近期感染急性脑梗死中医证型探讨及其与炎性反应因子的研究
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摘要
研究目的：①通过对近期感染急性脑梗死患者的中医证候进行横断面调查,探讨近期感染急性脑梗死的中医证候分布,为寻找近期感染急性脑梗死的中医证侯变化规律，制定防范措施提供依据。②在近期感染急性脑梗死疾病中，炎性反应因子相互调控，参与了脑梗死病急性期的血液循环、血管的病理变化过程。我们假定炎性反应还参与了近期感染急性脑梗死患者的中医证候的形成。调查近期感染急性脑梗死患者的炎性反应因子与其中医证候的相关性，从而探讨近期感染急性脑梗死患者中医证候形成的生物学基础，从而为证候研究的客观化提供理论依据。
研究方法：①理论探讨:回顾脑梗塞（中风）现代医学研究和中医证候研究概况,中风中医证候分布及演变规律，并探讨中风中医证候与相关的因素的研究进展。②确定急性脑梗塞中西医诊疗标准，研究对象的纳入和排除标准，采取横断面调查的方式,确定研究对象为92例近期感染急性脑梗死患者，采集92例患者的一般情况、阶段信息、中医四诊信息实验室检测结果等资料。由严格培训的专业人员,对研究对象集中进行统一的证候评价，将结果录入数据库。③按中风病辨证诊断标准，将92例近期感染急性脑梗死患者分类，即将收集的病例分为风、火、痰、瘀、气虚、阴虚六型。④采集全部病例的血液标本；每例病例抽取空腹静脉血6ml，用促凝管收集、立即派专人送往实验室，离心3000r∕min分离血清，放入-80℃的冰箱保存，最后进行统一检测，所有过程均严格执行无菌操作，采用酶联免疫吸附双抗体夹心法(ELISA)检测血清IL-1β、TGF-β、sICAM-l、sEPCR、MMP-9的含量，实验过程在湖北中医药大学昙华林校区实验室完成测定，所有操作均按说明书要求进行。将所检测的结果集中收集录入数据库。统计分析将采用SPSS13.0统计分析软件进行计算，不同组的计量资料采用x±s进行统计描述，采用t检验比较组间差异。P<0.05认为差别有统计学意义。计数资料使用频数表（构成比）进行统计描述。炎性反应因子与证候要素的相关性采用相关性检验的方法。
结果：①92例研究对象总体上以气虚证、痰证、火证出现频率最高。经分析,结合各证候要素在近期感染急性脑梗死患者中所占比例(气虚证53.3%、痰证45.7%、火证42.4%),可见,近期感染急性脑梗死患者主要证候表现均为气虚证、痰证、火热证。②研究对象中表现为一证独见和二证并见的比例最高，分别是42.4%、35.9%。一证独见的患者中,以“气虚”、“痰”和“火热”型最多，分别占33.3%、28.2%、25.6%；二证并见的,以“痰+气虚”型最多，是42.4%,其次是“火热+气虚”型和“风+火热”型，分别占18.2%，12.1%。③炎性反应因子IL-1β含量在火证中明显高于非火热证型，经t检验P<0.05，差别有统计学意义，并且IL-1β含量在气虚证组明显高于非气虚证组，经t检验P<0.05，差别有统计学意义；相关性分析结果，火证、气虚证与IL-1β水平相关，P<0.01，有统计学意义；④炎性反应因子TGF-β含量在痰证中高于非痰证，经t检验P<0.05，差别有统计学意义，相关性分析结果，痰证与TGF-β水平正相关，P<0.01，瘀证与TGF-β水平负相关，P<0.01有统计学意义。⑤炎性反应因子sICAM-1含量在瘀证中明显高于非瘀证型，经t检P<0.05，差别有统计学意义，sICAM-1含量在痰证中高于非痰证，经t检验P<0.05，差别有统计学意义；相关性分析结果，瘀证、痰证与sICAM-1水平正相关，P<0.01，有统计学意义；⑥炎性反应因子MMP-9、sEPCR含量在血瘀证明显高于非血瘀证，经t检验P<0.05，差别有统计学意义，相关性分析结果，瘀证与MMP-9、sEPCR水平正相关P<0.01，有统计学意义。
结论：①近期感染急性脑梗死的患者以气虚、痰、火为主要证候表现,证候要素的组合较为简单,多表现为气虚、痰、火的单独出现或几个证型相互组合；②近期感染急性脑梗死的患者血液中细胞白介素-1β（IL-lβ）的含量变化与火证、气虚证之间有明显的相关性，可能成为判定火证、气虚证的指标之一；③近期感染急性脑梗死的患者血液中转化生长因子β（TGF-β）的含量变化与痰证有相关性，与瘀证负相关，可能成为判定痰证和瘀证的指标之一；④近期感染急性脑梗死的患者血液中可溶性细胞粘附因子-1（sICAM-1）的含量变化与瘀血证、痰证有明显的相关性，可能成为判定瘀血证、痰证的指标之一。⑤近期感染急性脑梗死的患者血液中可容性细胞蛋白C（sEPCR）、金属蛋白酶9（MMP-9）的含量变化与瘀血证有明显的相关性，可能成为判定瘀血证指标之一。
Objective:①Through the cross-sectional survey of recent infection inpatients with acute cerebral infarction TCM Syndrome, Discussion onrecent infection in acute cerebral infarction TCM syndrome distribution,for the TCM syndrome changes of recent infection of acute cerebralinfarction, provide the basis for the formulation of preventive measures;②In the recent infection disease of acute cerebral infarction,Inflammatory cytokine regulation, pathological changes in bloodcirculation, with cerebral vascular disease period，We assume that theinflammatory reaction formation of recent infection in patients with acutecerebral infarction TCM syndrome also participate in, Investigation ofrelationship between recent infection in patients with acute cerebralinfarction and inflammatory factor and syndrome of traditional Chinesemedicine, To explore the biological basis of recent infection syndromein patients with acute cerebral infarction patterns formed, whichprovided a theoretical foundation for the research of the objectificationof syndrome.
