摘要
目的基于“正邪交争”理论分析不同年龄段肺炎患者临床特征的差异。方法选择2021年1月20日(大寒节气)至2022年1月20日(大寒节气)于首都医科大学附属北京中医医院发热门诊就诊的肺炎患者作为研究对象,基于“正气”理论将患者按年龄分为4组[第1组(年龄14~32岁)、第2组(年龄33~48岁)、第3组(年龄49~64岁)、第4组(年龄≥65岁)],比较4组患者宏观体征(体温峰值)、反映邪气程度的炎症指标[白细胞计数(WBC)、中性粒细胞计数(NEU)、中性粒细胞比例(NEU%)、C-反应蛋白(CRP)]、反映正气虚衰程度的免疫指标[淋巴细胞计数(LYM)、淋巴细胞比例(LYM%)]、反映邪正力量对比的中性粒细胞/淋巴细胞比值(NLR)、邪入营血转为重症趋势[血小板计数(PLT)]水平的差异。结果全年共接诊446例肺炎患者,剔除含缺失值数据病例,最终纳入377例。第1组49例,第2组57例,第3组76例,第4组195例。4组患者体温峰值比较差异无统计学意义;随年龄增长,WBC、NEU、NEU%、CRP、NLR均逐渐升高,LYM、LYM%、PLT均逐渐降低;与第1组比较,第4组WBC、NEU、NEU%、CRP、NLR均明显升高[WBC(×10^(9)/L):10.6(8.2,14.4)比8.2(6.1,11.2),NEU(×10^(9)/L):8.9(6.5,13.0)比(6.4(4.1,9.0),NEU%:85.9(80.1,90.2)比75.5(69.7,83.6),CRP(mg/L):57.4(18.2,123.8)比12.6(4.2,29.6),NLR:11.1(6.3,18.9)比4.8(3.4,9.7),均P<0.05],LYM、LYM%、PLT均明显降低[LYM(×10^(9)/L):0.9(0.5,1.2)比(1.1(0.8,1.8),LYM%:7.9(4.9,12.8)比15.4(8.8,20.6),PLT(×10^(9)/L):196.0(145.0,250.0)比227.0(190.0,272.5),均P<0.05];与第2组比较,第4组NEU、NEU%、CRP、NLR均明显升高[NEU(×10^(9)/L):8.9(6.5,13.0)比7.7(5.4,10.1),NEU%:85.9(80.1,90.2)比77.9(71.7,82.0),CRP(mg/L):57.4(18.2,123.8)比17.7(8.3,64.1),NLR:11.1(6.3,18.9)比5.2(3.8,7.1),均P<0.05],LYM、LYM%均明显降低[LYM(×10^(9)/L):0.9(0.5,1.2)比1.4(1.1,1.8),LYM%:7.9(4.9,12.8)比14.2(11.2,19.2),均P<0.05];与第3组比较,第4组CRP、NLR均明显升高[CRP(mg/L):57.4(18.2,123.8)比52.2(16.1,100.3),NLR:11.1(6.3,18.9)比6.9(4.7,10.3),均P<0.05]。结论不同年龄段肺炎患者临床特征存在显著差异,主要表现为高龄患者炎症指标更高(邪气更为炽盛)、免疫指标更低(正气更为虚衰),邪正对比表现出更显著的邪盛正衰趋势,病情更容易进展。
Objective To analyze differences in clinical characteristics of pneumonia patients across age groups based on the theory of"conflict between healthy qi and pathogenic qi".Methods Patients diagnosed with pneumonia at the fever clinic of Beijing Hospital of Traditional Chinese Medicine,Capital Medical University from 20 January 2021(Great Cold)to 20 January 2022(Great Cold)were selected as the study subjects.Based on the theory of"healthy qi",patients were divided into 4 age groups[Group 1(14-32 years),Group 2(33-48 years),Group 3(49-64 years),and Group 4(≥65 years)].The following macro-signs were compared among the groups:macroscopic signs(peak body temperature),inflammatory indicators reflecting the degree of evil qi[white blood cell count(WBC),neutrophil count(NEU),neutrophil percentage(NEU%),C-reactive protein(CRP)],immune indicators reflecting the degree of healthy qi deficiency[lymphocyte count(LYM),lymphocyte percentage(LYM%)],the neutrophil/lymphocyte ratio(NLR)reflecting the contrast between pathogenic and healthy qi;and the level of platelet count(PLT)indicating the trend of