他汀药对感染性休克患者凝血—炎症网络的影响

发布时间：2018-03-27 13:17

本文选题：他汀　切入点：脓毒症　出处：《广州中医药大学》2015年硕士论文

【摘要】：目的：观察他汀类药物对感染性休克病人的作用,了解感染性休克病人中炎症、凝血、血脂的关系,并对两组的7天病死率进行分析和比较两组入院时的炎症、凝血、血脂的情况。希望为改善感染性休克病人凝血、炎症情况,了解脓毒症病理生理过程,尤其是凝血-炎症网络关系在脓毒症病理生理过程中的作用及血脂对凝血-炎症网络、脓毒症病理生理过程的影响,积极寻找有益于降低感染性休克病人病死率的新思路。方法：通过查找广东省中医院2012年1月-2014年12月入院诊断为感染性休克的病人,通过收集其一般人口临床资料、7天内死亡率(不足7天出院的进行随访)、炎症指标(PCT、CRP)、凝血指标(APTT、AT、INR、FIB、PT)、血脂指标(HLD-C、LDL-C)和中成药类别及疗程的临床资料,并查找是否入院前2周及住院期间服用他汀类药物,按其是否服用他汀类药物,分成他汀类药物组、无他汀类药物组。运用SPSS 18.0进行统计分析,比较在是否他汀类药物组两组的炎症指标(PCT、CRP)、凝血指标(APTT、 AT、INR、FIB、PT)、血脂(HLD-C、LDL-C)的差异,及7天内死亡率,并对感染性休克病人7天内死亡影响因素进行logistic回归分析,得出结论。结果：本研究共纳入合格的病例625例,他汀类药物组7天内死亡率低于无他汀类药物组(2.2% vs.17.3%,P=0.001),进一步研究发现,他汀类药物组的入院第一次的PCT水平高于无他汀类药物组(0.22±0.09 vs.0.19±0.10,P=0.03)；而在凝血指标PT方面,前者低于后者他汀类药物组(14.41±4.88 vs.15.37±5.61；P=0.004)。炎症指标CRP、PCT的水平与APTT、AT、FIB相关(P0.05),其中CRP与FIB的有着较高的相关程度。而血脂指标HDL-C、LDL-C水平与炎症指标CRP、PCT水平,凝血指标APTT、AT、 PT、INR水平均相关。PCT (OR=0.004, P=0.013)、AT (OR=0.985, P=0.043),为感染性休克病人7天内死亡的独立影响因素。在收集的625例感染性休克病人中,中成药的比例达到59.2%,而血必净的为101例；参附注射液92例,两者共占52.2%。结论：长期服用他汀类药物能降低感染性休克患者7天死亡率,其病理生理过程与凝血-炎症网络相关,血脂或亦可能参与脓毒症患者机体凝血-炎症网络的调节。但他汀类药物是否普遍适用于感染性休克患者的标准治疗方案,还是只能适用于血脂代谢异常的感染性休克患者还有待于进一步深入研究。而脓毒症的中成药情况方面,品种繁多,干预尚缺乏统一规范,如何能利用好中医药对脓毒症的治疗,这都需要进一步的循证医学研究。
[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 卤0.09 vs.0.19 卤0.10 vs.0.19 卤0.10 vs.0.19 卤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 卤4.88 vs.15.37 卤5.61 vs.15.37 卤5.61 vs.15.37 卤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.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.7

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