基于IL-6為表達(dá)的急性腦梗死痰熱腑實(shí)證不同狀態(tài)點(diǎn)的炎癥水平變化特點(diǎn)的臨床研究
發(fā)布時(shí)間：2018-07-24 12:26
【摘要】：背景:在缺血性腦血管病發(fā)病率日益增高、發(fā)病趨勢日益年輕化的今天,其帶來的家庭和社會(huì)的經(jīng)濟(jì)負(fù)擔(dān)和精神負(fù)擔(dān)已成為一個(gè)不容忽視的問題。而卒中相關(guān)性感染(stroke-associated infection,SAI)的發(fā)生,更是對(duì)腦卒中患者病情的雪上加霜,嚴(yán)重影響患者的預(yù)后,甚至導(dǎo)致患者死亡。因此,早期積極預(yù)防SAI的發(fā)生、及時(shí)治療在臨床中顯得尤為重要。目的:以白介素-6(interleukin-6,IL-6)為炎癥研究指標(biāo),對(duì)急性腦梗死痰熱腑實(shí)證患者合并SAI與否進(jìn)行亞組比較,探究SAI患者與非SAI患者在不同狀態(tài)點(diǎn)下IL-6的動(dòng)態(tài)變化特點(diǎn);探究合并SAI患者中,通腑與通便不同治療手段下IL-6的不同狀態(tài)點(diǎn)的動(dòng)態(tài)變化特點(diǎn);并從炎癥反應(yīng)的層面上,初步探究腦、腸腑與肺及泌尿系的關(guān)系。方法:納入符合標(biāo)準(zhǔn)的患者共62例,按照隨機(jī)對(duì)照表法以2:1的比例隨機(jī)分為試驗(yàn)組和對(duì)照組,其中試驗(yàn)組41例,對(duì)照組21例。試驗(yàn)過程中,試驗(yàn)組脫落1例,對(duì)照組剔除1例。所有病人均予以常規(guī)內(nèi)科治療方案,在此基礎(chǔ)上,試驗(yàn)組服用星蔞承氣湯,對(duì)照組使用杜密克口服或甘油灌腸劑/開塞露肛用或灌腸。在通腑期間,合并SAI患者須符合卒中相關(guān)性感染診斷標(biāo)準(zhǔn)。療程5±2天,以腑氣通暢為度。治療期間每日訪視病人,收集四診信息。入組當(dāng)天及腑氣通下后均對(duì)所有患者進(jìn)行中風(fēng)病相關(guān)量表及IL-6檢測,合并SAI的病人則在感染點(diǎn)進(jìn)行自擬卒中相關(guān)性感染量表的評(píng)價(jià)及IL-6檢測,同時(shí)在治療結(jié)束后再次進(jìn)行自擬卒中相關(guān)性感染量表的評(píng)價(jià)。治療前后均對(duì)安全性指標(biāo)進(jìn)行檢測。結(jié)果:1.治療組與對(duì)照組患者在中醫(yī)癥狀與體征積分、缺血性中風(fēng)病證候要素評(píng)分的內(nèi)風(fēng)、內(nèi)火、痰濕、血瘀及陰虛證候要素、痰熱腑實(shí)證證候總積分、NIHSS評(píng)分較治療前均有改善(P0.05),但組間比較均無差異(P0.05);兩組在氣虛證候要素上較治療前均無改善(P0.05);2.治療后,治療組及對(duì)照組合并SAI的患者,自擬卒中相關(guān)性感染量表評(píng)分均較前有明顯改善(P0.05),組間比較無差異(P0.05);治療組與對(duì)照組合并SAI的發(fā)病率無差異(P0.05);3.治療前,對(duì)合并SAI患者(n=14)與未合并SAI患者(n=46)的IL-6濃度水平進(jìn)行組間比較,SAI組高于非SAI組(P0.05),符合臨床實(shí)際。治療后,分別對(duì)兩組進(jìn)行組內(nèi)比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05);組間比較無統(tǒng)計(jì)學(xué)差異(P0.05)。但經(jīng)過治療,兩組IL-6變化趨勢不同,SAI組IL-6濃度水平逐漸下降,非SAI組IL-6濃度水平緩慢上升,且有靠近某值的趨勢;4.治療前,對(duì)治療組合并SAI患者(n=7)與對(duì)照組合并SAI患者(n=7)的IL-6濃度水平進(jìn)行組間比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);治療后,兩組組內(nèi)比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05),組間比較無統(tǒng)計(jì)學(xué)差異(P0.05)。兩組IL-6濃度水平雖均呈現(xiàn)下降趨勢,但治療組IL-6水平的下降幅度較對(duì)照組更大,治療組IL-6濃度均值水平治療前高于對(duì)照組,但經(jīng)過治療卻低于對(duì)照組;5.治療前,治療組未合并SAI患者(n=33)與對(duì)照組未合并SAI患者(n=13)的IL-6濃度水平組間比較無差異(P0.05);兩組治療后分別進(jìn)行組內(nèi)比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。治療后組間比較無統(tǒng)計(jì)學(xué)差異(P0.05)。治療組與對(duì)照組未合并SAI的患者,經(jīng)過通腑及通便治療,IL-6濃度水平均呈上升趨勢,但治療組IL-6水平的上升幅度較對(duì)照組更大。結(jié)論:1.治療前后SAI患者與非SAI患者IL-6水平的變化趨勢不同,考慮化痰通腑法在改善感染人群與非感染人群的炎癥反應(yīng)上作用方向上不同,有著雙向調(diào)節(jié)作用,但總是使其趨向正常范圍,緩和炎癥反應(yīng)。2.通腑與通便干預(yù)手段下,合并SAI患者的IL-6水平逐漸下降,通腑治療組IL-6水平的下降幅度更大。SAI患者治療前后IL-6濃度水平的變化與WBC計(jì)數(shù)的變化不同步,表明IL-6在炎癥變化的反應(yīng)上更靈敏。3.通腑與通便干預(yù)手段下,未合并SAI的患者的IL-6水平逐漸上升,通腑治療組上升幅度更大,考慮化痰通腑法可能使IL-6的變化趨勢高峰前移或恢復(fù)正常的時(shí)長縮短,但仍需進(jìn)一步實(shí)驗(yàn)證實(shí)。4.伴隨IL-6的濃度水平在趨向平穩(wěn)的變化趨勢,中風(fēng)病癥狀與體征、神經(jīng)功能缺損癥狀、痰熱腑實(shí)證侯有明顯改善,內(nèi)風(fēng)、內(nèi)火、痰濕、血瘀等實(shí)證性缺血性中風(fēng)病證候要素有明顯改善,但亦有顧護(hù)陰液的作用。5.化痰通腑法可能通過恢復(fù)中焦氣機(jī)斡旋之力、幫助調(diào)整水液代謝的平衡、改善異常水液的聚積而改善泌尿系感染的癥狀與體征;通過"肺與大腸相表里"臟腑聯(lián)系,隨著腑實(shí)證、火熱證的解除,改善卒中相關(guān)性肺炎的癥狀與體征。
[Abstract]:Background: as the incidence of ischemic cerebrovascular disease is increasing and the trend of the disease is becoming younger, the economic burden and mental burden of family and society have become a problem that can not be ignored. The incidence of stroke related infection (stroke-associated infection, SAI) is more severe on the condition of stroke patients. It seriously affects the prognosis of the patients and even causes the death of the patients. Therefore, early active prevention of the occurrence of SAI and timely treatment are particularly important in the clinic. Objective: using interleukin-6 (IL-6) as an indicator of inflammation, the comparison of the subgroup of the patients with acute cerebral infarction phlegm heat syndrome and SAI is to explore the SAI patients and non SAI patients. The dynamic change characteristics of IL-6 under different state points; explore the dynamic change characteristics of different state points of IL-6 under different treatment means of Fu Fu and Tong Fu in the patients with SAI, and explore the relationship between the brain, the intestines and the lung and the urinary system from the level of inflammatory reaction. Methods: 62 cases of the patients were included, according to the random control. The table method was randomly divided into the test group and the control group by the proportion of 2:1, of which 41 cases in the experimental group and 