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頁籤選單縮合
題名 | 敗血症中醫證型與免疫細胞激素之相關性研究(2)=The Study of the Relationship between the Chinese Medical Syndrome and Serum Cytokine in Septic Patients (2) |
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作者姓名(中文) | 蘇奕彰; | 書刊名 | 中醫藥年報 |
卷期 | 28:7 2010.09[民99.09] |
頁次 | 頁391-423 |
分類號 | 415.27 |
關鍵詞 | 中醫; 證型; 敗血症; 細胞激素; Chinese medicine; Chinese Medical Syndrome; Sepsis; Cytokine; CLP; Prognosis; |
語文 | 中文(Chinese) |
中文摘要 | 敗血症的高死亡率是臨床上的難題,由於其病程發展快速,病理機轉 複雜,在治療上有其難以突破之處。敗血症發生後會產生大量的細胞激素, 文獻中已報導部分介白素的濃度與疾病預後有顯著的相關性。在先前的研究 中,我們也發現不論在敗血症患者或敗血症大鼠模型中,細胞激素表現、中 醫證型或中藥方與存活率具有相關性,值得進一步探討。因此,本研究將利 用蛋白質抗體晶片、細胞及血清分析技術來探討敗血症患者中醫辨證論治之 機轉,以做為中西醫結合研究敗血症治療之基礎。 本研究分三年進行,包括臨床觀察及動物試驗兩部分:前者採臨床追蹤之觀察性研究,將於加護病房觀察與記錄重度敗血症及敗血性休克患者,記錄其臨床表現、存活率及存活時間、中醫虛實證型分析、心血管參數、APACHE評分系統,以及細胞與血清激素及蛋白質分析。動物試驗以大鼠CLP模型造成敗血症,記錄大鼠心血管參數與存活率,並分析細胞與血清激素,以確認評估預後之指標;然後依照造型前後及病程不同時間給予扶正及祛邪中藥方,以評估中藥治療之效應與機轉。 延續第一年研究結果,在敗血症病人的中醫臨床證型分析,收案數已有115例,其中已完成細胞激素檢測的80位病人中,完成中醫證型者計93人,診斷為氣分熱證有24人,營分熱證有36人,血分熱證有36人,氣虛證有60人,血虛證有7人,陰虛證有2人,陽虛證有47人。此93位敗血症病患中,嚴重敗血症及敗血性休克分別是12位及71位,經卡方檢定(Chi-square test)發現嚴 重敗血症及敗血性休克的中醫證型並無顯著之相關性;而性別、中醫證型之「氣虛證」與「陽虛證」則與預後有顯著相關,在死亡組中男性的比例明顯多於女性。在敗血症中醫證型與細胞激素之相關性仍在分析中。而動物試驗,在術後6小時早期給予白虎湯能降低死亡率,且高劑量較低劑量效果明顯。 |
英文摘要 | The high mortality of sepsis is an difficult issue in clinical practice. There is little improvement is the treatment of sepsis due to its rapid progression and complicated pathogenesis. In previous study both in septic patients and animal model, the relationship among the expression of the cytokine, Chinese medical syndrome, treatment formula and survival rate were reported and worth of further investigation. Therefore, in this study we apply the analytical technique of serum protein to investigate the mechanism of the Chinese medial syndrome in septic patients. In order to provide a base to integrate the Chinese and western medicine in the treatment of sepsis. This is a 3 year study, including clinical observation and animal experiment. The clinical study will collect 50 septic patients in intensive care unit each year, totally 150 patients in 3 years. We have collected 115 septic patients until now, and had finished the measurement of cytokines in 115 of them and recorded the Chinese medical symdromes for 93 of them. The number of Qifen-heat syndrome was 24, the number of Yingfen-heat syndrome was 36, the number of Xuefen-heat syndrome was 36, the number of Qi-deficiency syndrome was 60, the number of blood-deficiency syndrome was 7, the number of Yin-deficiency syndrome is 2, and the number of Yan-deficiency syndrome is 47. The Qi-deficiency and Yan-deficiency syndrome both were statistically significant (P < 0.05) when compare the survival group with the non-survival group. It was also found that the male sex was more significant in the non survival group when compared with the female sex. In animal experiment, our data revealed that the treatment had some effects on the prognosis. The results of the animal experiment showed that when the Bai-Hu-tang was administered 6 hours after CLP, it lowered the mortality rate and was more significant in the high- dose group. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。