耐药革兰阴性杆菌肺炎中医证候要素分布特征及预后相关性分析

Distribution characteristics and prognostic relevance of traditional Chinese medicine syndrome elements in drug-resistant gram-negative bacilli pneumonia

关键词:  肺炎  耐药革兰阴性杆菌  中医证候要素  预后

Key words:  pneumonia  drug-resistant gram-negative bacilli  traditional Chinese medicine syndrome element  prognosis

摘要:

[目的] 总结耐药革兰阴性杆菌肺炎中医证候要素分布特征及预后相关风险证候，为临床辨证诊治提供参考。[方法] 收集91例耐药革兰阴性杆菌肺炎住院患者中医四诊信息，诊断并采用关联分析、聚类分析总结归纳证候要素分布特点。应用多因素回归分析对证候要素与预后进行相关性分析。[结果] 研究以80～89岁高龄患者居多。送检呼吸道标本共培养出97株、6种耐药菌，前3位分别是铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌，多重耐药菌检出率达69.2%。91例患者证候要素分布主要为气虚、肺、肾、痰浊、血虚、水饮，病性以虚实夹杂为主。综合关联及复杂网络分析结果，耐药革兰阴性杆菌肺炎患者证候要素组成以肺、肾、气虚、痰浊为中心，形成了肺—痰浊、肾—气虚、肺—气虚、气虚—痰浊、肾—痰浊、肺—肾6组强链接。聚类分析得到5组证候要素聚类，分别为G1肺—痰浊—气虚—肾，G2水饮—血虚—脾—心，G3阳虚—脱证，G4阴虚—热，G5血热—血瘀。预后多因素回归分析结果显示：阳虚（OR=8.377，P=0.001）、血瘀（OR=8.093，P=0.023）、脾（OR=5.146，P=0.003）、脱证（HR=3.364，P=0.002）是耐药革兰阴性杆菌肺炎预后相关的独立危险因素。[结论] 耐药革兰阴性杆菌肺炎病性属本虚标实，病及肺肾，气虚为本，痰浊为标，具有肺肾气虚，痰浊内蕴的病机特点。对出现阳虚、脱证、血瘀、脾脏受累的患者应提高警惕并积极治疗以改善预后。

Abstract:

[Objective] To summarize the distribution characteristics of traditional Chinese medicine syndrome elements in drug-resistant gram-negative bacilli pneumonia and the prognosis-related risk syndromes，and to provide reference for clinical diagnosis and treatment. [Methods] The information from the four diagnostic methods of traditional Chinese medicine was collected from 91 hospitalized patients with drug-resistant gram-negative bacilli pneumonia. Correlation and cluster analyses were used to summarize the distribution characteristics of syndrome elements. Multivariate regression analysis was applied to analyze the correlation between syndrome elements and prognosis. [Results] In this study，most patients were aged 80 to 89 years. A total of 97 strains and 6 types of drug-resistant bacteria were cultured from respiratory specimens. The top three were pseudomonas aeruginosa，klebsiella pneumoniae，and acinetobacter baumannii. The detection rate of multi-drug resistant bacteria was 69.2%. The main syndrome elements in 91 patients were qi deficiency，lung，kidney，phlegm，blood deficiency，and fluid retention，with the disease nature being a mixture of deficiency and excess. Based on association rules and complex network analysis，the syndrome elements of patients with drug-resistant gram-negative bacilli pneumonia were centered on lung，kidney，qi deficiency，and phlegm，forming six strong links：lung-phlegm，kidney-qi deficiency，lung-qi deficiency，qi deficiency-phlegm，kidney-phlegm，and lung-kidney. Cluster analysis yielded five groups of syndrome elements：G1（lung-phlegm-qi deficiency-kidney），G2（fluid retention-blood deficiency-spleen-heart），G3（yang deficiency-collapse syndrome），G4（yin deficiency-heat），and G5（blood heat-blood stasis）. Multivariate regression analysis showed that yang deficiency（OR=8.377，P=0.001），blood stasis（OR=8.093，P=0.023），spleen（OR=5.146，P=0.003），and collapse syndrome（HR=3.364，P=0.002） were independent risk factors for the prognosis of drug-resistant gram-negative bacilli pneumonia. [Conclusion] The nature of drug-resistant gram-negative bacilli pneumonia is deficiency in the root and excess in the branch. The disease affects the lung and kidney，with qi deficiency as the root cause and phlegm as the branch manifestation. It is characterized by lung and kidney qi deficiency and internal accumulation of phlegm. Patients with yang deficiency，collapse syndrome，blood stasis，and spleen involvement should be closely monitored and actively treated to improve prognosis.