摘要
【目的】探究脓毒症中医证型分布、病原学特征及T淋巴细胞亚群与预后的相关性。【方法】采用回顾性分析方式,选取2020年1月至2022年1月在广州中医药大学第一附属医院重症医学科住院治疗的脓毒症患者86例,总结中医证型分布规律及病原学特征,并根据疾病分期分为脓毒症组33例和脓毒症休克组53例,比较2组患者的T淋巴细胞亚群及相关辅助检查指标,分析2组间的指标差异及与预后的相关性。【结果】(1)86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阴竭阳脱证33例(38.4%)、热毒炽盛证25例(29.1%)、痰热壅肺证15例(17.4%)、肺脾气虚证13例(15.1%)。(2)86例脓毒症患者中,肺部感染占比最高,达到54.7%(47/86);其他依次为尿路感染[22.1%(19/86)]、腹腔感染[9.3%(8/86)]、血流感染[9.3%(8/86)]、胆道感染[4.6%(4/86)]。肺部感染患者以革兰阴性菌感染为主,肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌为前3种最常见的致病细菌。31.9%(15/47)的肺部感染患者合并真菌感染。(3)脓毒症组的CD4^(+)、CD8^(+)淋巴细胞水平高于脓毒症休克组(P<0.01),血乳酸(Lac)、D-二聚体、序贯器官衰竭评分(SOFA)低于脓毒症休克组(P<0.01)。(4)相关性分析结果显示:CD8^(+)淋巴细胞与脓毒症患者不良预后呈负相关(P<0.05);SOFA评分、血Lac与脓毒症患者不良预后呈正相关(P<0.01);CD4淋巴细胞、D-二聚体与脓毒症患者不良预后无明显相关关系(P>0.05)。【结论】脓毒症患者阴竭阳脱证占比最高,肺部是脓毒症患者最常见的感染部位,且容易合并真菌感染;CD8淋巴细胞与脓毒症患者不良预后存在负相关关系,可作为脓毒症患者预后的预测指标。
Objective To investigate the correlation of traditional Chinese medicine(TCM)syndrome types,pathogenic features and T lymphocyte subsets with the prognosis of sepsis.Methods A retrospective analysis was conducted in 86 patients with sepsis who were hospitalized in the Department of Intensive Care Medicine of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2020 to January 2022.The distribution of TCM syndromes and pathogenic features of the patients with sepsis were summarized.And then the patients were divided into the sepsis group(33 cases)and the septic shock group(53 cases)according to the stage of the disease.The levels of T lymphocyte subsets and related laboratory indexes of the two groups were compared,and the differences in the indexes between the two groups and the correlation of the indexes with the prognosis were analyzed.Results(1)The distribution of TCM syndrome types in decreasing sequence of frequency among the 86 patients with sepsis was as follows:depletion of yin causing yang collapse syndrome in 33 cases(38.4%),abundance of heat toxin syndrome in 25 cases(29.1%),phlegm-heat congesting the lung syndrome in 15 cases(17.4%),and lung-spleen qi deficiency syndrome in 13 cases(15.1%).(2)Among the 86 patients with sepsis,pulmonary infection accounted for the highest proportion of 54.7%(47/86).And the other types of infection manifested as urinary tract infection[22.1%(19/86)],intra-abdominal infection[9.3%(8/86)],bloodstream infection[9.3%(8/86)]and biliary tract infection[4.6%(4/86)].Patients with pulmonary infection were predominantly infected with gram-negative bacteria,and Klebsiella pneumoniae,Acinetobacter baumanni and Pseudomonas aeruginosa were the top 3 pathogenic bacteria.Of the patients with pulmonary infection,31.9%(15/47)were complicated with fungal infections.(3)CD4 and CD8^(+)lymphocyte levels in the sepsis group were higher(P<0.01),while blood lactate(Lac)level,D-dimer content and sequential organ failure assessment(SOFA)scores were lower than tho
作者
李乐
罗苑苑
温敏勇
LI Le;LUO Yuan-Yuan;WEN Min-Yong(The First Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;The First Affiliated Hospital,Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China)
出处
《广州中医药大学学报》
CAS
2023年第2期271-277,共7页
Journal of Guangzhou University of Traditional Chinese Medicine
基金
国家自然科学基金项目(编号:82104764)。
关键词
脓毒症
中医证型
阴竭阳脱证
病原学特征
T淋巴细胞亚群
预后
相关性
sepsis
traditional Chinese medicine(TCM)syndrome
depletion of yin causing yang collapse syndrome
pathogenic features
T lymphocyte subsets
prognosis
correlation
