代谢综合征患者常见中医证型与C-反应蛋白、白细胞介素6及肿瘤坏死因子α的相关性研究

发布时间：2018-08-23 10:36

【摘要】：目的通过复习文献资料和临床调查,归纳代谢综合征(MS)患者临床上常见的中医证型,探讨MS患者C-反应蛋白(hs-CRP)、白细胞介素6(IL-6)及肿瘤坏死因子α(TNF-α)水平与中医证型的关系,研究各指标中医证候间有无相对特异性,为临床微观辨证治疗提供客观依据。方法根据诊断标准,采集2015年3月至2015年12月在河南中医学院第一附属医院门诊就诊及住院的65例MS患者,采集患者症状、体征、舌脉等四诊信息,分析归纳出共有痰湿内蕴证、阴虚热盛证、肝郁脾虚证、痰瘀互结证四种临床常见中医证型,另外,选择20例健康人为正常对照组,分别检测腰围、血压、血脂、血糖、C-反应蛋白、白细胞介素6及肿瘤坏死因子α等指标,对不同证型各指标进行比较,探寻MS患者各证型与C-反应蛋白、白细胞介素6及肿瘤坏死因子α指标水平之间的关系。结果1.MS患者性别、年龄分布情况本研究65例MS患者中,男性40例,占61.54%,女性25例,占38.46%,男女比例为1.6∶1,年龄最小30岁,最大68岁,平均年龄50.12±9.47岁,其中50-59岁人数最多,占总人数的40%,经检验,与正常对照组的性别、年龄组间无显著性差异。2.MS患者临床常见4种证型,即痰湿内蕴证、阴虚热盛证、肝郁脾虚证、痰瘀互结证。3.MS组与正常对照组临床检测指标的比较:MS组患者的体重指数(BMI)、腰围、收缩压(SBP)、舒张压(DBP)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、C-反应蛋白(hs-CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平均高于正常对照组,差异均有统计学意义,P0.001;MS组患者的高密度脂蛋白胆固醇(HDL-C)低于正常对照组,但差异无统计学意义(P=0.060)。4.MS各证型之间hs-CRP的比较:各组hs-CRP水平高低顺序如下:阴虚热盛㧐肝郁脾虚㧐痰湿内蕴㧐痰瘀互结,阴虚热盛组的hs-CRP高于对照组、痰瘀互结组、肝郁脾虚组、痰湿内蕴组,组间差异有统计学意义(P0.05);痰瘀互结组与正常对照组相比无显著性差异(P㧐0.05);肝郁脾虚、痰湿内蕴组患者的hs-CRP高于对照组、痰瘀互结组,组间差异有统计学意义(P0.05);肝郁脾虚组与痰湿内蕴组相比无明显差异(P㧐0.05)。5.MS各证型之间IL-6的比较:各组IL-6水平高低顺序如下:阴虚热盛㧐痰湿内蕴㧐肝郁脾虚㧐痰瘀互结,阴虚热盛组的IL-6高于对照组、痰瘀互结组、肝郁脾虚、痰湿内蕴组,组间差异有统计学意义(P0.05);痰湿内蕴组的IL-6高于对照组、肝郁脾虚、痰瘀互结组,组间差异有统计学意义(P0.05);肝郁脾虚组、痰瘀互结组的IL-6高于对照组,但组间差异无统计学意义(P㧐0.05)。6.MS各证型之间TNF-α的比较:各组TNF-α水平高低顺序如下:痰湿内蕴㧐阴虚热盛㧐痰瘀互结㧐肝郁脾虚,阴虚热盛、痰湿内蕴患者的TNF-α高于对照组、痰瘀互结组、肝郁脾虚组,组间差异有统计学意义(P0.05);肝郁脾虚组与正常对照组相比无明显差异(P㧐0.05)。结论1.MS患病率随年龄的增长而升高,且男性明显多于女性。2.MS患者在临床上主要有痰湿内蕴证、阴虚热盛证、肝郁脾虚证、痰瘀互结证4种常见证型,以阴虚热盛证为主,证型随年龄增大呈以下趋势发展:肝郁脾虚→痰湿内蕴→阴虚热盛→痰瘀互结。3.在临床上,MS患者的BMI、腰围、SBP、DBP、TG、TC、LDL-C、FPG、hs-CRP、IL-6、TNF-α水平均有不同程度的升高。4.MS存在慢性炎症状态,MS各证型与hs-CRP、IL-6、TNF-α具有一定相关性,hs-CRP、IL-6、TNF-α3指标水平在阴虚热盛、痰湿内蕴组较高,在痰瘀互结组较低,各证型组间比较差异明显,可以作为MS微观辨证的客观依据。
[Abstract]:Objective To investigate the relationship between the levels of C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) in patients with metabolic syndrome (MS) and TCM syndromes by reviewing literature and clinical investigation, and to study the relative specificity of TCM syndromes in each index. Methods According to the diagnostic criteria, 65 MS patients were collected from March 2015 to December 2015 in the First Affiliated Hospital of Henan College of Traditional Chinese Medicine. The symptoms, signs, tongue and veins of the patients were collected. The four syndromes of phlegm and dampness, Yin deficiency and heat excess, liver depression and spleen deficiency, phlegm and blood stasis syndromes were analyzed and summarized. The waist circumference, blood pressure, blood lipids, blood glucose, C-reactive protein, interleukin-6 and tumor necrosis factor-alpha were detected in 20 healthy people as control group. The indexes of different syndromes were compared to explore the syndromes of MS patients and C-reactive protein, interleukin-6 and tumor necrosis factor-alpha finger. Results 1. The sex and age distribution of 65 MS patients in this study, male 40 cases, accounting for 61.54%, female 25 cases, accounting for 38.46%, the ratio of men and women is 1.6:1, the youngest 30 years old, the oldest 68 years old, the average age is 50.12 + 9.47 years old, of which 50-59 years old, accounting for 40% of the total number, the test, and the normal control group sex. There was no significant difference among the age groups. 2. There were four common syndromes in MS patients, namely phlegm-dampness syndrome, yin-deficiency-heat syndrome, liver-stagnation-spleen deficiency syndrome, phlegm-blood stasis syndrome. 