中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2014年
2期
112-116
,共5页
刘学花%卢建荣%李玲%田卓民
劉學花%盧建榮%李玲%田卓民
류학화%로건영%리령%전탁민
社区获得性肺炎%中医证型%C-反应蛋白%甘露聚糖结合凝集素
社區穫得性肺炎%中醫證型%C-反應蛋白%甘露聚糖結閤凝集素
사구획득성폐염%중의증형%C-반응단백%감로취당결합응집소
Community acquired pneumonia%Syndrome patterns of traditional Chinese medicine%C-reactive protein%Mannose-binding lectin
目的：研究社区获得性肺炎（CAP）中医证型血清C-反应蛋白（CRP）及甘露聚糖结合凝集素（MBL）的变化规律，探索中医辨证分型的客观指标。方法选择CAP患者104例，依据《社区获得性肺炎中医诊疗指南（2011版）》将CAP分为实证类（风热袭肺证、外寒内热证、痰热壅肺证、痰湿壅肺证）、正虚邪恋类（肺脾气虚证、气阴两虚证）、危重变证类（热陷心包证、邪陷正脱证）3类8个证候。以同期健康体检者100例为健康对照者。检测各受试者治疗前及治疗后4 d、7 d血清CRP及MBL水平。结果104例CAP患者中证型实证类居多（占63.5%），正虚邪恋类次之（占19.2%），危重变证类占17.3%。CAP各中医证型血清CRP水平高于健康对照者，且随时间变化及不同中医证型而存在差异。随治疗时间延长CAP各中医证型血清CRP水平均呈下降趋势，风热袭肺、外寒内热证型治疗后7 d已降至正常（mg/L：13.51±11.48、7.07±1.84比6.96±2.19，均P＞0.05）；肺脾气虚、气阴两虚证型血清CRP水平较高，但下降速度较快，治疗后7 d时接近正常，但仍高于健康对照组（25.25±25.90、18.17±23.19比6.96±2.19，均P＜0.05）；痰热壅肺、痰湿壅肺证型血清CRP水平虽有下降，治疗后7 d时仍保持较高水平（51.70±27.33、49.28±30.57）；热陷心包、邪陷正脱证型血清CRP水平无下降趋势。风热袭肺、外寒内热、痰热壅肺、痰湿壅肺、肺脾气虚及气阴两虚证型患者血清MBL水平高于健康对照者；热陷心包、邪陷正脱证型血清MBL水平低于其他证型，随治疗时间延长保持较低水平。结论血清CRP可作为判断CAP中医证型参考指标；低血清MBL提示CAP中医证型较重，预后不良。
目的：研究社區穫得性肺炎（CAP）中醫證型血清C-反應蛋白（CRP）及甘露聚糖結閤凝集素（MBL）的變化規律，探索中醫辨證分型的客觀指標。方法選擇CAP患者104例，依據《社區穫得性肺炎中醫診療指南（2011版）》將CAP分為實證類（風熱襲肺證、外寒內熱證、痰熱壅肺證、痰濕壅肺證）、正虛邪戀類（肺脾氣虛證、氣陰兩虛證）、危重變證類（熱陷心包證、邪陷正脫證）3類8箇證候。以同期健康體檢者100例為健康對照者。檢測各受試者治療前及治療後4 d、7 d血清CRP及MBL水平。結果104例CAP患者中證型實證類居多（佔63.5%），正虛邪戀類次之（佔19.2%），危重變證類佔17.3%。CAP各中醫證型血清CRP水平高于健康對照者，且隨時間變化及不同中醫證型而存在差異。隨治療時間延長CAP各中醫證型血清CRP水平均呈下降趨勢，風熱襲肺、外寒內熱證型治療後7 d已降至正常（mg/L：13.51±11.48、7.07±1.84比6.96±2.19，均P＞0.05）；肺脾氣虛、氣陰兩虛證型血清CRP水平較高，但下降速度較快，治療後7 d時接近正常，但仍高于健康對照組（25.25±25.90、18.17±23.19比6.96±2.19，均P＜0.05）；痰熱壅肺、痰濕壅肺證型血清CRP水平雖有下降，治療後7 d時仍保持較高水平（51.70±27.33、49.28±30.57）；熱陷心包、邪陷正脫證型血清CRP水平無下降趨勢。風熱襲肺、外寒內熱、痰熱壅肺、痰濕壅肺、肺脾氣虛及氣陰兩虛證型患者血清MBL水平高于健康對照者；熱陷心包、邪陷正脫證型血清MBL水平低于其他證型，隨治療時間延長保持較低水平。結論血清CRP可作為判斷CAP中醫證型參攷指標；低血清MBL提示CAP中醫證型較重，預後不良。
목적：연구사구획득성폐염（CAP）중의증형혈청C-반응단백（CRP）급감로취당결합응집소（MBL）적변화규률，탐색중의변증분형적객관지표。방법선택CAP환자104례，의거《사구획득성폐염중의진료지남（2011판）》장CAP분위실증류（풍열습폐증、외한내열증、담열옹폐증、담습옹폐증）、정허사련류（폐비기허증、기음량허증）、위중변증류（열함심포증、사함정탈증）3류8개증후。이동기건강체검자100례위건강대조자。검측각수시자치료전급치료후4 d、7 d혈청CRP급MBL수평。결과104례CAP환자중증형실증류거다（점63.5%），정허사련류차지（점19.2%），위중변증류점17.3%。CAP각중의증형혈청CRP수평고우건강대조자，차수시간변화급불동중의증형이존재차이。수치료시간연장CAP각중의증형혈청CRP수평균정하강추세，풍열습폐、외한내열증형치료후7 d이강지정상（mg/L：13.51±11.48、7.07±1.84비6.96±2.19，균P＞0.05）；폐비기허、기음량허증형혈청CRP수평교고，단하강속도교쾌，치료후7 d시접근정상，단잉고우건강대조조（25.25±25.90、18.17±23.19비6.96±2.19，균P＜0.05）；담열옹폐、담습옹폐증형혈청CRP수평수유하강，치료후7 d시잉보지교고수평（51.70±27.33、49.28±30.57）；열함심포、사함정탈증형혈청CRP수평무하강추세。풍열습폐、외한내열、담열옹폐、담습옹폐、폐비기허급기음량허증형환자혈청MBL수평고우건강대조자；열함심포、사함정탈증형혈청MBL수평저우기타증형，수치료시간연장보지교저수평。결론혈청CRP가작위판단CAP중의증형삼고지표；저혈청MBL제시CAP중의증형교중，예후불량。
