缺血性中风中医证型分布与血脂、颈动脉超声征象及Hcy的相关性研究
|
摘要
目的:分析缺血性中风的不同中医证型分布,并总结其与血脂、颈动脉超声征象及同型半胱氨酸(Hcy)之间的关系,为临床辨证论治提供客观依据。方法:选取2015年4月至2017年6月联勤保障部队第九〇〇医院体检的缺血性中风患者280例作为研究对象,参照2011年中风中西医结合诊疗共识对纳入者进行证型分类,并对患者的年龄、性别、吸烟史、酗酒史、血脂水平、颈动脉斑块性质、颈动脉内中膜厚度等进行分类比较。结果:1) 280例患者主要有风痰阻络、气虚血瘀及肝肾亏虚3个证型,其中风痰阻络的发病率所占比例最高,随之是气虚血瘀及肝肾亏虚。各证型中男性发病比例明显高于女性患者,各证型间年龄无统计学意义。2)男性酗酒或抽烟的例数明显高于女性患者,差异有统计学意义(χ2=4. 619,P=0. 032 <0. 05),但各证型之间性别分布差异无统计学意义(P> 0. 05)。3)各证型血脂指标中仅HDL-C水平正常,其余TC、TG、LDL-C均表达异常,其中以风痰阻络型表达最高(P <0. 05),其次为气虚血瘀型(P <0. 05)和肝肾亏虚型(P <0. 05)。4)风痰阻络组颈动脉斑块检出率最高,为80. 62%,继而是气虚血瘀,为74. 74%,最低为肝肾阴虚组58. 93%,各证型间斑块构成比分布比较,差异有统计学意义(P <0. 05),颈动脉内中膜厚度各证型之间比较,差异有统计学意义(P <0. 05)。5)风痰阻络组患者的Hcy水平最高,随之是气虚血瘀型及肝肾阴虚组(P <0. 05)。结论:缺血性中风存在风痰阻络、气虚血瘀及肝肾亏虚3种证型,不同证型之间血脂、颈动脉超声征象及Hcy水平存在一定差异。
Objective: To analyze the distribution of different TCM pattern types of ischemic stroke,and to summarize its correlations with blood lipid,carotid sonographic signs and homocysteine( HCY),to provide objective basis for clinical pattern differentiation and treatment. Methods: A total of 280 cases of patients with ischemic stroke examined in Fuzhou General Hospital from April2015 to June 2017 were included,who were categorized into different patterns in reference to the 2011 Integrated Medicine Diagnosis and Treatment Consensus on Stroke,and classified according to their age,gender,smoking history,history of alcoholism,blood lipid levels,carotid plaques properties,carotid intima-media thickness. SPSS 20. 0 software was used for statistical processing,and the differences were statistically significant when P < 0. 05. Results: 1) Among 280 cases of patients,there were mainly three types of TCM pattern,which were the wind-phlegm obstructing collaterals type,the qi deficiency and blood stasis type and the liver-kidney deficiency type,with the highest incidence rate of the wind-phlegm obstructing collaterals type,followed by the qi deficiency and blood stasis type,and the liver-kidney deficiency type. In each type of TCM pattern,the incidence ratio of male patients was significantly higher than that of female patients,whose difference was statistically significant,while no significant statistical difference was found in the distribution of age among each type. 2) The counting of cases of male patients with alcoholism or smoking were significantly higher than that of female patients,whose difference was statistically significant( χ2= 4. 619,P = 0. 032 < 0. 05),but no statistical difference was found in gender distribution among each type. 3) Only the level of HDL-C among all blood lipid indexes was normal in each type,while the rest of the lipids,TC,TG and LDL-C all presented anomaly in expression,with the highest expression in the wind-phlegm obstructing collaterals type( P < 0. 05),followed by qi deficiency and blood stasis type( P < 0. 05 =and liver-kidney deficiency type( P < 0. 05). 4) The wind-phlegm obstructing collaterals type had the highest detection rate of carotid artery plaque of 80. 62%,followed by qi deficiency and blood stasis type of 74. 74%,and the liver-kidney deficiency type had the lowest rate,only being 58. 93%; the distribution of plaque constituent rate of different pattern types was statistically different( P< 0. 05),and the carotid intima-media thickness differences between each type were statistically significant( P < 0. 05). 5) Patients of the wind-phlegm obstructing collaterals type had the highest level of HCY,followed by qi deficiency and blood stasis type and the liver-kidney deficiency type( P < 0. 05). Conclusion: There are three TCM pattern types of ischemic stroke as the wind-phlegm obstructing collaterals type,qi deficiency and blood stasis type and the liver-kidney deficiency type; different types presented certain differences in blood lipid levels,carotid sonographic signs and HCY levels.