progression to severe disease(entering the nutrient and blood aspects).Results A total of 446 pneumonia patients were admitted throughout the year.After excluding cases with missing data,377 cases were finally included:49 cases in Group 1,57 cases in Group 2,76 cases in Group 3,and 195 cases in Group 4.No statistically significant difference was found in peak body temperature among the four groups.With increasing age,WBC,NEU,NEU%,CRP,and NLR gradually increased,while LYM,LYM%,and PLT gradually decreased.Compared with Group 1,Groups 4 showed significant increases in WBC,NEU,NEU%,CRP,and NLR[WBC(×10^(9)/L):10.6(8.2,14.4)vs.8.2(6.1,11.2),NEU(×10^(9)/L):8.9(6.5,13.0)vs.6.4(4.1,9.0),NEU%:85.9(80.1,90.2)vs.75.5(69.7,83.6),CRP(mg/L):57.4(18.2,123.8)vs.12.6(4.2,29.6),NLR:11.1(6.3,18.9)vs.4.8(3.4,9.7),all P<0.05],and significant decreases in LYM,LYM%,and PLT[LYM(×10^(9)/L):0.9(0.5,1.2)vs.1.1(0.8,1.8),LYM%:7.9(4.9,12.8)vs.15.4(8.8,20.6);PLT(×10^(9)/L):196.0(145.0,250.0)vs.227.0(190.0,272.5),all P<0.05].Compared with Group 2,Group 4 showed significant increases in NEU,NEU%,CRP,and NLR[NEU(×10^(9)/L):8.9(6.5,13.0)vs.7.7(5.4,10.1),NEU%:85.9(80.1,90.2)vs.77.9(71.7,82.0),CRP(mg/L):57.4(18.2,123.8)vs.17.7(8.3,64.1),NLR:11.1(6.3,18.9)vs.5.2(3.8,7.1),all P<0.05],and significant decreases in LYM and LYM%[LYM(×10^(9)/L):0.9(0.5,1.2)vs.1.4(1.1,1.8),LYM%:7.9(4.9,12.8)vs.14.2(11.2,19.2),both P<0.05].Compared with Group 3,Group 4 showed significant increases in CRP and NLR[CRP(mg/L):57.4(18.2,123.8)vs.52.2(16.1,100.3),NLR:11.1(6.3,18.9)vs.6.9(4.7,10.3),both P<0.05].Conclusions Clinical characteristics of pneumonia patients vary significantly across different age groups.This is mainly manifested by higher inflammatory indicators(more intense pathogenic qi)and lower immune indicators(more deficient healthy qi)in older patients,showing a more significant trend of excessive evil qi and deficient healthy qi,making the condition more prone to progression.
作者
陈腾飞
高子恒
徐霄龙
曲志成
郭伟
刘清泉
Chen Tengfei;Gao Ziheng;Xu Xiaolong;Qu Zhicheng;Guo Wei;Liu Qingquan(Department of Critical Care Medicine,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;Clinical Medical College of Beijing University of Traditional Chinese Medicine,Beijing 100010,China)
出处
《中国中西医结合急救杂志》
2025年第5期550-555,共6页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
北京市医院管理中心青年人才培养“青苗”计划(QML20231007)
中华中医药学会雏鹰计划中医青年临床人才研修项目(CYJH2024006)。
关键词
肺炎
年龄
中医
正气
Pneumonia
Age
Traditional Chinese medicine
Healthy qi