21 cases in the control group. In the test process, 1 cases were lost in the experimental group and 1 cases were eliminated in the control group. All the patients were treated with routine medical treatment plan. On this basis, the experimental group took the star Chengqi Decoction, the control group was taken orally or Enemia Glycerini / Enema Glycerini in the control group. Anus or enema. During the passage of the Fu Fu, the patients with SAI must conform to the diagnosis standard of the stroke related infection. The course of treatment is 5 + 2 days. The patient is visited daily and the information of four diagnosis is collected. All patients are tested for stroke related scale and IL-6 examination, and the patients with SAI are at the infection point. The evaluation of self-made stroke related infection scale and IL-6 test, and the evaluation of self-made stroke related infection scale again after the treatment. The safety indexes were detected before and after treatment. Results: the symptoms and signs of TCM in the 1. treatment group and the control group were divided into the symptoms and signs of TCM, and the internal wind of the score of the ischemic stroke syndrome factor scores. Internal fire, phlegm dampness, blood stasis and yin deficiency syndrome factors, total score of phlegm syndrome, NIHSS score improved (P0.05) before treatment (P0.05), but there was no difference between the two groups on Qi deficiency syndrome factors before treatment (P0.05); after 2. treatment, the treatment group and the control combination and SAI patients were self-designed for the stroke related infection scale The scores were significantly improved (P0.05), there was no difference between the groups (P0.05); the incidence of SAI in the treatment group and the control group was not different (P0.05); before 3., the IL-6 concentration level of the combined SAI patients (n=14) and the non SAI patients (n=46) was compared, the SAI group was higher than the non SAI group (P0.05), which was in accordance with the clinical practice. After treatment, to two respectively, to the clinical practice. There was no statistical difference in group comparison (P0.05), but there was no statistical difference between groups (P0.05). But after treatment, the change trend of two groups of IL-6 was different, IL-6 concentration level in group SAI decreased gradually, the concentration level of IL-6 in non SAI group increased slowly, and there was a trend near a certain value; before treatment, the combination of treatment and SAI patients (n=7) and control group There was no significant difference in the level of IL-6 concentration in the patients with SAI (n=7). There was no statistically significant difference between the two groups after treatment (P0.05), and there was no statistical difference between the groups (P0.05). The level of IL-6 concentration in the two groups was all decreased, but the decrease of IL-6 level in the treatment group was greater than that in the control group. The mean level of IL-6 concentration in the treatment group was higher than the control group before treatment, but the treatment group was lower than the control group. Before 5. treatment, there was no difference between the group of SAI patients (n=33) and the control group without SAI (n=13) in the IL-6 concentration level group (P0.05), and the difference was not statistically significant (P0.05) in the two groups after the treatment. There was no statistical difference between the two groups (P0.05). The level of IL-6 concentration in the treatment group and the control group was higher than that of the control group, but the level of IL-6 in the treatment group was higher than that of the control group. Conclusion: the change trend of the level of IL-6 in the treatment group is greater than that of the control group. Conclusion: the trend of the IL-6 level of SAI patients and non SAI patients before and after 1. treatment is different, considering the phlegm and Fu Fu organs. The action of the method is different in improving the inflammatory response of the infected people and non infected people, and there is a two-way regulating effect, but it always makes it tend to the normal range. The level of IL-6 in the patients with SAI is gradually reduced, and the decrease of the level of the IL-6 in the treatment group of Tongfu is greater than that of the.SAI