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目的探讨严重脓毒症及脓毒症休克阴阳辨证的分布规律,并分析其与炎症指标的相关性。方法选择208例严重脓毒症及脓毒症休克患者,根据中医辨证分为阴证98例,阳证110例,记录患者急性生理与慢性健康状况评分(APACHEⅡ评分)和全身炎症反应综合征评分(SIRS评分),同时检测患者的乳酸(LAC)、白细胞计数(WBC)、中性粒细胞百分比(NE%)、C反应蛋白(CRP)、降钙素原(PCT)各炎症指标水平,并统计两组患者28天死亡率。结果阴证患者比阳证患者SIRS评分明显降低(P<0.05),而阴证患者PCT水平显著高于阳证患者(P<0.05)。两组的APACHEⅡ评分、WBC、NE%及CRP比较,差异无统计学意义(P>0.05)。阴证患者存活组与死亡组比较,NE%值以及APACHEⅡ评分差异有统计学意义(P<0.05)。阳证患者死亡组PCT水平、APACHEⅡ评分明显高于存活组(P<0.05)。结论中医阴阳辨证对严重脓毒症及脓毒症休克炎症状态判断有一定的预测价值。
Objective To investigate the distribution of yin and yang syndromes in severe sepsis and septic shock, and to analyze its correlation with inflammatory markers. Methods A total of 208 patients with severe sepsis and septic shock were selected and divided into 98 cases of yin syndrome and 110 cases of yang syndrome according to syndrome differentiation of traditional Chinese medicine. The acute physiology and chronic health status score (APACHEⅡscore) and systemic inflammatory response syndrome score (SIRS score). The levels of lactic acid (LAC), white blood cell count (WBC), neutrophil percentage (NE%), C-reactive protein (CRP) and procalcitonin (PCT) The 28-day mortality was calculated in both groups. Results SIRS scores in patients with yin syndrome were significantly lower than those in yang syndrome (P <0.05), while those in yin syndrome were significantly higher than those in yang syndrome (P <0.05). There was no significant difference in APACHEⅡscore, WBC, NE% and CRP between the two groups (P> 0.05). There was significant difference between NE% value and APACHEⅡscore in survivors and death patients of Yin syndrome (P <0.05). The PCT level and APACHEⅡ score in the death group of Yang syndrome patients were significantly higher than those in survivors group (P <0.05). Conclusion Syndrome Differentiation of Yin and Yang of TCM can predict the inflammatory state of severe sepsis and septic shock to some extent.