急性脑梗塞辨证分型与血脂.doc
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1、福建中医学院2005届临床硕士研究生毕业论文急性脑梗塞辨证分型与血脂、血糖、血压及神经功能缺损的关系研究专 业:中医内科学研究生:林心君 导 师:梁晖 主任医师 副教授摘 要目的:通过观测急性脑梗塞患者的临床神经功能缺损积分值、甘油三酯(TG)、胆固醇(TC)、低密度脂蛋白(LDL-C)载脂蛋白A1、载脂蛋白B(ApoA1,ApoB), ApoB/ApoA1,及血糖、血压的变化,探讨急性脑梗塞辨证分型与血脂、血糖、血压及临床神经功能缺损四个方面多指标的关系。资料与方法:临床收集符合要求的急性脑梗塞的病例104例,其中男56例,女48例,平均年龄70.979.55岁(43-89岁)。根据中经络证
2、型分为5组,肝阳暴亢组18例,风痰瘀阻组28例,痰热腑实组23例,气虚血瘀组17例,阴虚风动组18例。入院当时测量血压,并按照“脑卒中临床神经功能缺损程度评分标准”评分。于入院次日清晨空腹采集肘静脉血,检测其空腹血糖,血清TC、TG、LDL-C、ApoA1、ApoB、ApoB/ApoA1.结果:1、急性脑梗塞患者中医辨证分型以风痰瘀阻型所占比例最高,其次是痰热腑实型。各证类组的神经功能缺损积分以痰热腑实组最高,气虚血瘀组最低。气虚血瘀组与痰热腑实组比较差异显著(P0.05)。2、各证类组的血脂水平以风痰瘀阻组最高,其次是痰热腑实组,风痰瘀阻组与其余各证类组的血脂质比较差异显著或异常显著(P0.
3、05, P0.01)。痰热腑实组与气虚血瘀组、阴虚风动组比较,差异极其显著(P0.01)。 3、各证类组的载脂蛋白比较,风痰瘀阻组ApoA1水平最低,ApoB及ApoB/ApoA1水平最高,其次是痰热腑实组。风痰瘀阻组与其余4组比较差异显著或异常显著(P0.05, P0.05)。5、从各证类组的血压变化分析来看,肝阳暴亢组血压最高,其次是痰热腑实组。肝阳暴亢组血压与痰热腑实组比较差异显著(P0.05),与风痰瘀阻组、气虚血瘀组及阴虚风动组比较差异异常显著(P0.01)。痰热腑实组血压明显高于风痰瘀阻组、气虚血瘀组及阴虚风动组,差异极其显著(P0.01)。6、血糖增高组的神经功能缺损程度评分明显
4、高于血糖正常组(P0.01)。且神经功能缺损程度评分与血糖水平呈中度相关(r=0.522),相关性显著(P0.01),而与血脂水平、血压水平仅低度相关(r0.40).结论:1、中风急性期以标实症状突出,痰浊和瘀血可能为脑梗塞的主要病理产物和致病因素,而阳明实热可能是该病的加剧因素。2、急性脑梗塞患者存在较严重的血糖、血脂代谢紊乱,及血压水平的增高。3、血脂、血压水平与中医证型关系密切,可为脑梗塞急性期证候分类提供客观量度。4、血糖水平在一定程度上反映病情的轻重,而血脂水平、血压水平作为发病的危险因素与中风病发病率有关,但是否能反映脑梗塞患者的病情及脑实质损害严重程度尚有待于进一步研究。主题词:
5、中风病(中医)/诊断脑血管病/诊断辨证分型神经病学检查血脂/血液空腹血糖/血液血压Study on Relationship between Syndrome Types and Serum Lipids, Blood Glucose, Blood Pressure and Nervous Impairment in Patients with Acute Cerebral Infarction Major:Traditional Chinese Internal MedicinePostgraduate:Lin XinjunTutor:Liang Hui Chief Physician As
6、sociate Professor ABSTRACTObjectives: To detect the serum level of triglyceride(TG), total cholesterol(TC), low-density-lipoprotein-cholesterol(LDL-C), ApoA1, ApoB, ApoB/ApoA1 and the fasting blood glucose(FBG), blood pressure(BP) ; calculate the score of nervous impairment (SNI);so as to investigat
7、e into the relationship between syndrome types of Acute Cerebral Infarction (ACI) and the four aspects indexes: the scores of nervous impairment, serum lipids, FBG and BP.Materials and methods: 104 patients with ACI were collected, among which 56 were male and 48 were female. The average age was 70.
