中国中医急症2024，Vol.33Issue(2) ：227-230,255.DOI:10.3969/j.issn.1004-745X.2024.02.009

脓毒症相关急性肾损伤的疾病分型与中医辨证要素的回顾性研究

A Retrospective Study on the Disease Classification of Sepsis-associated Acute Kidney Injury and the Elements of TCM Syndrome Differentiation

曾瑞峰 赖芳 杨苏仪 陈国聪 邓雅文 黄威 陈瑞 李俊
中国中医急症2024，Vol.33Issue(2) ：227-230,255.DOI:10.3969/j.issn.1004-745X.2024.02.009
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脓毒症相关急性肾损伤的疾病分型与中医辨证要素的回顾性研究

A Retrospective Study on the Disease Classification of Sepsis-associated Acute Kidney Injury and the Elements of TCM Syndrome Differentiation

曾瑞峰 1赖芳 1杨苏仪 2陈国聪 1邓雅文 2黄威 1陈瑞 1李俊3
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作者信息

  • 1. 广州中医药大学第二附属医院,广东省中医院,广东省中医急症研究重点实验室,广东广州 510120
  • 2. 广州中医药大学,广东广州 510006
  • 3. 广州中医药大学第二附属医院,广东省中医院,广东省中医急症研究重点实验室,广东广州 510120;广州中医药大学第一附属医院,广东广州 510405
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摘要

目的 探寻脓毒症相关急性肾损伤(SA-AKI)患者疾病分型与中医辨证要素之间的关系.方法 对广东省中医院急诊病区住院患者进行回顾性分析,选择2018年6月至2023年5月的SA-AKI为研究对象,根据纳入排除标准筛选出160例SA-AKI患者,按诊断标准分为短暂性SA-AKI和持续性SA-AKI.收集患者纳入当时的一般情况、中医临床四诊信息、实验室指标、危重症评分、基础疾病、感染部位等.结果 短暂性SA-AKI和持续性SA-AKI比较,年龄[(69.48±15.72)vs.(75.90±12.03),P=0.007]、肌酐[137.70µmol/L(115.50,197.25)vs.156.20 μmol/L(133.00,238.25),P=0.031]之间差异存在统计学意义.证候分型方面,急性虚证占比最多(50.63％),其次为毒热证(18.75％)、腑实证(16.88％)、血瘀证(13.75％),短暂性SA-AKI与持续性SA-AKI在不同证型占比之间不具有统计学差异(P＞0.05).急性虚证患者与非急性虚证患者比较,SOFA评分[5.00(3.00,9.00)vs.4.00(3.00,6.00),P=0.044]更高.结论 SA-AKI的早期理化特征无法预测患者的AKI分型.证型方面急性虚证占比最多,且疾病严重程度及预后更差.病机方面,短暂性SA-AKI以邪盛正虚为主,持续性SA-AKI以正虚受邪为主.

Abstract

Objective:To investigate the correlation between traditional Chinese medicine(TCM)syndrome dif-ferentiation factors and disease classification in patients with sepsis-associated acute kidney injury(SA-AKI).Methods:A retrospective analysis was conducted on in-patients in the Guangdong Provincial Hospital of Chinese Medicine emergency ward.SA-AKI patients from June 2018 to May 2023 were selected as the research subjects.According to the inclusion and exclusion criteria,160 SA-AKI patients were screened out and divided into tran-sient SA-AKI and persistent SA-AKI.The general conditions,TCM clinical diagnosis information,laboratory indi-cators,Sequential Organ Failure Assessment(SOFA)scores,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEII)scores,underlying diseases,and infection sites were collected on the day of admission,and 28-day mortality were followed.Results:Compared between transient SA-AKI and persistent SA-AKI,the differences of age[(69.48±15.72)vs.(75.90±12.03),P=0.007],creatinine[137.70 μmol/L(115.50,197.25)vs.156.20 μmol/L(133.00,238.25),P=0.031]were statistically significant.In terms of syndrome differentiation,acute deficiency syndrome accounted for the most critical proportion(50.63％),followed by toxic heat syndrome(18.75％),bowel ex-cess syndrome(16.88％),and blood stasis syndrome(13.75％).No statistical difference existed between the propor-tion of different syndromes in transient and persistent SA-AKI(P＞0.05).Compared with patients with non-acute deficiency syndrome,SOFA score[5.00(3.00,9.00)vs.4.00(3.00,6.00),P=0.044]was higher.Conclusion:Based on the early physicochemical characteristics of SA-AKI,it is not possible to predict a patient's AKI classifi-cation.Acute deficiency syndrome is the most prevalent type of syndrome with worse disease severity and progno-sis.Transient SA-AKI is caused by an excess of pathogens and a deficiency of qi,while persistent SA-AKI is characterized by a deficiency of qi and affected by pathogens.

关键词

脓毒症/脓毒症相关急性肾损伤/急性虚证证候分析/回顾性研究

Key words

Sepsis/Sepsis-associated acute kidney injury/Acute deficiency syndrome/Syndrome differentiation/Retrospective study

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基金项目

广东省自然科学基金-面上项目(2020A1515010512)

广东省中医院中医药科学技术研究专项资助(YN2018ZD03)

广东省中医院临床研究专项(YN10101908)

广东省中医药局科研专项课题(20213007)

广东省中医急症研究重点实验室(2023B1212060062)

广东省中医院"优势病种"突破专项(脓毒症优势病种)()

出版年

2024
中国中医急症
中华中医药学会

中国中医急症

CSTPCD
影响因子：1.144
ISSN：1004-745X
参考文献量21
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