敗血症中醫證型與免疫細胞激素之相關性研究
蘇奕彰
中國醫藥大學
敗血症的高死亡率是臨床上的難題，由於其病程發展快速，病理機轉複雜，在治療上有其難以突破之處。敗血症發生後會產生大量的細胞激素，文獻中已報導部分介白素的濃度與疾病預後有顯著的相關性。在先前的研究中，我們也發現不論在敗血症患者或敗血症大鼠模型中，細胞激素表現、中醫證型或中藥方與存活率具有相關性，值得進一步探討。因此，本研究將利用血清蛋白質分析技術來探討敗血症患者中醫辨證論治之機轉，以做為中西醫結合研究敗血症治療之基礎。研究預計分三年進行，包括臨床觀察及動物試驗兩部分：前者採臨床追蹤之觀察性研究，將於加護病房觀察與記錄重度敗血症及敗血性休克患者，記錄其臨床表現、存活率及存活時間、中醫虛實證型分析、心血管參數、APACHE評分系統，以及血清激素及蛋白質分析。預計每年完成收案50位患者，三年完成收案數150位患者。動物試驗以大鼠CLP模型造成敗血症，第一年記錄大鼠心血管參數與存活率，並分析細胞與血清激素，以確認評估預後之指標；第二及第三年之研究，將依照造型前後及病程不同時間給予扶正及祛邪中藥方，以評估中藥治療之效應與機轉。預期研究結果，在臨床研究上將可瞭解敗血症患者中醫證型表現、細胞激素表現與調控、患者預後狀況，以及三者之相關性，進而嘗試找出預測敗血症病患預後的迴歸方程式，以作為臨床提前評估療效與預測預後之依據。在動物試驗中將可瞭解敗血症大鼠循環參數與細胞激素之關係，並嘗試建立評估中藥方之療效與預測預後之迴歸方程式，同時臨床與動物試驗結合之研究平台將有助於探討中醫辨證論治之機轉及尋找敗血症治療之中藥方。
關鍵字：中醫；證型；敗血症；細胞激素；預後
The Study of the Relationship between the Chinese Medical Syndrome and Serum Cytokine in Septic Patients
Yi-Chang Su
China Medical University
The high mortality of sepsis is an difficult issue in clinical practice. There is little improvement is the treatment of sepsis due to its rapid progression and complicated pathogenesis. In previous study both in septic patients and animal model, the relationship among the expression of the cytokine, Chinese medical syndrome, treatment formula and survival rate were reported and worth of further investigation. Therefore, in this study we apply the analytical technique of serum protein to investigate the mechanism of the Chinese medial syndrome in septic patients. In order to provide a base to integrate the Chinese and western medicine in the treatment of sepsis. This is a 3 year study, including clinical observation and animal experiment. The clinical study will collect 50 septic patients in intensive care unit each year, totally 150 patients in 3 years. We will record the septic patients？H？H signs and symptoms, survival time, Chinese medical syndrome, APACHE score, and measure the serum cytokine and protein. Animal experiment will be performed in cecum ligation and puncture (CLP) rats to establish the index for prognosis evaluation in the first year, followed by treatment evaluation, and mechanism study in the second and third year.
關鍵字：Chinese medicine；Chinese Medical Syndrome；sepsis；cytokine；CLP；prognosis
