毒热证35例(23.65%)、血瘀证31例(20.95%)、腑气不通证18例(12.16%)。死亡组患者中急性虚证比例高于存活组(P<0.05)。急性虚证、AT-Ⅲ降低、NT-proBNP升高、SOFA评分、男性均为脓毒症患者死亡的危险因素(P<0.05)。AT-Ⅲ、NTproBNP、SOFA评分预测脓毒症患者死亡的ROC曲线下面积分别为0.676、0.715、0.724。当三者联合诊断时,ROC曲线下面积提高到0.8,敏感度高达90.9%。结论:脓毒症中医证型分布依次是急性虚证、毒热证、血瘀证和腑气不通证,急性虚证、AT-Ⅲ降低、NT-proBNP升高、SOFA评分、男性均为脓毒症患者死亡的危险因素。AT-Ⅲ联合NT-proBNP及SOFA评分可有效提升脓毒症患者死亡的早期预测准确性。

Objective:To discuss the distribution rules of traditional Chinese medicine(TCM) syndrome types of sepsis and the contributory factors of its prognosis,and to analyze the value of antithrombin Ⅲ(AT-Ⅲ),N-terminal pro-brain natriuretic peptide(NT-proBNP) and score of Sequential Organ Failure Assessment(SOFA) in the evaluation of prognosis of sepsis.Methods:A total of 148 patients with sepsis were selected as the study subjects and the distribution rules of TCM syndrome types were summarized.They were divided into the survival group and the death group according to the prognosis profile,with 115 and 33 cases in each group.The related contributory factors of prognosis of patients with sepsis were analyzed by univariate and multivariate logistic regression.The value of AT-Ⅲ,NT-proBNP and SOFA score in the evaluation of the prognosis were evaluated by drawing the receiver operating characteristic curve(ROC).Results:The distribution of TCM syndrome types in 148 patients with sepsis was ranked from high to low in order of frequency was respectively 64 cases(43.24%) with acute deficiency syndrome,35(23.65%) with toxin-heat syndrome,31(20.95%) with blood stasis syndrome,and 18(12.16%) with bowel qi obstruction syndrome.The proportion of acute deficiency syndrome in the death group was higher than that in the survival group(P<0.05).The acute deficiency syndrome,decreased AT-Ⅲ,increased NTproBNP,SOFA score and being male were the risky factors of death of patients with sepsis(P<0.05).The areas under the ROC of AT-Ⅲ,NT-proBNP and SOFA score in predicting the death of sepsis patients were respectively 0.676,0.715 and 0.724.When the three indexes were combined for diagnosis,the area under the ROC was increased to 0.8,and the sensitivity was as high as 90.9%.Conclusion:The distribution of TCM syndrome types of sepsis in sequence is acute deficiency syndrome,toxin-heat syndrome,blood stasis syndrome,and bowel qi obstruction syndrome.The acute deficiency syndrome,decreased AT-Ⅲ,increased NT-proBNP,SOFA score and being male are the risky factors of death of patients with sepsis.The therapy of AT-Ⅲ combined with NT-proBNP and SOFA score can effectively enhance the accuracy in early prediction of death of patients with sepsis.