目的：研究社区获得性肺炎（CAP）中医证型血清C-反应蛋白（CRP）及甘露聚糖结合凝集素（MBL）的变化规律，探索中医辨证分型的客观指标。方法选择CAP患者104例，依据《社区获得性肺炎中医诊疗指南（2011版）》将CAP分为实证类（风热袭肺证、外寒内热证、痰热壅肺证、痰湿壅肺证）、正虚邪恋类（肺脾气虚证、气阴两虚证）、危重变证类（热陷心包证、邪陷正脱证）3类8个证候。以同期健康体检者100例为健康对照者。检测各受试者治疗前及治疗后4 d、7 d血清CRP及MBL水平。结果104例CAP患者中证型实证类居多（占63.5%），正虚邪恋类次之（占19.2%），危重变证类占17.3%。CAP各中医证型血清CRP水平高于健康对照者，且随时间变化及不同中医证型而存在差异。随治疗时间延长CAP各中医证型血清CRP水平均呈下降趋势，风热袭肺、外寒内热证型治疗后7 d已降至正常（mg/L：13.51±11.48、7.07±1.84比6.96±2.19，均P＞0.05）；肺脾气虚、气阴两虚证型血清CRP水平较高，但下降速度较快，治疗后7 d时接近正常，但仍高于健康对照组（25.25±25.90、18.17±23.19比6.96±2.19，均P＜0.05）；痰热壅肺、痰湿壅肺证型血清CRP水平虽有下降，治疗后7 d时仍保持较高水平（51.70±27.33、49.28±30.57）；热陷心包、邪陷正脱证型血清CRP水平无下降趋势。风热袭肺、外寒内热、痰热壅肺、痰湿壅肺、肺脾气虚及气阴两虚证型患者血清MBL水平高于健康对照者；热陷心包、邪陷正脱证型血清MBL水平低于其他证型，随治疗时间延长保持较低水平。结论血清CRP可作为判断CAP中医证型参考指标；低血清MBL提示CAP中医证型较重，预后不良。%Objective To study the regularity changes in serum levels of C-reactive protein(CRP)and mannose-binding lectin(MBL)in patients of community acquired pneumonia(CAP)with different syndrome patterns of traditional Chinese medicine(TCM),and to explore the new objective markers to differentiate the syndrome patterns of TCM. Methods According to The Guideline on TCM diagnosis and treatment of CAP(2011 edition),104 patients with CAP were selected and their syndromes were cassified into 3 classes and 8 patterns of syndrome:excessive class〔including following patterns:wind-heat invading lung(fengrexifei),exopathic cold and interior heat(waihanneire), accumulation of heat in lung(tanreyongfei),accumulation of phlegm-dampness in lung(tanshiyongfei)〕,deficient vital QI leading to lingering of pathogen class〔qi deficiency of lung and spleen(feipiqixu),both qi and yin deficiency (qiyinliangxu)〕,TCM critical class〔heat falling into pericardium(rexianxinbao),pathogen invasion and vital qi deterioration(xiexianzhengtuo)〕. In the same period,after physical examinations,100 healthy volunteers were chosen as healthy control group. The serum levels of CRP and MBL were detected before treatment and after treatment for 4 days and 7 days. Results Among the 104 CAP patients,the most popular class of syndrome was the excessive one(63.5%),followed by deficient vital QI leading to lingering of pathogen(19.2%)and TCM critical class(17.3%). The serum CRP level in CAP patients at each time point was higher than that in healthy control group,which had a different tendency to change over time in different syndrome patterns of TCM. With the prolongation of treatment time,the serum CRP levels in fengrexifei and waihanneire patterns returned to a normal level on the 7th day(mg/L:13.51±11.48,7.07±1.84 vs. 6.96±2.19,both P>0.05),in feipiqixu and qiyinliangxu patterns the CPR levels were higher,but its descent rate was relatively fast,and on the 7th day it was approximately normal in spite of being higher than the level in healthy control group(25.25±25.90,18.17±23.19 vs. 6.96±2.19,both P<0.05);in tanreyongfei and tanshiyongfei patterns,although the CPR levels were decreased,they still maintained at relatively high levels on the 7th day after treatment(51.70±27.33,49.28±30.57),and no downtrend of CPR was seen in rexianxinbao and xiexianzhengtuo patterns. Before treatment,the serum MBL levels in CAP patients with fengrexifei,waihanneire, tanreyongfei,tanshiyongfei,feipiqixu and qiyinliangxu patterns were higher than the level in healthy control group, and in rexianxinbao and xiexianzhengtuo patterns,the levels were lower than those in other patterns and kept being at relatively lower levels along with the prolongation of the therapy. Conclusion Serum CRP can be used as a reference marker for different syndrome patterns of TCM in patients with CAP,and low serum MBL level was a risk factor of severe syndrome patterns of TCM and a poor prognosis in CAP.
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