Methods:①Theoretical study:Review of research on brain infarction ofmodern medicine and TCM Syndrome Study, And the evolution rules of distribution of TCM Syndromes of apoplexy, And discusses theresearch progress of TCM syndrome of stroke and related factors;②Determination of Western medicine diagnosis standard of acutecerebral infarction, The object of study inclusion and exclusion criteria,Cross-sectional survey method, To determine the object of study for92cases of infection in patients with acute cerebral infarction, In general,phase information and information of four diagnostic methods, data of92patients, By the strict training of professionals, the object of study,mainly syndromes evaluation are unified, the results into the database;③Blood samples were collected for all patients, Each case of fastingvenous blood were extracted by6mlprocoagulant andcollection,immediately delivered Laboratory,Centrifugal separatingserum3000r/min,-80℃preservation， unified examination, allprocesses are strict sterile manipulation, Using enzyme-linkedimmunosorbent assay (ELISA) for detection of serum antibodysandwich method IL-1β、TGF-β、slCAM-l、sEPCR、MMP-9, All theoperation requirements according to the instructions, The collected datais collected into the database. Statistical analysis using SPSS13.0statistical analysis software for calculation, Measurement data bydifferent groups for statistical description use x±s, The differencebetween the group use t test. P<0.05,That difference was significant,Count data using frequency tables (ratio) of statistical description, By using the method of correlation analysis of the correlation betweeninflammatory factors and syndrome elements
Results:①92subjects in general Qi, phlegm syndrome, heatsyndrome had the highest frequency, Through the analysis, combinedwith the syndrome factors of infection ratio in patients with acutecerebral infarction in the near future(Qi deficiency, phlegm fire45.7%,53.3%，42.4%),Visible, recent infection in patients with acute cerebralinfarction and the main symptoms were Qi-deficiency, phlegmsyndrome, heat syndrome;②The research object of performance for asingle syndrome and two cards and the highest proportion, respectivelyis42.4%,35.9%，A certificate of the patients, the "Qi","phlegm" and"hot" type is the most, accounting for33.3%,28.2%,25.6%respectively，Two cards and see, most in the "phlegm+Qi",42.4%, Thesecond is "hot+Qi" and "air+hot" type, accounted for18.2%,12.1%.③Inflammatory factors of IL-1β content in fire syndrome wassignificantly higher than that of non-heat syndromes, testing by tP<0.05，The difference was significant. And the IL-1β content in the Qideficiency syndrome group was significantly higher than that in non-qideficiency syndrome group，testing by t P<0.05，The difference wassignificant. Results of correlation analysis：Fire syndrome, Qi deficiencysyndrome associated with the level of IL-1β, P<0.01, there was statistical significance.④Inflammatory factors of TGF-β were higherthan that of non-phlegm syndrome in phlegm syndrome，testing by tP<0.05，The difference was significant. Results of correlation analysis：Phlegm syndrome associated with the levels of TGF-β, P<0.01，Negative correlation between blood stasis syndrome and the level ofTGF-β, P<0.01had statistical significanc⑤Inflammatory factors andsICAM-1content in blood stasis syndrome was significantly higher thanthat of non blood stasis syndrome，By t P<0.05, the difference wassignificant，The content of sICAM-1is higher than that of non-phlegmsyndrome，Testing by t P<0.05, the difference was significant，Resultsof correlation analysis：Syndrome of blood stasis, phlegm syndromeand the level of sICAM-1positive correlation, P<0.01, there wasstatistical significance。⑥Inflammatory factors MMP-9, sEPCR contentin the blood were significantly higher than that of blood stasissyndrome，Testing by t P<0.05, the difference was significant，Resultsof correlation analysis：Positive correlation with MMP-9, sEPCR levelsin blood stasis syndrome P<0.01, there was statistical significance.