3. Comparison of clinical indexes between MS group and normal control group: body mass index (BMI), waist circumference, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), total cholesterol (TC), low density. Lipoprotein cholesterol (LDL-C), fasting blood glucose (FPG), C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) levels were higher than the normal control group, the difference was statistically significant (P 0.001); high-density lipoprotein cholesterol (HDL-C) in MS group was lower than the normal control group, but the difference was not statistically significant (P=0.060). 4. MS Comparing the levels of hs-CRP among syndrome types: the order of the levels of hs-CRP in each group is as follows: Yin deficiency and heat excess? Liver depression and spleen deficiency? Phlegm and dampness accumulation? Phlegm and blood stasis mutual knot, Yin deficiency and heat excess group is higher than the control group, phlegm and blood stasis mutual knot group, liver depression and spleen deficiency group, phlegm and dampness accumulation group, the difference is statistically significant (P 0.05); phlegm and blood stasis mutual knot group Difference (P? 0.05); liver depression and spleen deficiency, phlegm and dampness accumulation group of hs-CRP higher than the control group, phlegm and blood stasis group, the difference was statistically significant (P 0.05); liver depression and spleen deficiency group and phlegm and dampness accumulation group compared with no significant difference (P? 0.05). The IL-6 levels in the group of blood stasis, Yin deficiency and heat excess were higher than those in the control group, the group of phlegm and blood stasis, the group of liver depression and spleen deficiency, the group of phlegm and dampness accumulation, the difference was statistically significant (P 0.05); the IL-6 levels in the group of phlegm and dampness accumulation were higher than those in the control group, the group of liver depression and spleen deficiency, and the group of phlegm and blood stasis accumulation, the difference was statistically significant (P 0.05). There was no significant difference (P? 0.05). 6. Comparison of TNF - alpha levels among different syndrome types of MS: the order of TNF - alpha levels in each group was as follows: phlegm-dampness accumulation? Yin-deficiency-heat excess? Phlegm-blood stasis interaction? Liver stagnation-spleen deficiency, yin-deficiency-heat excess, phlegm-dampness accumulation of TNF - alpha was higher than that in the control group, phlegm-blood stasis interaction group, liver stagnation-spleen deficiency group, the difference was statistically significant (P 0.05); liver stagnation Conclusion 1. The morbidity of MS increased with age, and the number of males was significantly higher than that of females. 2. The clinical manifestations of MS patients were mainly phlegm-dampness syndrome, yin-deficiency-heat excess syndrome, liver-stagnation-spleen deficiency syndrome, phlegm-stasis syndrome, and phlegm-blood stasis syndrome, mainly yin-deficiency-heat excess syndrome. In clinic, BMI, waist circumference, SBP, DBP, TG, TC, LDL-C, FPG, hs-CRP, IL-6, TNF-alpha levels of MS patients increased in varying degrees. 4. MS has chronic inflammation, and the syndrome types of MS have certain correlation with hs-CRP, IL-6, TNF-alpha, hs-CRP, IL-6, IL-6, IL-6, and TNF-alpha levels in Yin deficiency. The heat-rich, phlegm-dampness intrinsic group is higher, the phlegm-blood stasis mutual knot group is lower, the difference between each syndrome group is obvious, can be used as the objective basis of MS micro-syndrome differentiation.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

【相似文献】