Study For The Relationship Between The Level Of Inflammatory Mediator And The Theory Of Wei Qi Ying Xue

Objective:By classification of ICU patients meeting sepsis diagnostic criteria in this hospital according to wei-qi-ying-xue zheng differentiation,with acute physiology and chronic health evaluation APACHE II score and detection of TNF-a mass concentration of each sepsis type, the correlation and regularity was investigated to explore the relationship between severity of sepsis in patients with different syndrome and Inflammatory mediator TNF-a mass concentration and a better understanding of the pathological features of each sepsis type, and to lay a foundation for integrated tcm-wm treatment for sepsis.Methods:Patients meeting sepsis diagnostic criteria admitted to ICU and Emergency Department from2011.4to2012.4in this hospital were divided into Weifen group, Qifen group, Yingfen group, Xuefen group, according to wei-qi-ying-xue zheng differentiation. APACHE II evaluation, corresponding to wei-qi-ying-xue zheng differentiation, was used to estimate the sepsis patients admitted to the hospital within24hs. And the correlation between APACHE II evaluation and wei-qi-ying-xue zheng differentiation was studied.5mL patients’venous blood was collected and anticoagulated with heparin. Blood plasma was then obtained after the blood was centrifuged at2500rpm for5min and restored at-20℃. TNF-a mass concentration was detected with ELISA double antibody sandwich method,and its correlation with APACHE II evaluation and wei-qi-ying-xue zheng differentiation was studied.Results:1.When patients were classified according to wei-qi-ying-xue zheng differentiation,no Wei-fen-zheng patient was found. The comparison of ARACHEII score among Qifen group, Yingfen group and Xuefen group:Xuefen group> Yingfen group> Qifen group (P<0.01).Therefor,the score of Qifen group, Yingfen group,and Xuefen group correlated with each other positively(P<0.01).2.The comparison of mortality among Qifen group, Yingfen group,and Xuefen group:no one died in Qifen group in7days.the mortality was0%;one patient died in Yingfen group in7days with a mortality12.5%(1/8);four patients died in Xuefen group in7days with a mortality50%(4/8).No significant difference was found between the mortality of Qifen group and Yingfen group(P>0.05); no significant difference was found between the mortality of Yingfen group and Xuefen group(P>0.05);the mortality of Xuefen group was significantly higher than that of Qifen group(P<0.05).The results showed that the mortality of Xuefen group was higher than that of Qifen group.3.The correlation analysis of ARACHEII score and TNF-a mass concentration of each group:pearson correlation analysis indicated that TNF-a mass concentration has a positive correlation with ARACHE II score(P<0.01).4.The comparison of TNF-a mass concentration between each group:no significant difference was found between the TNF-a mass concentration of Yingfen group and Xuefen group(P<0.05); the TNF-a mass concentration of Qifen group was significantly lower than that of Yingfen group(P<0.01); the TNF-a mass concentration of Qifen group was significantly lower than that of Xuefen group(P<0.01).The result showed that TNF-a mass concentration became higher as sepsis patient’s type of syndrome developed from Qifen syndrome to Yingfen syndrome and Xuefen syndrome. Spearman correlation analysis indicated that the serum TNF-a mass concentration of sepsis patient has a positive correlation with patient’s type of syndrome as patients’condition developed from Qifen syndrome to Yingfen syndrome and Xuefen syndrome.Conclusion:The concept of "sepsis", not proposed by Traditional Chinese medicine, now because of the main manifestation-fever, is usually classified to Fever Diseases Caused by Exogenous Pathogenic Factors. The manifestation and development of Sepsis and syndrome of each phase of wei-qi-ying-xue zheng differentiation basically correspond to each other. From the point of view of pathology pathogenesis, early stage of sepsis was local inflammation(Weifen syndrome).Then sepsis developed to Systematic Inflammation stage (Qifen syndrome).Then organ dysfunction occured(all viscera Qifen syndrome、Yingfen syndrome).And finally multiple organ failure and DIC occured(Xuefen syndrome, unconsciousness and collapse zheng).Wei-qi-ying-xue zheng differentiation could be used in sepsis in clinical work. The inflammatory mediator TNF-α participated in the process of development of each sepsis syndrome type. The TNF-α mass concentration showed a tendency of development in the process of sepsis pathology, the severer the condition, the higher the TNF-α mass concentration,which showed that the TNF-α mass concentration reflected the development in the process of sepsis pathology and could be used as a clinical reference for severity and prognosis of sepsis.Analysis of the results indicated that sepsis patient’s type of syndrome,as developing from Qifen syndrome to Yingfen syndrome and Xuefen syndrome, has a positive correlation with APACHE Ⅱ score and the TNF-α mass concentration. High APACHE Ⅱ score, TNF-α mass concentration and mortality were detected in Yingfen and Xuefen group; Low APACHE Ⅱ score,TNF-α mass concentration and mortality were detected in Qifen group.Combination of wei-qi-ying-xue zheng differentiation, APACHE Ⅱ evaluation and TNF-α mass concentration in the assessment of sepsis could provide a more accurate assessment for severity and prognosis of sepsis in clinic and lay a foundation for integrated tcm-wm treatment for sepsis.