急性脑梗死中医证型与血脂、颈动脉斑块及狭窄的关系探讨

发布时间：2018-06-24 15:55

本文选题：急性脑梗死 + 中医辨证分型　；参考：《大连医科大学》2016年硕士论文

【摘要】：目的:本次研究旨在探讨急性脑梗死中医辨证分型与血脂、颈动脉斑块及狭窄之间的关系,为急性脑梗死中医微观辨证分型提供客观依据,使急性脑梗死的中医辨证分型和治疗更加客观化、准确化、个体化。方法:制定统一的纳入标准和排除标准,参照《中医病证诊断疗效标准》[1],将符合标准的156例急性脑梗死患者进行辨证分型。收集所有患者的血脂及颈动脉彩超的结果,应用SPSS 22.0进行数据的录入和统计。比较各证型间血脂、颈动脉彩超结果,探讨急性脑梗死患者各证型与血脂、颈动脉斑块及狭窄之间的关系。结果:1.急性脑梗死中医证型分布依次为:风痰阻络型(32.69%)气虚血瘀型(25.64%)肝阳暴亢型(16.03%)痰热腑实型(14.10%)阴虚风动型(11.54%)。2.各证型男女构成及年龄的差异无统计学意义(P0.05)。3.各证型合并高血压的差异有统计学意义:肝阳暴亢型明显高于其他四个证型(P0.05或P0.01),风痰阻络型高于阴虚风动型(P0.05),合并冠心病与糖尿病在各证型分布的差异无统计学意义(P0.05)。4.各证型间血脂异常的差异有统计学意义:其中肝阳暴亢型与阴虚风动型血脂异常所占比例明显低于风痰阻络型、痰热腑实型、气虚血瘀型(P0.01)。各证型之间血脂平均水平的差异有统计学意义:从TC上看:风痰阻络型和痰热腑实型明显高于肝阳暴亢型(P0.05或P0.01),痰热腑实型明显高于阴虚风动型(P0.05);从TG上看:各证候间差别无统计学意义(P0.05);从HDL-C上看:气虚血瘀型与其余四型相比显著降低(P0.01);从LDL-C上看:风痰阻络型和痰热腑实型明显高于阴虚风动型(P0.05或P0.01)。5.各证型颈动脉斑块发生率的差异有统计学意义:与肝阳暴亢型和阴虚风动型比较,其余三型的斑块检出率较高(P0.05或P0.01);各证型颈动脉斑块分布的差异无统计学意义(P0.05)。6.各证型颈动脉狭窄率的差异有统计学意义:其中肝阳暴亢型与阴虚风动型狭窄率明显低于其他三个证型(P0.05或P0.01);各证型颈动脉狭窄程度分布的差异无统计学意义(P0.05)。结论:1.急性脑梗死中医证型与血脂的分布及其平均水平、斑块的形成率、颈动脉狭窄率、合并高血压之间存在关系,与年龄、性别、斑块性质的分布、颈动脉狭窄程度的分布、合并冠心病和糖尿病无关;2.急性脑梗死患者TC、LDL-C的升高可作为痰证、瘀证辨证的参考指标,HDL-C的降低可作为气虚血瘀型辨证的参考指标;3.急性脑梗死患者颈动脉斑块及狭窄的形成与中医证型间存在关系,其形成率在与痰证、瘀证相关的证型中较高。
[Abstract]:Objective: to explore the relationship between TCM syndrome differentiation and blood lipid, carotid plaque and stenosis in acute cerebral infarction, and to provide objective basis for TCM micro syndrome differentiation of acute cerebral infarction. To make the acute cerebral infarction syndrome differentiation and treatment more objective, accurate, individualized. Methods: according to the criteria of diagnosis and curative effect of TCM disease syndrome, 156 patients with acute cerebral infarction were classified according to the criteria of inclusion and exclusion. The results of blood lipid and carotid ultrasound were collected, and SPSS 22.0 was used to input and statistics the data. To compare the blood lipids and the results of carotid artery color Doppler sonography among different syndrome types, and to explore the relationship between each syndrome type and blood lipid, carotid plaque and stenosis in patients with acute cerebral infarction. The result is 1: 1. The distribution of TCM syndromes of acute cerebral infarction was as follows: wind phlegm blocking collaterals (32.69%), qi deficiency and blood stasis (25.64%), hyperactivity of liver-yang (16.03%), phlegm and heat (14.10%), yin deficiency (11.54%) .2. There was no significant difference in composition and age between men and women of each syndrome type (P0.05). 3. There were significant differences between the syndrome types and hypertension: the type of hyperactivity of liver-yang was significantly higher than that of the other four syndrome types (P0.05 or P0.01), the type of wind-phlegm blocking collaterals was higher than that of the type of Yin deficiency wind movement (P0.05), and the distribution of coronary heart disease and diabetes mellitus in each syndrome type had no statistical significance (P0.05). 4. The difference of dyslipidemia among different syndromes was statistically significant: the proportion of dyslipidemia in hyperactive liver-yang type and wind-asthenia type was significantly lower than that in wind-phlegm blocking collaterals type, phlegm and heat entrails type, Qi deficiency and blood stasis type (P0.01). The difference of average level of blood lipids among different syndromes was statistically significant: from the TC point of view, the types of wind-phlegm blocking collaterals and phlegm-heat entrails were significantly higher than those of liver-yang violent hyperactivity (P0.05 or P0.01), and the phlegm and heat entrails were significantly higher than those of yin deficiency and wind movement (P0.05); from the TG point of view: There was no significant difference between syndromes (P0.05); from the point of view of HDL-C: Qi deficiency and blood stasis compared with the other four types significantly decreased (P0.01); from LDL-C: wind phlegm blocking collaterals and phlegm heat Fu solid type was significantly higher than Yin deficiency wind movement (P0.05 or P0.01) .5. The incidence rate of carotid plaques in each syndrome type was statistically significant: compared with the hyperactive type of liver-yang and the wind movement type of Yin deficiency, the detection rate of plaque in the other three types was higher (P0.05 or P0.01), and there was no significant difference in the distribution of carotid plaques in each syndrome type (P0.05). 6. The rate of carotid artery stenosis in each syndrome type was significantly lower than that in the other three syndrome types (P0.05 or P0.01), and there was no significant difference in the degree distribution of carotid artery stenosis between different syndromes (P0.05). Conclusion 1. The distribution and average level of blood lipid, plaque formation rate, carotid artery stenosis rate, hypertension, age, sex, the distribution of plaque nature, the degree of carotid artery stenosis, the distribution of TCM syndrome type of acute cerebral infarction, the degree of carotid artery stenosis, and the relationship between TCM syndrome type and blood lipid distribution, plaque formation rate, carotid artery stenosis rate, and hypertension. Coronary heart disease is not associated with diabetes. The increase of LDL-C in acute cerebral infarction can be used as the reference index of phlegm syndrome and the decrease of HDL-C in syndrome differentiation of blood stasis can be used as the reference index of syndrome differentiation of qi deficiency and blood stasis. The formation of carotid artery plaque and stenosis in patients with acute cerebral infarction was related to TCM syndrome type, and its formation rate was higher in the syndromes related to phlegm syndrome and stasis syndrome.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

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