Cheng Yung-Yen, Lin Sunny Jui-Shan, Chang Chih-Hung, Lin Chien-Jung, Tsai Chen-Chen, Su Yi-Chang
Department of Internal Medicine, Nantou Hospital, Department of Health, Executive Yuan, Nantou, Taiwan, 54044, China.
Chin J Integr Med. 2014 Sep 24. doi: 10.1007/s11655-014-1840-4.
To evaluate and compare the predictive value of the physical signs mentioned by ZHANG Zhong-jing in Treatise on Cold Damaged Diseases (Shang Han Lun), together with other clinically determined diagnostic scores and laboratory values in modern medicine on 28-day mortality in septic patients.
Three-year prospective observation was conducted in medical intensive care unit in two local community hospitals. In all, 126 patients with severe sepsis and/or septic shock were consecutively enrolled. Ten diagnostic signs (lack of fever, lethargy, delirium, clammy skin, mottled skin, edematous limbs, cool extremities, threadlike pulse, tachycardia, and abdominal distension), acute physiology and chronic health evaluation (APACHE) II, cardiovascular component (CV score) in multiple organ dysfunction syndrome (MODS) score and blood sampled for cytokine measurement, including tumor necrosis factor α (TNF-α), interleukin (IL)-6, IL-8, IL-10 and IL-18, were collected within 24 h after admission. Main outcome was 28-day mortality; independent predictors were determined by multivariate logistic regression analysis.
Significant correlation between lack of fever, cool extremities, abdominal distension, plasma IL-10 level and mortality emerged. Areas under the receiver operating characteristic curves for cool extremities (0.73, 95% confidence interval: 0.64-0.82, P<0.01) and IL-10 (0.74, 95% confidence interval: 0.66-0.83, P<0.01) indicated comparable discrimination between survivors and non-survivors.
Assessment of cool extremities in septic patients, which showed comparable discriminant ability as IL-10, proves prognostic value of diagnostic signs recorded in Treatise on Cold Damaged Diseases, and may provide a quicker, easily-observed, and non-invasive predictor of sepsis mortality.
评估并比较张仲景在《伤寒论》中提及的体征，以及现代医学中其他临床确定的诊断评分和实验室值对脓毒症患者28天死亡率的预测价值。
在两家当地社区医院的医学重症监护病房进行了为期三年的前瞻性观察。共连续纳入126例严重脓毒症和/或脓毒性休克患者。在入院后24小时内收集10项诊断体征（无发热、嗜睡、谵妄、皮肤湿冷、皮肤花斑、四肢水肿、四肢发凉、脉细、心动过速和腹胀）、急性生理与慢性健康状况评估（APACHE）II、多器官功能障碍综合征（MODS）评分中的心血管成分（CV评分）以及用于细胞因子测量的血样，包括肿瘤坏死因子α（TNF-α）、白细胞介素（IL）-6、IL-8、IL-10和IL-18。主要结局为28天死亡率；通过多变量逻辑回归分析确定独立预测因素。
无发热、四肢发凉、腹胀、血浆IL-10水平与死亡率之间存在显著相关性。四肢发凉（曲线下面积为0.73，95%置信区间：0.64 - 0.82，P<0.01）和IL-10（曲线下面积为0.74，95%置信区间：0.66 - 0.83，P<0.01）的受试者工作特征曲线下面积表明，在区分存活者和非存活者方面具有相当的辨别能力。
对脓毒症患者四肢发凉的评估显示出与IL-10相当的辨别能力，证明了《伤寒论》中记录的诊断体征的预后价值，并且可能为脓毒症死亡率提供一种更快、易于观察且非侵入性的预测指标。