Objective To study the regularity changes in serum levels of C-reactive protein(CRP)and mannose-binding lectin(MBL)in patients of community acquired pneumonia(CAP)with different syndrome patterns of traditional Chinese medicine(TCM),and to explore the new objective markers to differentiate the syndrome patterns of TCM. Methods According to The Guideline on TCM diagnosis and treatment of CAP(2011 edition),104 patients with CAP were selected and their syndromes were cassified into 3 classes and 8 patterns of syndrome:excessive class〔including following patterns:wind-heat invading lung(fengrexifei),exopathic cold and interior heat(waihanneire), accumulation of heat in lung(tanreyongfei),accumulation of phlegm-dampness in lung(tanshiyongfei)〕,deficient vital QI leading to lingering of pathogen class〔qi deficiency of lung and spleen(feipiqixu),both qi and yin deficiency (qiyinliangxu)〕,TCM critical class〔heat falling into pericardium(rexianxinbao),pathogen invasion and vital qi deterioration(xiexianzhengtuo)〕. In the same period,after physical examinations,100 healthy volunteers were chosen as healthy control group. The serum levels of CRP and MBL were detected before treatment and after treatment for 4 days and 7 days. Results Among the 104 CAP patients,the most popular class of syndrome was the excessive one(63.5%),followed by deficient vital QI leading to lingering of pathogen(19.2%)and TCM critical class(17.3%). The serum CRP level in CAP patients at each time point was higher than that in healthy control group,which had a different tendency to change over time in different syndrome patterns of TCM. With the prolongation of treatment time,the serum CRP levels in fengrexifei and waihanneire patterns returned to a normal level on the 7th day(mg/L:13.51±11.48,7.07±1.84 vs. 6.96±2.19,both P>0.05),in feipiqixu and qiyinliangxu patterns the CPR levels were higher,but its descent rate was relatively fast,and on the 7th day it was approximately normal in spite of being higher than the level in healthy control group(25.25±25.90,18.17±23.19 vs. 6.96±2.19,both P<0.05);in tanreyongfei and tanshiyongfei patterns,although the CPR levels were decreased,they still maintained at relatively high levels on the 7th day after treatment(51.70±27.33,49.28±30.57),and no downtrend of CPR was seen in rexianxinbao and xiexianzhengtuo patterns. Before treatment,the serum MBL levels in CAP patients with fengrexifei,waihanneire, tanreyongfei,tanshiyongfei,feipiqixu and qiyinliangxu patterns were higher than the level in healthy control group, and in rexianxinbao and xiexianzhengtuo patterns,the levels were lower than those in other patterns and kept being at relatively lower levels along with the prolongation of the therapy. Conclusion Serum CRP can be used as a reference marker for different syndrome patterns of TCM in patients with CAP,and low serum MBL level was a risk factor of severe syndrome patterns of TCM and a poor prognosis in CAP.
