血脂异常中医证候和2型糖尿病周围血管病变相关性的初步探讨

发布时间：2018-12-29 10:24

【摘要】：目的:对220例血脂异常患者病历进行回顾性分析,初步探讨血脂异常的中医证型分布规律。对其中130例血脂异常合并2型糖尿病周围血管病变患者,初步分析其血脂、载脂蛋白、CRP等理化因素与颈动脉粥样硬化的相关性,以及各中医证型中血脂等理化因素与颈总动脉内中膜厚度、Crouse斑块积分的相关性,探讨血脂异常与2型糖尿病周围血管病变的关系。为中医临床治疗血脂异常和防治2型糖尿病周围血管病变提供参考。方法:采集患者信息,运用统计学方法对采集数据进行分析,明确血脂异常的各个指标与CIMT、Crouse斑块积分和斑块等级积分的相关性,以及这种相关性在各个中医证型中的分布情况。所有数据均使用SPSS19.0统计软件分析。结果:1.220例血脂异常患者中血脂异常的知晓率仅为18.63%。2.220例血脂异常患者中,患病人群集中在51-70岁年龄段。3.220例血脂异常患者各个中医证型中,TG平均水平:脾肾阳虚证组气滞血瘀证组,痰浊阻遏证组气滞血瘀证组;TC/HDL-C平均水平:痰浊阻遏证组阴虚阳亢证组。4.130例血脂异常合并2型糖尿病周围血管病变患者中,TC、LDL-C、TC/HDL-C、Lp(a)与CIMT正相关,HDL-C、ApoA/B与CIMT负相关,ApoB与CIMT、斑块等级积分正相关,Lp(a)与Crouse斑块积分正相关。年龄与Crouse斑块积分、斑块等级积分正相关,Hb A1c与斑块等级积分正相关。5.130例血脂异常合并2型糖尿病周围血管病变患者五个中医证型中,痰浊阻遏证TC/HDL-C、Lp(a)与CIMT、Crouse斑块积分正相关;肝肾阴虚证ApoA/B与CIMT负相关;阴虚阳亢证TC、ApoA与Crouse斑块积分正相关;气滞血瘀证TC/HDL-C、ApoB与CIMT正相关,LDL-C、ApoB与Crouse斑块积分正相关。结论:1.血脂异常患者的知晓率较低,中老年人群发病率高。2.血脂异常合并2型糖尿病周围血管病变患者,年龄、TC、LDL-C、TC/HDL-C、ApoB、Lp(a)、HbA1c水平升高是发生糖尿病周围血管病变的危险因素,HDL-C、ApoA/B水平升高是糖尿病周围血管病变的保护性因素。3.痰浊阻遏型血脂异常患者,当其合并2型糖尿病时,尤其要关注TC/HDL-C比值和Lp(a)水平,当TC/HDL-C比值升高时,则患者出现糖尿病周围血管病变的风险将增加,Lp(a)与糖尿病周围血管病变的严重程度正相关。肝肾阴虚型血脂异常患者,当其合并2型糖尿病时,其糖尿病周围血管病变的发生率随ApoA/B的升高而降低。阴虚阳亢型血脂异常患者,当其合并2型糖尿病时,其糖尿病周围血管病变的严重程度随TC、ApoA的增加而增加。气滞血瘀型血脂异常患者,当其合并2型糖尿病时,其糖尿病周围血管病变的发生率与TC/HDL-C比值、ApoB成正相关,LDL-C、ApoB与糖尿病周围血管病变的严重程度成正相关。
[Abstract]:Objective: to analyze the medical records of 220 patients with dyslipidemia and to explore the distribution of TCM syndromes of dyslipidemia. Among them, 130 cases of dyslipidemia complicated with peripheral vascular disease of type 2 diabetes mellitus were studied. The correlation between the physical and chemical factors such as blood lipid, apolipoprotein, CRP and carotid atherosclerosis was analyzed. The relationship between blood lipids in TCM syndromes and intima media thickness of common carotid artery and plaque score of Crouse was also discussed in order to explore the relationship between dyslipidemia and vascular lesions around type 2 diabetes mellitus. To provide a reference for the clinical treatment of dyslipidemia and the prevention and treatment of type 2 diabetic peripheral vascular disease. Methods: to collect the patient information and analyze the collected data by statistical method to determine the correlation between the indexes of dyslipidemia and CIMT,Crouse plaque score and plaque grade score. And the distribution of this correlation in each TCM syndrome type. All data were analyzed by SPSS19.0 statistical software. Results: among 1.220 patients with dyslipidemia, the awareness rate of dyslipidemia was only 18.63.2.220 cases of dyslipidemia. The patients were concentrated in the age group of 51 to 70 years old. 3.220 cases of dyslipidemia patients had different TCM syndromes. TG average level: spleen and kidney yang deficiency syndrome group qi stagnation and blood stasis syndrome group, phlegm and turbid repressor syndrome group Qi stagnation blood stasis syndrome group; TC/HDL-C mean level: phlegm turbid repressor syndrome group yin deficiency and yang hyperactivity syndrome group. 4.130 cases of dyslipidemia with type 2 diabetic peripheral vascular disease patients, TC,LDL-C,TC/HDL-C,Lp (a) and CIMT positive correlation, HDL-C, ApoA/B was negatively correlated with CIMT, ApoB was positively correlated with CIMT, plaque grade score, Lp (a) was positively correlated with Crouse plaque score. Age was positively correlated with Crouse plaque score and plaque grade score, and Hb A1c was positively correlated with plaque grade score. 5.130 patients with dyslipidemia and peripheral vascular disease of type 2 diabetes mellitus had five TCM syndromes, phlegm turbid repressor syndrome TC/HDL-C, There was a positive correlation between Lp (a) and plaque score of CIMT,Crouse. There was a negative correlation between ApoA/B and CIMT in liver and kidney yin deficiency syndrome, a positive correlation between TC,ApoA and Crouse plaque score in yin deficiency and yang hyperactivity syndrome, a positive correlation between TC/HDL-C,ApoB and CIMT in Qi stagnation and blood stasis syndrome, and a positive correlation between LDL-C,ApoB and Crouse plaque score. Conclusion: 1. The awareness rate of dyslipidemia patients is low, the incidence of middle and old people is high. 2. 2. Age and TC,LDL-C,TC/HDL-C,ApoB,Lp (a), HbA1c were risk factors in patients with dyslipidemia and type 2 diabetic perivascular disease. HDL-C, was a risk factor for diabetic peripheral vascular disease. Elevated ApoA/B level is a protective factor for diabetic peripheral vascular disease. When patients with type 2 diabetes complicated with type 2 diabetes, they should pay particular attention to the ratio of TC/HDL-C and the level of Lp (a). When the ratio of TC/HDL-C increased, the risk of peridiabetic vascular disease would increase. Lp (a) was positively correlated with the severity of peridiabetic vascular disease. The incidence of peripheral vascular lesions in patients with lipids abnormality of liver and kidney yin deficiency type 2 diabetes decreased with the increase of ApoA/B. The severity of peripheral vascular lesions in patients with hyperactivity of yin and yang was increased with the increase of TC,ApoA when they were complicated with type 2 diabetes. In patients with abnormal blood lipids with Qi stagnation and blood stasis, the incidence of peripheral vascular disease was positively correlated with the ratio of TC/HDL-C and ApoB, and that of LDL-C,ApoB was positively correlated with the severity of peripheral vascular disease in patients with type 2 diabetes.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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