阴阳虚损学说在判断腹部外科危重病患者炎症免疫状态及病情预后中的应用价值研究

Research on the Application Role of Yin Yang Consumption Theory in Evaluating the Inflammatory Immune State and Prognosis of Patients with Abdominal Surgical Critical Illness

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DOI：

中文关键词: 阴阳虚损学说急性生理与慢性健康评分 Ⅱ 人类白细胞抗原DR位点调节性T淋巴细胞转归预后

英文关键词:yin yang consumption theory acute physiology and chronic health evaluation Ⅱ human leukocyte antigen DR site regulatory T cell sequelae and prognosis

基金项目:国家重点基础发展计划（973计划）资助项目（No. 2009CB522703）

作者	单位	E-mail
王娜,杜超
傅强	天津市南开医院重症科（天津300100）	fq@medmail.com.cn

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中文摘要:

目的研究腹部外科危重病阴阳虚损患者病情严重程度，炎症免疫反应以及转归预后的差异，探讨阴阳虚损学说在判断腹部外科危重病患者的炎症免疫状态，以及病情严重程度和转归预后方面的应用价值。方法选择145例2007年1月—2010年3月天津市南开医院外科重症监护病房收治的腹部外科危重病患者，根据中医辨证分型将患者分为阳虚组（82例）和阴虚组（63例）。记录患者体温、脉搏、呼吸、平均动脉压等生命体征以及急性生理与慢性健康评分 Ⅱ（acute physiology and chronic health evaluation Ⅱ，APACHE Ⅱ）评分，测定患者的白细胞（white blood cell，WBC）计数、C反应蛋白（C reactive protein，CRP）、人类白细胞抗原DR位点（human leucocyte antigen DR site， HLA DR）及调节性T淋巴细胞（regulatory T lymphocyte，Treg），统计两组患者ICU住院时间、总住院时间、住院费用及病死率。结果两组患者性别、年龄及原发病比较，差异无统计学意义（P>0.05）。阳虚组APACHE Ⅱ评分、脏器功能损伤数目、平均动脉压、HLA DR、ICU住院时间、总住院时间及住院费用均显著高于阴虚组，体温、心率、呼吸、WBC、CRP及Treg低于阴虚组，差异均有统计学意义（P<0.05）。两组病死率比较，差异无统计学意义（P>0.05）。结论在腹部外科危重病领域，原发病耗阳与伤阴的差异能够在一定程度上辅助判断患者病情严重程度，炎症免疫失衡状态等，阴阳虚损学说在临床中具有较强协助诊断及治疗的应用价值。

英文摘要:

Objective To study the differences of the inflammation immune state， severity， and prognosis of patients with abdominal surgical critical illness between yin consumption and yang consumption， to clarify the clinical application of yin yang consumptin theory in evaluating their inflammatory immune state， pathological severity， and prognosis. Methods One hundred and forty five patients with abdominal surgical critical illness were recruited from Surgical Intensive Care Unit， Tianjin Nankai Hospital from January 2007 to March 2010. According to syndrome typing， all patients were assigned to yang deficiency group （82 cases） and yin deficiency group （63 cases）. The patient′s vital signs were measured， including body temperature， pulse， respiration， mean arterial pressure （MAP）， and so on. The acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score was performed. The patients′ white blood cell （WBC） count， C reactive protein （CRP）， human leukocyte antigen DR site （HLA DR）， as well as regulatory T lymphocytes （Treg） were determined. The ICU length of stay， the total hospitalization time， the hospitalization cost， and the mortality， were also statistically recorded. Results There was no statistical difference in gender， age， or primary disease between the two groups （P>0.05） . The APACHE Ⅱ score， the number of organ dysfunction， MAP， HLA DR， the ICU length of stay， the total hospitalization time， and the hospitalization cost were significantly higher in yang deficiency group than in yin deficiency group （P<0.05）. But the body temperature， heart rate， respiration， WBC count， CRP， and Treg were significantly lower in yang deficiency group than in yin deficiency group （P<0.05）. There was no statistical difference in the mortality between the two groups （P>0.05）. Conclusions In the domain of abdominal surgerical critical diseases， the differences in yang consumption and yin consumption of primary disease could help judge the severity of patient′s condition and immunodissonance. Yin yang consumption theory had stronger application value in assistant diagnosis and treatment.

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