本文選題：他汀　切入點(diǎn)：膿毒癥　出處：《廣州中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的：觀察他汀類藥物對(duì)感染性休克病人的作用,了解感染性休克病人中炎癥、凝血、血脂的關(guān)系,并對(duì)兩組的7天病死率進(jìn)行分析和比較兩組入院時(shí)的炎癥、凝血、血脂的情況。希望為改善感染性休克病人凝血、炎癥情況,了解膿毒癥病理生理過程,尤其是凝血-炎癥網(wǎng)絡(luò)關(guān)系在膿毒癥病理生理過程中的作用及血脂對(duì)凝血-炎癥網(wǎng)絡(luò)、膿毒癥病理生理過程的影響,積極尋找有益于降低感染性休克病人病死率的新思路。方法：通過查找廣東省中醫(yī)院2012年1月-2014年12月入院診斷為感染性休克的病人,通過收集其一般人口臨床資料、7天內(nèi)死亡率(不足7天出院的進(jìn)行隨訪)、炎癥指標(biāo)(PCT、CRP)、凝血指標(biāo)(APTT、AT、INR、FIB、PT)、血脂指標(biāo)(HLD-C、LDL-C)和中成藥類別及療程的臨床資料,并查找是否入院前2周及住院期間服用他汀類藥物,按其是否服用他汀類藥物,分成他汀類藥物組、無(wú)他汀類藥物組。運(yùn)用SPSS 18.0進(jìn)行統(tǒng)計(jì)分析,比較在是否他汀類藥物組兩組的炎癥指標(biāo)(PCT、CRP)、凝血指標(biāo)(APTT、 AT、INR、FIB、PT)、血脂(HLD-C、LDL-C)的差異,及7天內(nèi)死亡率,并對(duì)感染性休克病人7天內(nèi)死亡影響因素進(jìn)行l(wèi)ogistic回歸分析,得出結(jié)論。結(jié)果：本研究共納入合格的病例625例,他汀類藥物組7天內(nèi)死亡率低于無(wú)他汀類藥物組(2.2% vs.17.3%,P=0.001),進(jìn)一步研究發(fā)現(xiàn),他汀類藥物組的入院第一次的PCT水平高于無(wú)他汀類藥物組(0.22±0.09 vs.0.19±0.10,P=0.03)；而在凝血指標(biāo)PT方面,前者低于后者他汀類藥物組(14.41±4.88 vs.15.37±5.61；P=0.004)。炎癥指標(biāo)CRP、PCT的水平與APTT、AT、FIB相關(guān)(P0.05),其中CRP與FIB的有著較高的相關(guān)程度。而血脂指標(biāo)HDL-C、LDL-C水平與炎癥指標(biāo)CRP、PCT水平,凝血指標(biāo)APTT、AT、 PT、INR水平均相關(guān)。PCT (OR=0.004, P=0.013)、AT (OR=0.985, P=0.043),為感染性休克病人7天內(nèi)死亡的獨(dú)立影響因素。在收集的625例感染性休克病人中,中成藥的比例達(dá)到59.2%,而血必凈的為101例；參附注射液92例,兩者共占52.2%。結(jié)論：長(zhǎng)期服用他汀類藥物能降低感染性休克患者7天死亡率,其病理生理過程與凝血-炎癥網(wǎng)絡(luò)相關(guān),血脂或亦可能參與膿毒癥患者機(jī)體凝血-炎癥網(wǎng)絡(luò)的調(diào)節(jié)。但他汀類藥物是否普遍適用于感染性休克患者的標(biāo)準(zhǔn)治療方案,還是只能適用于血脂代謝異常的感染性休克患者還有待于進(jìn)一步深入研究。而膿毒癥的中成藥情況方面,品種繁多,干預(yù)尚缺乏統(tǒng)一規(guī)范,如何能利用好中醫(yī)藥對(duì)膿毒癥的治療,這都需要進(jìn)一步的循證醫(yī)學(xué)研究。
[Abstract]:Objective: to observe the effect of statins on patients with septic shock, to understand the relationship among inflammation, coagulation and blood lipids in patients with septic shock. In order to improve blood coagulation and inflammation in patients with septic shock, we hope to understand the pathophysiological process of sepsis, especially the role of clotting and inflammation network in the pathophysiological process of sepsis and the effect of blood lipids on coagulation and inflammation network. The effect of pathophysiological process of sepsis, and actively looking for a new way to reduce the mortality of septic shock patients. Methods: by looking up the patients diagnosed as septic shock in Guangdong traditional Chinese Medicine Hospital from January 2012 to December 2014, the patients with septic shock were diagnosed as septic shock from January 2012 to December 2014. By collecting the clinical data of the general population, the mortality rate within 7 days (less than 7 days after discharge), the inflammatory index PCT, the blood coagulation index, the serum lipid index, the serum lipids index and the classification and course of treatment of traditional Chinese patent medicine, the clinical data were collected. The patients were divided into statins group and no statins group according to whether they took statins 2 weeks before admission and during hospitalization. SPSS 18.0 was used for statistical analysis. To compare the difference of inflammatory index (PCT), blood clotting index (APTT), blood clotting index (APTT), ATT INR FIBPTT, serum lipids (HLD-CU LDL-C), and the mortality rate within 7 days between the two groups. Logistic regression analysis was used to analyze the influencing factors of death in septic shock patients within 7 days. Results: a total of 625 eligible cases were included in this study. The mortality rate within 7 days in the statins group was lower than that in the no statins group (2.2% vs 17.3P 0.001). The level of PCT in the statins group was higher than that in the statins group (0.22 鹵0.09 vs.0.19 鹵0.10 vs.0.19 鹵0.10 vs.0.19 鹵0.03), and the blood coagulation index PT was higher in the statin group than that in the non-statins group. The former group was lower than that of the latter group (14.41 鹵4.88 vs.15.37 鹵5.61 vs.15.37 鹵5.61 vs.15.37 鹵0.004). The level of inflammatory marker CRPnPCT was correlated with APTTT FIB (P 0.05), and the level of CRP and FIB had a higher correlation, while the level of serum lipids, HDL-C, LDL-C, and inflammation index, CRPPCT, was correlated with the level of CRPPCT. The serum levels of APTTT and PTT INR were all correlated with .PCT OR0.004, P0.013 with AT ORP 0.985, P0. 043 with P0. 043 with septic shock. Among the 625 patients with septic shock, the proportion of Chinese patent medicine was 59.2%, while that of Xuebijing was 101 cases. Conclusion: the long-term administration of statins can reduce the death rate of septic shock patients on 7 days, and its pathophysiological process is related to clotting and inflammatory network. Blood lipids may also be involved in the regulation of clotting and inflammatory networks in septic patients. Or can only be applied to septic shock patients with abnormal blood lipid metabolism. However, there are many kinds of Chinese patent medicines for sepsis, and the intervention is still lack of uniform standard. How to make good use of traditional Chinese medicine in the treatment of sepsis requires further evidence-based medicine research.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R459.7

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本文編號(hào)：1671671