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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) (2-2)=The Study of the Relationship between the Chinese Medical Syndrome and Serum Cytokine in Septic Patients (2) (2-2) |
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作者姓名(中文) | 蘇奕彰; | 書刊名 | 中醫藥年報 |
卷期 | 29:8 2011.09[民100.09] |
頁次 | 頁379-404 |
專輯 | 中醫藥基因體相關研究 |
分類號 | 414.53 |
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。今年完成本研究預期目標150 例,而在完成收案及細胞激素測量的150 位敗血症病患中,能有效評估其中醫證型者計126 人,診斷為氣分熱證有46 人,營分熱證有51 人,血分熱證有45 人,氣虛證有86 人,血虛證有9 人,陰虛證有6人,陽虛證有65 人。最後我們以「性別、中醫陽虛證之有無、Log IL-6、Log IL-10、以及CV factorDay 1」等五個因子建立預測敗血症患者預後之模型,且預測百分比可達78.6%。在動物試驗方面,CLP 大鼠在術後6 小時及12 小時給予參附湯可改善死亡率,但給藥的早晚對於其預後無明顯影響;血液動力學參數變化趨勢不管早晚期給藥無顯著差別。但在早期給予低濟量參附湯造成IL-6 與IL-10 明顯上升,因此以熱藥治療敗血症大鼠時在晚期給藥可能是較佳時機。 |
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 150 septic patients until now, and had finished the measurement of cytokines in 150 of them and recorded the Chinese medical symdromes for 126 of them. The number of Qifen-heat syndrome was 46, the number of Yingfen-heat syndrome was 51, the number of Xuefen-heat syndrome was 45, the number of Qi-deficiency syndrome was 86, the number of blood-deficiency syndrome was 9, the number of Yin-deficiency syndrome is 6, and the number of Yan-deficiency syndrome is 65. Five factors. “Yan-defiency syndrome, Log IL-6, Log IL-10, sex, and CV factor day 1” were selected to build a prediction model of septic patients, and its specificity achieved 78.6%. The results of the animal experiment showed that when the Shen-Fu-tang was administered 6 hours or 12 hours after CLP, the survival rate of the CLP rats were elevated but didn’t show significant differences between the 2 groups. The early administration of low dose of Shen-fu tang elevated IL-6 and IL-10. The late administration time may be a better choice when the heat drug is given. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。