施良虎++余昆山++钟伟++王艳++和丽菊++解开红

摘要：目的通过对社区获得性肺炎（Community acquired pneumonia，CAP）患者血白细胞计数（WBC）、C反应蛋白（CRP）、D-二聚体（D-D）、血清降钙素原（PCT）等炎性指标的临床观察研究，找出其差异性，为中医“风温肺热病”辨证分型提供客观依据。 方法选取CAP中医证型属邪犯肺卫（60例）、痰热壅肺（68例）、痰浊阻肺（65例）、正虚邪恋（56例）4个证型，检测各证型WBC，CRP，D-D，PCT等4项指标，分析各证型间炎性指标的差异性。 结果WBC：在4证型间比较：痰热壅肺>痰浊阻肺>邪犯肺卫>正虚邪恋；CRP：在4证型间比较：痰热壅肺>邪犯肺卫>痰浊阻肺>正虚邪恋；D-D：在4证型间比较：正虚邪恋>痰浊阻肺>痰热壅肺>邪犯肺衛；PCT：在4证型间比较：邪犯肺卫>痰热雍肺>痰浊阻肺>正虚邪恋。 结论CAP各炎性指标（WBC、CRP、D-D、PCT）在不同中医证型间其数值存在差异，具有一定的规律性，这可为CAP（相当于中医学之“风温肺热病”）中医辨证分型提供客观参考依据。

关键词：社区获得性肺炎；风温肺热病；中医证型；炎性指标；差异性分析

中图分类号：R5631文献标志码：A文章编号：1007-2349（2017）07-0024-04

【Abstract】Objective： To study the inflammatory indicators of white blood cell count （WBC）， C-reactive protein （CRP）， D-dimer （D-D）， serum procalcitonin （PCT） in patients with community acquired pneumonia （CAP） and to find out differences in order to provide an objective basis for TCM “wind-warm lung-heat disease？” syndrome differentiation Methods： CAP patients with 4 TCM syndromes were selected， namely， 60 cases with pathogen invading lung-defense phase， 68 cases with phlegm-heat obstructing lung， 65 cases with turbid phlegm obstructing lung and 56 cases with lingering pathogen due to vital qi deficiency WBC， CRP， D-D and PCT of each syndrome were detected to analyze the differences of inflammatory indicators among these different syndromes Results： In comparison of four types of syndromes， WBC was as phlegm-heat obstruction lungs>turbid phlegm obstructing lung>pathogen invading lung-defense phase>lingering pathogen due to vital qi deficiency， CRP was as phlegm-heat obstructing lung>pathogen invading lung-defense phase>turbid phlegm obstructing lung>lingering pathogen due to vital qi deficiency， D-D was as lingering pathogen due to vital qi deficiency>turbid phlegm obstructing lung>phlegm-heat obstruction lungs>pathogen invading lung-defense phase and PCT was as pathogen invading lung-defense phase>phlegm-heat obstructing lung>turbid phlegm obstructing lung>lingering pathogen due to vital qi deficiency Conclusion： There are some differences and some regularity in numerical values of WBC， CRP， DD and PCT indicators of CAP patients among different TCM syndromes， which can provide an objective reference for TCM syndrome differentiation of CAP

【Key words】community acquired pneumonia， wind-warm lung-heat disease， TCM syndrome， inflammatory indicator， difference analysis[HJ2.9mm]

社区获得性肺炎（Community acquired pneumonia，CAP），亦称院外肺炎，指在医院外罹患的感染性肺实质（含肺泡壁即广义上的肺间质）炎症，包括在社区感染，尚在潜伏期，因其他原因住院后而发病的肺炎，并排除在医院内感染而于出院后发病的肺炎。祖国医学多数将其归属于“风温”、“肺热病”、“风温肺热病”、“咳嗽”等范畴。古代并无“风温肺热病”病名，但有“风温”和“肺热病”病名。风温首见于《伤寒论》，“太阳病，发热而渴，不恶寒者，为温病，若发汗已，身灼热者，为风温”。肺热病则起源于《黄帝内经》，《素问·刺热篇》曰：“肺热病者，先淅然厥起毫毛，恶风寒，舌上黄身热，热争则喘咳，痛走胸膺背，不得大息，头痛不堪，汗出而寒，丙丁甚，庚辛大汗，气逆则丙丁死”。现代医家将“风温”和“肺……