Objective: To analyze the distribution of different TCM pattern types of ischemic stroke,and to summarize its correlations with blood lipid,carotid sonographic signs and homocysteine( HCY),to provide objective basis for clinical pattern differentiation and treatment. Methods: A total of 280 cases of patients with ischemic stroke examined in Fuzhou General Hospital from April2015 to June 2017 were included,who were categorized into different patterns in reference to the 2011 Integrated Medicine Diagnosis and Treatment Consensus on Stroke,and classified according to their age,gender,smoking history,history of alcoholism,blood lipid levels,carotid plaques properties,carotid intima-media thickness. SPSS 20. 0 software was used for statistical processing,and the differences were statistically significant when P < 0. 05. Results: 1) Among 280 cases of patients,there were mainly three types of TCM pattern,which were the wind-phlegm obstructing collaterals type,the qi deficiency and blood stasis type and the liver-kidney deficiency type,with the highest incidence rate of the wind-phlegm obstructing collaterals type,followed by the qi deficiency and blood stasis type,and the liver-kidney deficiency type. In each type of TCM pattern,the incidence ratio of male patients was significantly higher than that of female patients,whose difference was statistically significant,while no significant statistical difference was found in the distribution of age among each type. 2) The counting of cases of male patients with alcoholism or smoking were significantly higher than that of female patients,whose difference was statistically significant( χ2= 4. 619,P = 0. 032 < 0. 05),but no statistical difference was found in gender distribution among each type. 3) Only the level of HDL-C among all blood lipid indexes was normal in each type,while the rest of the lipids,TC,TG and LDL-C all presented anomaly in expression,with the highest expression in the wind-phlegm obstructing collaterals type( P < 0. 05),followed by qi deficiency and blood stasis type( P < 0. 05 =and liver-kidney deficiency type( P < 0. 05). 4) The wind-phlegm obstructing collaterals type had the highest detection rate of carotid artery plaque of 80. 62%,followed by qi deficiency and blood stasis type of 74. 74%,and the liver-kidney deficiency type had the lowest rate,only being 58. 93%; the distribution of plaque constituent rate of different pattern types was statistically different( P< 0. 05),and the carotid intima-media thickness differences between each type were statistically significant( P < 0. 05). 5) Patients of the wind-phlegm obstructing collaterals type had the highest level of HCY,followed by qi deficiency and blood stasis type and the liver-kidney deficiency type( P < 0. 05). Conclusion: There are three TCM pattern types of ischemic stroke as the wind-phlegm obstructing collaterals type,qi deficiency and blood stasis type and the liver-kidney deficiency type; different types presented certain differences in blood lipid levels,carotid sonographic signs and HCY levels.
引文
[1]黄宁芳,杨桂钦,陈强,等.瑞舒伐他汀钙治疗老年脑梗死患者合并颈动脉粥样硬化斑块的疗效及对血脂、C反应蛋白水平的影响[J].中国老年学杂志,2017,37(6):1382-1383.
[2]张晶,关欣,王伟,等.血脂代谢与颈动脉粥样硬化不稳定性斑块的相关性[J].中国动脉硬化杂志,2012,20(9):833-836.
[3]杜杰.黄芪总苷和人参皂苷降低缺血性脑卒中患者脑脊液中谷氨酸、磷酸化Tau[J].东南大学学报:医学版,2017,36(5):828-832.
[4]库兰丹·木普提,甄晓敏,张云云.从中西医角度探讨中医“脾”与缺血性脑卒中的关系[J].中西医结合心脑血管病杂志,2017,15(6):746-748.
[5]刘芳,周德生,贺海霞.缺血性脑卒中患者复发与其中医体质的相关性研究[J].世界中医药,2017,12(5):1014-1017.
[6]惠琳莉,董菲.中医辨病辨证治疗缺血性脑卒中临床价值评析[J].内蒙古中医药,2015,(9):2-2.
[7]吕素真.复发性缺血性脑卒中的中医体质临床调查[J].济南:山东中医药大学,2016.
[8]麻志恒,施志琴,张汉新,等.崇明地区急性脑梗死患者中医辨证分型特点及与血黏度的相关性[J].中国实验方剂学杂志,2012,18(1):231-233.