patients before the treatment of.SAI. The change of the concentration level of the post IL-6 was not synchronized with the change of the WBC count, indicating that IL-6 was more sensitive to the response of the inflammatory changes with the intervention of the.3. and the defecation. The level of IL-6 in the patients without SAI was gradually increased, and the increase in the treatment group was greater. The change trend of the phlegm and Tongfu method may lead to the peak of the change of the IL-6 and restore normal. The time length shortened, but further experiments still need further experiments to prove that the concentration level of.4. accompanied with IL-6 tends to be stable, the symptoms and signs of the stroke, the symptoms of nerve function, and the positive symptoms of phlegm and heat are obviously improved, and the syndromes of internal wind, internal fire, phlegm dampness and blood stasis are obviously improved. The method of.5. phlegm and phlegm and Tong Fu can help to adjust the force of mediator of the central coke gas machine, help to adjust the balance of water metabolism, improve the accumulation of abnormal water and improve the symptoms and signs of urinary system infection, and improve the symptoms and signs of stroke related pneumonia through the "lung and the large intestine form" viscera, with the demonstration of the Fu Fu and the heat syndrome.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R277.7
本文編號(hào)：2141379
[Abstract]:Background: as the incidence of ischemic cerebrovascular disease is increasing and the trend of the disease is becoming younger, the economic burden and mental burden of family and society have become a problem that can not be ignored. The incidence of stroke related infection (stroke-associated infection, SAI) is more severe on the condition of stroke patients. It seriously affects the prognosis of the patients and even causes the death of the patients. Therefore, early active prevention of the occurrence of SAI and timely treatment are particularly important in the clinic. Objective: using interleukin-6 (IL-6) as an indicator of inflammation, the comparison of the subgroup of the patients with acute cerebral infarction phlegm heat syndrome and SAI is to explore the SAI patients and non SAI patients. The dynamic change characteristics of IL-6 under different state points; explore the dynamic change characteristics of different state points of IL-6 under different treatment means of Fu Fu and Tong Fu in the patients with SAI, and explore the relationship between the brain, the intestines and the lung and the urinary system from the level of inflammatory reaction. Methods: 62 cases of the patients were included, according to the random control. The table method was randomly divided into the test group and the control group by the proportion of 2:1, of which 41 cases in the experimental group and 21 cases in the control group. In the test process, 1 cases were lost in the experimental group and 1 cases were eliminated in the control group. All the patients were treated with routine medical treatment plan. On this basis, the experimental group took the star Chengqi Decoction, the control group was taken orally or Enemia Glycerini / Enema Glycerini in the control group. Anus or enema. During the passage of the Fu Fu, the patients with SAI must conform to the diagnosis standard of the stroke related infection. The course of treatment is 5 + 2 days. The patient is visited daily and the information of four diagnosis is collected. All patients are tested for stroke related scale and IL-6 examination, and the patients with SAI are at the infection point. The evaluation of self-made stroke related infection scale and IL-6 test, and the evaluation of self-made stroke related infection scale again after the treatment. The safety indexes were detected before and after treatment. Results: the symptoms and signs of TCM in the 1. treatment group and the control group were divided into the symptoms and signs of TCM, and the internal wind of the score of the ischemic stroke syndrome factor scores. Internal fire, phlegm dampness, blood stasis and yin deficiency syndrome factors, total score of phlegm syndrome, NIHSS score improved (P0.05) before treatment (P0.05), but there was no difference between the two groups on Qi deficiency syndrome factors before treatment (P0.05); after 2. treatment, the