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Objective To observe the incidence of malnutrition, the therapeutic effect of nutritional support and the prognosis of patients with chronic obstructive pulmonary disease (COPD) under mechanical ventilation (MV) in patients with different traditional Chinese medicine (TCM) syndrome types and discuss the relationships between these indicators and the differentiation of cold-heat/deficiency-excess syndrome. Methods One hundred and three patients with COPD and MV admitted to Zhuji Hospital of TCM from September 2015 and July 2017 were enrolled, according to the different TCM syndromes, they were divided into an excess-heat syndrome group 42 cases and an asthenia-cold syndrome group 61 cases, and the differences in nutrition indexes and prognosis between the two groups were compared. Results The acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score, nutritional risk screening 2002 (NRS2002) score and the incidence of malnutrition in excess-heat syndrome group were significantly lower than those in the asthenia-cold syndrome group, while the body mass index (BMI) in excess-heat syndrome group was obviously higher than that in the asthenia cold syndrome group [APACHE Ⅱ score: 20.1±5.4 vs. 22.0±3.4,NRS2002 score: 5.2±0.6 vs. 6.2±0.8, incidence of malnutrition: 61.9% (26/42) vs. 80.3% (49/61), BMI (kg/m2): 22.6±3.8 vs. 19.9±4.8, all P < 0.05]. The levels of albumin (Alb), prealbumin (PA) and transferrin (TF) of the excess-heat syndrome group were higher than those in the asthenia-cold syndrome group, and the differences between the two groups were statistically significant on the 7th day under MV [Alb (g/L): 36.14±2.97 vs. 34.40±3.37, PA (mg/L): 237.67±28.01 vs. 185.34±30.86, TF (g/L): 2.13±0.38 vs. 1.95±0.12, all P < 0.05]. In the excess-heat syndrome group, the percentage of weaning from MV was higher than that of the asthenia-cold syndrome group [85.7% (36/42) vs. 65.6% (40/61)], the 28-day mortality [14.3% (6/42) vs. 31.1% (19/61)] and ICU stay time (days: 9.21±2.96 vs. 11.13±3.96) were lower than those of the asthenia cold syndrome group (all P < 0.05). Conclusion The analysis of TCM differentiation of cold-heat/deficiency-excess syndrome has a certain reference value to realize the changing rules in nutritional status and prognosis of patients with COPD under mechanical ventilation.
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Objective To explore the application value of traditional Chinese medicine (TCM) symptom score in the evaluation of the prognosis of patients with acute exacerbation of chronic cardiac insufficiency and establish a mortality probability model to assess the patients' consistency between the risk of death and actual death. Methods A retrospective observational study was conducted. Three hundred and twenty patients with acute exacerbation of chronic cardiac insufficiency admitted to Zhuji Hospital of TCM from January 2015 to June 2017 were divided into survival and death groups according to 28-day prognosis. The TCM symptom score and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score were recorded on admission, then Spearman correlation analysis was used to determine the correlation between the two types of evaluating score; the differences in APACHE Ⅱ score and TCM symptom score between the two groups of patients were compared; the receiver operating characteristic curve (ROC) was drawn, and the area under ROC curve (AUC) was calculated to evaluate the values of APACHE Ⅱ score and TCM symptom score in predicting the prognosis of patients. Whether the patients being dead or not and the TCM symptom score were used to carry out the logistic regression analysis and establish the regression model, then the relationship between the risk of death and actual death was verified. Results A total of 320 patients were enrolled, of whom 279 survived and 41 died.① The APACHE Ⅱ score and TCM symptom score in the dead group were significantly higher than those in survival group [APACHE Ⅱ score: 30.0 (22.5, 33.5) vs. 14.0 (8.0, 21.0); TCM symptom score: 28 (25, 33) vs. 15 (10, 20); both P < 0.01]. ② The APACHE Ⅱ score of patients with acute exacerbation of chronic cardiac insufficiency was positively correlated with their TCM symptom score obviously (r = 0.814, P < 0.01). ③ The AUC for predicting the prognosis of patients with acute exacerbation of chronic cardiac insufficiency by APACHE Ⅱ score and TCM symptom score were 0.816 and 0.920 respectively, when the best critical value of APACHE Ⅱ score was 21, the sensitivity of predicting death in the patients was 82.9%, and specificity was 74.1%, and the 95% confidence interval (95%CI) was 0.739-0.893;when the best critical value of TCM symptom score was 25, the sensitivity of predicting death in patients was 82.7%, specificity was 91.0% and 95%CI was 0.876-0.964. ④ Whether the patient being dead or not and TCM symptom score were brought into logistic regression analysis to obtain the death risk model: ln [R/(1-R)] = -8.131+0.283×TCM symptom score, after the TCM symptom score was substituted into the death risk model, the result revealed that the death risk was consistent with the actual death situation, that is with the rising of TCM symptom score, the death risk rate increases, and the actual fatality rate also increases gradually. Conclusions The application of TCM symptom score is helpful to realize the degree of disease severity and early judgement of prognosis in patients with chronic cardiac insufficiency.