Conclusion:①The recent infection in patients with acute cerebralinfarction with Qi deficiency, phlegm, fire as the main symptoms,combination of syndrome elements of more complex， Moreperformance for the separate Qi, phlegm, fire or some type of syndrome combination；②Recent interleukin infection of acute cerebral infarctionin patients with (IL-lβ) there were significant correlations between thecontent changes and fire syndrome, Qi deficiency, may become one ofthe indexes for judging the fire syndrome, Qi deficiency syndrome;③Recent infection of acute cerebral infarction in patients withtransforming growth factorβ (TGF-β) were correlated with the changesof the content of phlegm syndro，Associated with blood stasis syndromenegative, may become one of the indexes for judging the phlegm andblood stasis.④The soluble cell adhesion infection in acute cerebralinfarction in patients with factor-1(sICAM-1) were significantlycorrelated with the content changes of blood stasis, phlegm, could beone of the index of blood stasis, phlegm syndrome⑤Recent infection ofacute cerebral infarction patients with blood compatibility of cell proteinC (sEPCR), matrix metalloproteinase9(MMP-9) content changes had asignificantcorrelation with blood stasis syndrome, blood stasis may beone of the index determination.
研究方法：①理论探讨:回顾脑梗塞（中风）现代医学研究和中医证候研究概况,中风中医证候分布及演变规律，并探讨中风中医证候与相关的因素的研究进展。②确定急性脑梗塞中西医诊疗标准，研究对象的纳入和排除标准，采取横断面调查的方式,确定研究对象为92例近期感染急性脑梗死患者，采集92例患者的一般情况、阶段信息、中医四诊信息实验室检测结果等资料。由严格培训的专业人员,对研究对象集中进行统一的证候评价，将结果录入数据库。③按中风病辨证诊断标准，将92例近期感染急性脑梗死患者分类，即将收集的病例分为风、火、痰、瘀、气虚、阴虚六型。④采集全部病例的血液标本；每例病例抽取空腹静脉血6ml，用促凝管收集、立即派专人送往实验室，离心3000r∕min分离血清，放入-80℃的冰箱保存，最后进行统一检测，所有过程均严格执行无菌操作，采用酶联免疫吸附双抗体夹心法(ELISA)检测血清IL-1β、TGF-β、sICAM-l、sEPCR、MMP-9的含量，实验过程在湖北中医药大学昙华林校区实验室完成测定，所有操作均按说明书要求进行。将所检测的结果集中收集录入数据库。统计分析将采用SPSS13.0统计分析软件进行计算，不同组的计量资料采用x±s进行统计描述，采用t检验比较组间差异。P<0.05认为差别有统计学意义。计数资料使用频数表（构成比）进行统计描述。炎性反应因子与证候要素的相关性采用相关性检验的方法。
结果：①92例研究对象总体上以气虚证、痰证、火证出现频率最高。经分析,结合各证候要素在近期感染急性脑梗死患者中所占比例(气虚证53.3%、痰证45.7%、火证42.4%),可见,近期感染急性脑梗死患者主要证候表现均为气虚证、痰证、火热证。②研究对象中表现为一证独见和二证并见的比例最高，分别是42.4%、35.9%。一证独见的患者中,以“气虚”、“痰”和“火热”型最多，分别占33.3%、28.2%、25.6%；二证并见的,以“痰+气虚”型最多，是42.4%,其次是“火热+气虚”型和“风+火热”型，分别占18.2%，12.1%。③炎性反应因子IL-1β含量在火证中明显高于非火热证型，经t检验P<0.05，差别有统计学意义，并且IL-1β含量在气虚证组明显高于非气虚证组，经t检验P<0.05，差别有统计学意义；相关性分析结果，火证、气虚证与IL-1β水平相关，P<0.01，有统计学意义；④炎性反应因子TGF-β含量在痰证中高于非痰证，经t检验P<0.05，差别有统计学意义，相关性分析结果，痰证与TGF-β水平正相关，P<0.01，瘀证与TGF-β水平负相关，P<0.01有统计学意义。⑤炎性反应因子sICAM-1含量在瘀证中明显高于非瘀证型，经t检P<0.05，差别有统计学意义，sICAM-1含量在痰证中高于非痰证，经t检验P<0.05，差别有统计学意义；相关性分析结果，瘀证、痰证与sICAM-1水平正相关，P<0.01，有统计学意义；⑥炎性反应因子MMP-9、sEPCR含量在血瘀证明显高于非血瘀证，经t检验P<0.05，差别有统计学意义，相关性分析结果，瘀证与MMP-9、sEPCR水平正相关P<0.01，有统计学意义。
结论：①近期感染急性脑梗死的患者以气虚、痰、火为主要证候表现,证候要素的组合较为简单,多表现为气虚、痰、火的单独出现或几个证型相互组合；②近期感染急性脑梗死的患者血液中细胞白介素-1β（IL-lβ）的含量变化与火证、气虚证之间有明显的相关性，可能成为判定火证、气虚证的指标之一；③近期感染急性脑梗死的患者血液中转化生长因子β（TGF-β）的含量变化与痰证有相关性，与瘀证负相关，可能成为判定痰证和瘀证的指标之一；④近期感染急性脑梗死的患者血液中可溶性细胞粘附因子-1（sICAM-1）的含量变化与瘀血证、痰证有明显的相关性，可能成为判定瘀血证、痰证的指标之一。⑤近期感染急性脑梗死的患者血液中可容性细胞蛋白C（sEPCR）、金属蛋白酶9（MMP-9）的含量变化与瘀血证有明显的相关性，可能成为判定瘀血证指标之一。
