流行性出血热患者下丘脑——垂体——肾上腺轴变化与中医虚实辨证观察

作者	单位
刘俊彬	第四军医大学西京医院传染病科西安 710032
殷义才	第四军医大学西京医院传染病科西安 710032
康文臻	第四军医大学西京医院传染病科西安 710032
惠武利	第四军医大学西京医院传染病科西安 710032

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中文摘要:

本研究通过87例流行性出血热患者血清皮质醇和24小时尿17羟类固醇(17-OH)含量测定,探讨其同下丘脑—垂体—肾上腺轴系统分泌功能关系。结果表明:本病初期以寒热交错或实热兼血瘀证为主,此轴分泌功能亢进,血清皮质醇升高;低血压期以虚实错杂或气滞血瘀证、或气脱虚证为主,此轴分泌功能减退;至少尿期以肾虚兼实热血瘀证为主,此轴功能明显降低,尿17-OH最低仅达7.5±8.2mg/24h;至多尿后期各项指标开始恢复,但近半数尚未正常。提示血清皮质醇和尿17-OH含量同时升高可作为血热血瘀实证指标,尿17-OH的降低可作为肾气虚衰的寒证虚证指标,这为流行性出血热的中西医结合治疗提供了中医辨证的理论基础。

英文摘要:

In order to understand the relationship between the functional changes of hypothalamus-pituitary-adrenal (HPA) axis and the Deficiency-Excess Syndrome Differentiation of traditionalChinese medicine(TCM), the levels of serum cortisol and urinary 17-hydroxy-corticosteroid (U17-OH) per 24 hours were studied. 171 serum samples and 139 urinary samples were obtained from87 patients suffering from epidemic hemorrhagic fever (EHF) in various stage. Result: The Syn-drome displayed as Excess-Heat type accompanied with Blood Stasis in febrile phase of EHF, boththe level of serum cortisol and the U 17-OH increased to meet the stress. But the Syndrome convertedfrom the Excess-Heat type to the Cold-Deficiency type in hypotensive and shock phase and thesecretion of HPA axis began to reduce. However, in oliguric phase, the Syndrome was KidneyDeficiency complicated with Blood-Heat and Blood Stasis, their U 17-0H lowered significantly(7.53±3.82mg/24 h.) in comparing with normal control (P<0.01), but the level of serum cortisol, onthe contrary, raised significantly (1517.96±421.96mol/L) in comparing with control (P<0.01).And in diuretic phase, the Syndrome was the Cold-Deficiency type, the HPA excretion tended torestore gradually but 17-OH maintain at a lower level in serious case. Therefore the change of serumcortisol was closely related with the HPA excretion in all phases of EHF, as well as to theDeficiency-Excess Syndrome Differentiation. It suggested that the increase of serum cortisol and17-OH could be used as the criteria of the Heat-Excess Syndrome in clinical practice; while thereduction of 17-OH, the index of Cold-Deficiency Syndrome, and both increase of serum cortisol andreduction of 17-OH the criteria of the Kidney-Qi Deficiency Syndrome accompanied with BloodStasis in the oliguric phase which could be taken as the theoretical basis for the combined therapyof TCM-WM for EHF with complication of oliguric renal failure.

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