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Objective To explore the application value of traditional Chinese medicine (TCM) symptom score in the evaluation of the prognosis of patients with acute exacerbation of chronic cardiac insufficiency and establish a mortality probability model to assess the patients' consistency between the risk of death and actual death. Methods A retrospective observational study was conducted. Three hundred and twenty patients with acute exacerbation of chronic cardiac insufficiency admitted to Zhuji Hospital of TCM from January 2015 to June 2017 were divided into survival and death groups according to 28-day prognosis. The TCM symptom score and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score were recorded on admission, then Spearman correlation analysis was used to determine the correlation between the two types of evaluating score; the differences in APACHE Ⅱ score and TCM symptom score between the two groups of patients were compared; the receiver operating characteristic curve (ROC) was drawn, and the area under ROC curve (AUC) was calculated to evaluate the values of APACHE Ⅱ score and TCM symptom score in predicting the prognosis of patients. Whether the patients being dead or not and the TCM symptom score were used to carry out the logistic regression analysis and establish the regression model, then the relationship between the risk of death and actual death was verified. Results A total of 320 patients were enrolled, of whom 279 survived and 41 died.① The APACHE Ⅱ score and TCM symptom score in the dead group were significantly higher than those in survival group [APACHE Ⅱ score: 30.0 (22.5, 33.5) vs. 14.0 (8.0, 21.0); TCM symptom score: 28 (25, 33) vs. 15 (10, 20); both P < 0.01]. ② The APACHE Ⅱ score of patients with acute exacerbation of chronic cardiac insufficiency was positively correlated with their TCM symptom score obviously (r = 0.814, P < 0.01). ③ The AUC for predicting the prognosis of patients with acute exacerbation of chronic cardiac insufficiency by APACHE Ⅱ score and TCM symptom score were 0.816 and 0.920 respectively, when the best critical value of APACHE Ⅱ score was 21, the sensitivity of predicting death in the patients was 82.9%, and specificity was 74.1%, and the 95% confidence interval (95%CI) was 0.739-0.893;when the best critical value of TCM symptom score was 25, the sensitivity of predicting death in patients was 82.7%, specificity was 91.0% and 95%CI was 0.876-0.964. ④ Whether the patient being dead or not and TCM symptom score were brought into logistic regression analysis to obtain the death risk model: ln [R/(1-R)] = -8.131+0.283×TCM symptom score, after the TCM symptom score was substituted into the death risk model, the result revealed that the death risk was consistent with the actual death situation, that is with the rising of TCM symptom score, the death risk rate increases, and the actual fatality rate also increases gradually. Conclusions The application of TCM symptom score is helpful to realize the degree of disease severity and early judgement of prognosis in patients with chronic cardiac insufficiency.
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10.3969/j.issn.1008-9691.2013.03.012
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Objective To invcstigate the effects of Maixiansan on insulin-like growth factor binding protein 7 (IGFBP7) and apoptosis in rats with ulcerative colitis related colorectal cancer.Methods The rat model of ulcerative colitis-related coloreetal cancer was induced by dextran sulfate sodium (DSS) and azoxymethane(AOM). 40 male SD rats [weight (160 ± 10) g] were randomly divided into 4 groups: model, Maixiansan and Meisalazine treatment as well as normal group peritoneally irjected with saline.The expression of IGFBP7 and apoptosis in coloreetal tissue were detected by real-time PCR and TUNEL after 16 weeks. Results The numbers of colorectal cancer in model group( 1.2 ± 0.4 ),in Maixiansan group ( 0.70 ± 0.15 ),in Meisalazine group ( 0.60 ± 0.16 )were higher than in normal control (P ＜ 0.05), but no differences were found among model,Maixiansan and Meisalazine groups(P＞0.05).The apoptosis in colonic mucosa for Meixiansan(8.70±3.47) group and Mesalazine group were enhanced as compared with that in model group( 1.20 ±0.26 vs.0.38±0.11,P＜0.05).The mRNA expression of IGFBP7 in colon for Meixiansan group were higher than those in model group,Meisalazine group,and normal control(50.5 ± 14.0 vs.18.0 ±3.9 and 39.3±11.4,46.4±6.0,P＜0.05). Conclusions Maixiansan may resist the occurrence and development of ulcerative colitis-related colorectal cancer through upregulating IGFBP7 expression of colorectal tissue and promoting apoptosis of tumor cell.