基于IL-6为表达的急性脑梗死痰热腑实证不同状态点的炎症水平变化特点的临床研究
发布时间：2018-07-24 12:26
【摘要】：背景:在缺血性脑血管病发病率日益增高、发病趋势日益年轻化的今天,其带来的家庭和社会的经济负担和精神负担已成为一个不容忽视的问题。而卒中相关性感染(stroke-associated infection,SAI)的发生,更是对脑卒中患者病情的雪上加霜,严重影响患者的预后,甚至导致患者死亡。因此,早期积极预防SAI的发生、及时治疗在临床中显得尤为重要。目的:以白介素-6(interleukin-6,IL-6)为炎症研究指标,对急性脑梗死痰热腑实证患者合并SAI与否进行亚组比较,探究SAI患者与非SAI患者在不同状态点下IL-6的动态变化特点;探究合并SAI患者中,通腑与通便不同治疗手段下IL-6的不同状态点的动态变化特点;并从炎症反应的层面上,初步探究脑、肠腑与肺及泌尿系的关系。方法:纳入符合标准的患者共62例,按照随机对照表法以2:1的比例随机分为试验组和对照组,其中试验组41例,对照组21例。试验过程中,试验组脱落1例,对照组剔除1例。所有病人均予以常规内科治疗方案,在此基础上,试验组服用星蒌承气汤,对照组使用杜密克口服或甘油灌肠剂/开塞露肛用或灌肠。在通腑期间,合并SAI患者须符合卒中相关性感染诊断标准。疗程5±2天,以腑气通畅为度。治疗期间每日访视病人,收集四诊信息。入组当天及腑气通下后均对所有患者进行中风病相关量表及IL-6检测,合并SAI的病人则在感染点进行自拟卒中相关性感染量表的评价及IL-6检测,同时在治疗结束后再次进行自拟卒中相关性感染量表的评价。治疗前后均对安全性指标进行检测。结果:1.治疗组与对照组患者在中医症状与体征积分、缺血性中风病证候要素评分的内风、内火、痰湿、血瘀及阴虚证候要素、痰热腑实证证候总积分、NIHSS评分较治疗前均有改善(P0.05),但组间比较均无差异(P0.05);两组在气虚证候要素上较治疗前均无改善(P0.05);2.治疗后,治疗组及对照组合并SAI的患者,自拟卒中相关性感染量表评分均较前有明显改善(P0.05),组间比较无差异(P0.05);治疗组与对照组合并SAI的发病率无差异(P0.05);3.治疗前,对合并SAI患者(n=14)与未合并SAI患者(n=46)的IL-6浓度水平进行组间比较,SAI组高于非SAI组(P0.05),符合临床实际。治疗后,分别对两组进行组内比较,差异均无统计学意义(P0.05);组间比较无统计学差异(P0.05)。但经过治疗,两组IL-6变化趋势不同,SAI组IL-6浓度水平逐渐下降,非SAI组IL-6浓度水平缓慢上升,且有靠近某值的趋势;4.治疗前,对治疗组合并SAI患者(n=7)与对照组合并SAI患者(n=7)的IL-6浓度水平进行组间比较,差异无统计学意义(P0.05);治疗后,两组组内比较差异均无统计学意义(P0.05),组间比较无统计学差异(P0.05)。两组IL-6浓度水平虽均呈现下降趋势,但治疗组IL-6水平的下降幅度较对照组更大,治疗组IL-6浓度均值水平治疗前高于对照组,但经过治疗却低于对照组;5.治疗前,治疗组未合并SAI患者(n=33)与对照组未合并SAI患者(n=13)的IL-6浓度水平组间比较无差异(P0.05);两组治疗后分别进行组内比较,差异均无统计学意义(P0.05)。治疗后组间比较无统计学差异(P0.05)。治疗组与对照组未合并SAI的患者,经过通腑及通便治疗,IL-6浓度水平均呈上升趋势,但治疗组IL-6水平的上升幅度较对照组更大。结论:1.治疗前后SAI患者与非SAI患者IL-6水平的变化趋势不同,考虑化痰通腑法在改善感染人群与非感染人群的炎症反应上作用方向上不同,有着双向调节作用,但总是使其趋向正常范围,缓和炎症反应。2.通腑与通便干预手段下,合并SAI患者的IL-6水平逐渐下降,通腑治疗组IL-6水平的下降幅度更大。