血尿素氮水平与脓毒症患者中医证候要素的相关性研究

目的探讨不同BUN水平脓毒症患者中医证候要素的特征。方法将符合入选标准的2017年1月-2018年12月广州中医药大学第二附属医院(广东省中医院)大学城医院252例重症医学科住院患者,按BUN水平分为较低水平组(BUN<9.25 mmol/L)与较高水平组(BUN≥9.25 mmol/L),收集患者的基线资料、并发症、感染部位等数据,按中医四诊信息并结合BUN水平进行中医证候要素判定,对单因素分析中P<0.2的变量作为候选变量引入并进行中医证候要素与BUN的相关性多因素logistic回归分析。结果与较低水平组比较,较高水平组中医实性证候要素中瘀血证74.60%(94/126)比53.17%(67/126)]患者比例更高(P<0.01),毒热证52.38%(66/126)比65.87%(83/126)]患者比例更低(P=0.029);中医虚性证候要素中气虚证67.46%(85/126)比45.24%(57/126),P<0.01]、阳虚证11.90%(15/126)比3.97%(5/126),P=0.032]患者比例更高(P<0.05)。Logistic回归分析显示,较高水平组脓毒症发生率与气虚证(OR=3.425,95%CI:1.934~6.068,P<0.01)、阳虚证(OR=3.460,95%CI:1.160~10.325,P=0.026)、肾虚证(OR=2.212,95%CI:1.173~4.173,P=0.014)有相关性。结论较高水平组脓毒症患者瘀血证、气虚证、阳虚证比例更高,可能与气虚证、阳虚证、肾虚证发生率增加有关。

Correlation between blood urea nitrogen level and Traditional Chinese Medicine syndromes in sepsis patients

Objective To explore the characteristics of Traditional Chinese Medicine(TCM)syndromes in sepsis patients with different blood urea nitrogen(BUN)levels.Methods From January 2017 to December 2018,252 sepsis patients,who were admitted in the Department of Intensive Care Unit of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine(Guangdong Provincial Hospital of Chinese Medicine)and met the inclusion criteria,were divided into lower level group(BUN<9.25 mmol/L)and higher level group(BUN≥9.25 mmol/L)according to BUN levels.The baseline data,complications,infection sites and other data were collected.TCM syndromes were judged according to the four diagnostic information of TCM and BUN levels.Variables with P<0.2 in univariate analysis were introduced as candidate variables,and the correlation between TCM syndrome elements and BUN was analyzed by multivariate logistic regression.Results The comparison of TCM syndromes showed that the proportion of blood stasis syndrome in higher level group was significantly higher than that of the lower level group74.60%(94/126)vs.53.17%(67/126),P<0.01],and the proportion of toxic heat syndrome in the higher level group was significantly lower than that of the lower level group52.38%(66/126)vs.65.87%(83/126),P=0.029].The comparison of TCM deficiency syndromes showed that the proportion of qi deficiency syndrome and yang deficiency syndrome in the higher level group was significantly higher than that of the lower level group67.46%(85/126)vs.45.24%(57/126),P<0.01;11.90%(15/126)vs.3.97%(5/126),P=0.032,respectively].Logistic regression analysis showed that the higher blood urea nitrogen level was correlated with the increased incidence of qi deficiency syndrome(OR=3.425,95%CI:1.934-6.068,P<0.01),yang deficiency syndrome(OR=3.460,95%CI:1.160-10.325,P=0.026)and kidney deficiency syndrome(OR=2.212,95%CI:1.173-4.173,P=0.014)in sepsis patients.Conclusion Sepsis patients with higher blood urea nitrogen level have a higher proportion of blood stasis syndrome,qi deficiency syndrome and yang deficiency syndrome and may be related to the increased incidence of qi deficiency syndrome,yang deficiency syndrome and kidney deficiency syndrome.