世界中医药

作者	单位
朱敏1，詹增土2，王梅平1	1 联勤保障部队第九〇〇医院/原福州总医院,福州,350025 2 福建省康复医院神经康复科,福州,350003

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中文摘要:

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。

English Summary:

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 April 2015 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.

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