SAI患者治疗前后IL-6浓度水平的变化与WBC计数的变化不同步,表明IL-6在炎症变化的反应上更灵敏。3.通腑与通便干预手段下,未合并SAI的患者的IL-6水平逐渐上升,通腑治疗组上升幅度更大,考虑化痰通腑法可能使IL-6的变化趋势高峰前移或恢复正常的时长缩短,但仍需进一步实验证实。4.伴随IL-6的浓度水平在趋向平稳的变化趋势,中风病症状与体征、神经功能缺损症状、痰热腑实证侯有明显改善,内风、内火、痰湿、血瘀等实证性缺血性中风病证候要素有明显改善,但亦有顾护阴液的作用。5.化痰通腑法可能通过恢复中焦气机斡旋之力、帮助调整水液代谢的平衡、改善异常水液的聚积而改善泌尿系感染的症状与体征;通过"肺与大肠相表里"脏腑联系,随着腑实证、火热证的解除,改善卒中相关性肺炎的症状与体征。
[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.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.7
本文编号：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.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.7
【参考文献】
相关期刊论文 前10条
1 林萍;童巧文;夏作利;张有超;郑丽芬;林一均;;脑卒中患者发生卒中相关性感染的危险因素研究[J];现代预防医学;2016年13期
2 阙玉梅;莫晔;何锴;丁莉;朱滢;;脑卒中患者肺部感染体液及细胞免疫功能变化研究[J];中华医院感染学杂志;2016年11期
3 单凯;郭伟;;卒中相关性肺炎诊疗进展[J];中国卒中杂志;2016年04期
4 巫丽娟;赵丹;刘敏雪;陈知行;肖玉玲;李冬冬;康梅;谢轶;;四川大学华西医院脑卒中伴感染患者临床数据分析[J];中风与神经疾病杂志;2016年03期
5 李书恒;;脑梗死后炎性因子的动态变化研究[J];中国现代药物应用;2016年04期
6 唐林云;闫福岭;;他汀类药物与卒中后感染的研究进展[J];中华脑科疾病与康复杂志(电子版);2015年05期
7 刘惠杰;徐寅平;顾兆一;肖丁;;化痰通腑法治疗中风病急性期痰热腑实证105例临床观察[J];中国中医基础医学杂志;2015年05期
8 陈海生;;星蒌承气汤治疗重症急性期中风病的临床研究[J];辽宁中医杂志;2015年05期
9 高玉红;;饮酒与老年脑卒中患者伴发肺炎的Meta分析[J];东南国防医药;2015年02期
10 郑声浩;吴晓谦;林群力;;免疫调节剂防治脑卒中相关性感染的临床研究[J];中华医院感染学杂志;2015年06期
相关会议论文 前1条
1 李亚鹏;宋波;方慧;高远;赵璐;许予明;;A2DS2评分对中国急性缺血性卒中患者住院期间肺炎发生风险的预测作用研究[A];中华医学会第十七次全国神经病学学术会议论文汇编（下）[C];2014年
相关重要报纸文章 前1条
1 王丹;;近半中风患者是中年人[N];健康报;2015年
相关硕士学位论文 前4条
1 凌丽丽;星蒌承气汤对缺血性中风急性期患者证候变化及IL-6的影响[D];北京中医药大学;2015年
2 刘彩丽;卒中相关性肺炎的危险因素及A2DS2评分对其评价研究[D];大连医科大学;2015年
3 杨俊芳;急性缺血性脑卒中相关性肺炎的危险因素及A~2DS~2评分的预测价值研究[D];新疆医科大学;2014年
4 杨亚红;急性脑卒中相关性肺炎危险因素分析及病原学特点[D];郑州大学;2013年
，本文编号：2141379
本文链接：https://www.wllwen.com/shoufeilunwen/mpalunwen/2141379.html
最近更新
教材专著