treatment group and the control combination and SAI patients were self-designed for the stroke related infection scale The scores were significantly improved (P0.05), there was no difference between the groups (P0.05); the incidence of SAI in the treatment group and the control group was not different (P0.05); before 3., the IL-6 concentration level of the combined SAI patients (n=14) and the non SAI patients (n=46) was compared, the SAI group was higher than the non SAI group (P0.05), which was in accordance with the clinical practice. After treatment, to two respectively, to the clinical practice. There was no statistical difference in group comparison (P0.05), but there was no statistical difference between groups (P0.05). But after treatment, the change trend of two groups of IL-6 was different, IL-6 concentration level in group SAI decreased gradually, the concentration level of IL-6 in non SAI group increased slowly, and there was a trend near a certain value; before treatment, the combination of treatment and SAI patients (n=7) and control group There was no significant difference in the level of IL-6 concentration in the patients with SAI (n=7). There was no statistically significant difference between the two groups after treatment (P0.05), and there was no statistical difference between the groups (P0.05). The level of IL-6 concentration in the two groups was all decreased, but the decrease of IL-6 level in the treatment group was greater than that in the control group. The mean level of IL-6 concentration in the treatment group was higher than the control group before treatment, but the treatment group was lower than the control group. Before 5. treatment, there was no difference between the group of SAI patients (n=33) and the control group without SAI (n=13) in the IL-6 concentration level group (P0.05), and the difference was not statistically significant (P0.05) in the two groups after the treatment. There was no statistical difference between the two groups (P0.05). The level of IL-6 concentration in the treatment group and the control group was higher than that of the control group, but the level of IL-6 in the treatment group was higher than that of the control group. Conclusion: the change trend of the level of IL-6 in the treatment group is greater than that of the control group. Conclusion: the trend of the IL-6 level of SAI patients and non SAI patients before and after 1. treatment is different, considering the phlegm and Fu Fu organs. The action of the method is different in improving the inflammatory response of the infected people and non infected people, and there is a two-way regulating effect, but it always makes it tend to the normal range. The level of IL-6 in the patients with SAI is gradually reduced, and the decrease of the level of the IL-6 in the treatment group of Tongfu is greater than that of the.SAI patients before the treatment of.SAI. The change of the concentration level of the post IL-6 was not synchronized with the change of the WBC count, indicating that IL-6 was more sensitive to the response of the inflammatory changes with the intervention of the.3. and the defecation. The level of IL-6 in the patients without SAI was gradually increased, and the increase in the treatment group was greater. The change trend of the phlegm and Tongfu method may lead to the peak of the change of the IL-6 and restore normal. The time length shortened, but further experiments still need further experiments to prove that the concentration level of.4. accompanied with IL-6 tends to be stable, the symptoms and signs of the stroke, the symptoms of nerve function, and the positive symptoms of phlegm and heat are obviously improved, and the syndromes of internal wind, internal fire, phlegm dampness and blood stasis are obviously improved. The method of.5. phlegm and phlegm and Tong Fu can help to adjust the force of mediator of the central coke gas machine, help to adjust the balance of water metabolism, improve the accumulation of abnormal water and improve the symptoms and signs of urinary system infection, and improve the symptoms and signs of stroke related pneumonia through the "lung and the large intestine form" viscera, with the demonstration of the Fu Fu and the heat syndrome.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R277.7
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