8、979.55years(aged 43-89 years). All were divided into five groups:sudden excess of liver yang group(SELY,18 cases), wind-phlegm and blood stasis group(WPBS,28 cases), phlegm-heat and sthenia of fu-organ group(PHSF, 23 cases),qi deficiency and blood stasis group(QDBS,17 cases) and Yin-deficiency and w
9、ind generating group(YDWG,18 cases). Measure the onset blood pressure and calculate SNI .Detect serum level of TG, TC, LDL-C, ApoA1, ApoB and FBG the next day onset. Results: 1. Among all of the syndromes of ACI , the highest proportion was WPBS syndrome and the second was PHSF syndrome.The highest
10、SNI of patients with ACI was in the group of PHSF, and the lowest one was in the group of QDBS. The difference between them was significant(P0.05).2.The highest serum level of lipids was WPBS group, and followed by PHSF group; The difference between WPBS group and every other groups was significant(
11、P0.05, P0.01); so as between PHSF group and QDBS group, YDWG group(P0.01).3.Among all groups, level of ApoA1 in WPBS group was the lowest,while ApoB and ApoB/ApoA1 was the highest, followed by PHSF. There was significant difference between WPBS group and every other groups(P0.05, P0.05).5 Our analys
12、e on blood pressure show that level of BP in SELY group was 1 and PHSF group was 2.The difference between them was significant (P0.05). that level of BP in SELY group was markedly higher than that of WPBS group, QDBS group, YDWG group(P0.01). And that level of BP in PHSF group was markedly higher th
13、an that of WPBS group,QDBS group, YDWG group(P0.01).6. The SNI in higher-glucose group was markedly higher than that of normal-glucose group (,P0.01). Correlation between SNI and level of glucose was medium (r=0.522), and the relativity was markedly (P0.01). While there was lighter correlation betwe
14、en SNI and level of serum lipids and BP(r0.40).Conclusion: 1. the stroke acute stage was prominent by the sthenia symptom.,Phlegm and stasis blood may be the primary pathlological products and pathogenesis factor. sthenic-heat of yangming possibly aggravate ACI.2. There was serious lipids, glucose d
15、isturbance and increase of BP in patients with ACI.3. The level of serum lipids and BP were relative with TCM types of ACI, so they can be objective index for ACI.4. The level of blood glucose can reflect the severity of ACI., while the level of serum lipids and BP were relative with ACI. as risk fa
16、ctors, But whether it can reflect ACI patients condition still waited for further studies.Subject headings: stroke(TCM)/diagcerebrovascular accident/diag Syndrome Differention-Classification / diagnurologic examinationSerum Lipids /bloodFBG /bloodblood pressure急性脑梗塞辨证分型与血脂、血糖、血压及神经功能缺损的关系研究专 业:中医内科学
17、研究生:林心君 导 师:梁晖 主任医师 副教授前 言INTRODUCTION急性脑血管疾病为临床常见的危重症之一,具有发病率高,死亡率高,致残率高的三高的特点,其起病急骤,变化迅速,严重危害中老年人的生命和健康。流行病学资料显示,在我国构成死亡原因的重大疾病第一位就是脑血管疾病1。提高对急性脑血管病的认识和积极防治一直是中西医界的重大课题。积极地结合现代医学的精华去深层次认识和把握此阶段的病机,既关系到本病临床诊疗水平的提高和发展,又关系到中西医学的沟通和交流,对本病的治疗和预后具有极为重要的意义。在中风发病过程中,“本虚标实”贯穿始,而在急性期又以标实的症状为主,虚损证候较少显现。王永炎教授
18、2认为该病以本虚标实为主,急性期以内风、邪热、痰浊、血瘀、腑实等标实症状突出,同时相互转化,其核心病理为“痰瘀互阻”。急性脑梗塞是治疗的关键时期,认识和把握此阶段的病机,重视急性脑梗塞辨证的早期量化诊断,做到及早防范、干预治疗,对降低脑梗塞病死率与致残率具有极为重要的意义。因此很有必要开展证候诊断的客观化、定量化研究。脑梗塞是脑血管病最常见的一种类型,几乎占80,且以动脉粥样硬化(AS)为其主要病理基础3。在形成AS的各因素中,高血压、血脂代谢起着异常重要作用。糖尿病不仅是急性脑血管病的独立危险因素,高血糖和脑血管病及其危险因子之间有极为复杂的关系。而在临床实践中发现,急性脑梗塞的患者常同时存
19、在着高血压及血脂、血糖代谢紊乱。现代医学研究认为,动脉粥样硬化(atheria sclerote,AS)与高血压动脉硬化是导致ACVD 的发生的最常见的血管壁病变4。高脂血症可损伤内皮细胞,刺激平滑肌细胞增生,形成泡沫细胞,并通过增加血液凝固度,降低纤溶功能而促进AS的发生发展和ACVD的发生。血脂代谢异常亦可使脑血管内膜脆性增加,加速脑动脉硬化发生。近年来,脂类代谢与动脉粥样硬化关系的研究已发展到载脂蛋白水平。有学者5认为ApoA1、ApoB是当前临床试验室脂类检测项目中预测动脉粥样硬化性心血管疾病最有价值的指标,而对于血脂与脑血管疾病的关系尚存在不同的见解。急性脑梗塞患者多伴有糖尿病史,有
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