[9]张永全,唐芳芳,唐昂.急性脑梗死风痰阻络证患者血脂及颈动脉彩色多普勒超声检查的临床研究[J].河北中医,2010,32(5):662-663,756.
[10]徐瑾,李艳成,王国权,等.不同性别青年型脑梗死临床特征分析[J].卒中与神经疾病,2013,20(4):217-220.
[11]张玉玲,陈自光,罗传松,等.短暂性脑缺血发作发展至脑梗死危险因素分析[J].淮海医药,2016,34(4):423-424.
[12]王天鹏,陈进荣.烟酒与青年脑梗死[J].临床荟萃,2000,15(3):111.
[13]尹爱兵,郝媌,李筱媛.针药并举联合西药治疗高血压颈动脉粥样硬化80例临床观察[J].中医杂志,2015,56(7):590-593.
[14]冯凯.中医对颈动脉粥样硬化的辨证分类[J].贵阳中医学院学报,2013,35(5):68-69.
[15]生书萌,霍清萍.中医对颈动脉粥样硬化的认识及其研究进展[J].中西医结合心脑血管病杂志,2015,13(3):276-278.
[16]赵小梅.Hcy、hs-CRP、DDR和IMT在脑梗死中的诊断价值[J].中国实验诊断学,2014,18(6):961-963.
[17]张冬,张继明.血清同型半胱氨酸与2型糖尿病患者脑梗死相关性研究[J].天津医药,2016,44(7):902-905.
[18]刘睦胜.血清Hcy及UA水平与老年脑梗死患者头颈部动脉粥样硬化及狭窄的关系[J].中国老年学杂志,2014,34(23):6758-6759.
[2]张晶,关欣,王伟,等.血脂代谢与颈动脉粥样硬化不稳定性斑块的相关性[J].中国动脉硬化杂志,2012,20(9):833-836.
[3]杜杰.黄芪总苷和人参皂苷降低缺血性脑卒中患者脑脊液中谷氨酸、磷酸化Tau[J].东南大学学报:医学版,2017,36(5):828-832.
[4]库兰丹·木普提,甄晓敏,张云云.从中西医角度探讨中医“脾”与缺血性脑卒中的关系[J].中西医结合心脑血管病杂志,2017,15(6):746-748.
[5]刘芳,周德生,贺海霞.缺血性脑卒中患者复发与其中医体质的相关性研究[J].世界中医药,2017,12(5):1014-1017.
[6]惠琳莉,董菲.中医辨病辨证治疗缺血性脑卒中临床价值评析[J].内蒙古中医药,2015,(9):2-2.
[7]吕素真.复发性缺血性脑卒中的中医体质临床调查[J].济南:山东中医药大学,2016.
[8]麻志恒,施志琴,张汉新,等.崇明地区急性脑梗死患者中医辨证分型特点及与血黏度的相关性[J].中国实验方剂学杂志,2012,18(1):231-233.
[9]张永全,唐芳芳,唐昂.急性脑梗死风痰阻络证患者血脂及颈动脉彩色多普勒超声检查的临床研究[J].河北中医,2010,32(5):662-663,756.
[10]徐瑾,李艳成,王国权,等.不同性别青年型脑梗死临床特征分析[J].卒中与神经疾病,2013,20(4):217-220.
[11]张玉玲,陈自光,罗传松,等.短暂性脑缺血发作发展至脑梗死危险因素分析[J].淮海医药,2016,34(4):423-424.
[12]王天鹏,陈进荣.烟酒与青年脑梗死[J].临床荟萃,2000,15(3):111.
[13]尹爱兵,郝媌,李筱媛.针药并举联合西药治疗高血压颈动脉粥样硬化80例临床观察[J].中医杂志,2015,56(7):590-593.
[14]冯凯.中医对颈动脉粥样硬化的辨证分类[J].贵阳中医学院学报,2013,35(5):68-69.
[15]生书萌,霍清萍.中医对颈动脉粥样硬化的认识及其研究进展[J].中西医结合心脑血管病杂志,2015,13(3):276-278.
[16]赵小梅.Hcy、hs-CRP、DDR和IMT在脑梗死中的诊断价值[J].中国实验诊断学,2014,18(6):961-963.
[17]张冬,张继明.血清同型半胱氨酸与2型糖尿病患者脑梗死相关性研究[J].天津医药,2016,44(7):902-905.
[18]刘睦胜.血清Hcy及UA水平与老年脑梗死患者头颈部动脉粥样硬化及狭窄的关系[J].中国老年学杂志,2014,34(23):6758-6759.