Objective:①Through the cross-sectional survey of recent infection inpatients with acute cerebral infarction TCM Syndrome, Discussion onrecent infection in acute cerebral infarction TCM syndrome distribution,for the TCM syndrome changes of recent infection of acute cerebralinfarction, provide the basis for the formulation of preventive measures;②In the recent infection disease of acute cerebral infarction,Inflammatory cytokine regulation, pathological changes in bloodcirculation, with cerebral vascular disease period，We assume that theinflammatory reaction formation of recent infection in patients with acutecerebral infarction TCM syndrome also participate in, Investigation ofrelationship between recent infection in patients with acute cerebralinfarction and inflammatory factor and syndrome of traditional Chinesemedicine, To explore the biological basis of recent infection syndromein patients with acute cerebral infarction patterns formed, whichprovided a theoretical foundation for the research of the objectificationof syndrome.
Methods:①Theoretical study:Review of research on brain infarction ofmodern medicine and TCM Syndrome Study, And the evolution rules of distribution of TCM Syndromes of apoplexy, And discusses theresearch progress of TCM syndrome of stroke and related factors;②Determination of Western medicine diagnosis standard of acutecerebral infarction, The object of study inclusion and exclusion criteria,Cross-sectional survey method, To determine the object of study for92cases of infection in patients with acute cerebral infarction, In general,phase information and information of four diagnostic methods, data of92patients, By the strict training of professionals, the object of study,mainly syndromes evaluation are unified, the results into the database;③Blood samples were collected for all patients, Each case of fastingvenous blood were extracted by6mlprocoagulant andcollection,immediately delivered Laboratory,Centrifugal separatingserum3000r/min,-80℃preservation， unified examination, allprocesses are strict sterile manipulation, Using enzyme-linkedimmunosorbent assay (ELISA) for detection of serum antibodysandwich method IL-1β、TGF-β、slCAM-l、sEPCR、MMP-9, All theoperation requirements according to the instructions, The collected datais collected into the database. Statistical analysis using SPSS13.0statistical analysis software for calculation, Measurement data bydifferent groups for statistical description use x±s, The differencebetween the group use t test. P<0.05,That difference was significant,Count data using frequency tables (ratio) of statistical description, By using the method of correlation analysis of the correlation betweeninflammatory factors and syndrome elements
Results:①92subjects in general Qi, phlegm syndrome, heatsyndrome had the highest frequency, Through the analysis, combinedwith the syndrome factors of infection ratio in patients with acutecerebral infarction in the near future(Qi deficiency, phlegm fire45.7%,53.3%，42.4%),Visible, recent infection in patients with acute cerebralinfarction and the main symptoms were Qi-deficiency, phlegmsyndrome, heat syndrome;②The research object of performance for asingle syndrome and two cards and the highest proportion, respectivelyis42.4%,35.9%，A certificate of the patients, the "Qi","phlegm" and"hot" type is the most, accounting for33.3%,28.2%,25.6%respectively，Two cards and see, most in the "phlegm+Qi",42.4%, Thesecond is "hot+Qi" and "air+hot" type, accounted for18.2%,12.1%.③Inflammatory factors of IL-1β content in fire syndrome wassignificantly higher than that of non-heat syndromes, testing by tP<0.05，The difference was significant. And the IL-1β content in the Qideficiency syndrome group was significantly higher than that in non-qideficiency syndrome group，testing by t P<0.05，The difference wassignificant. Results of correlation analysis：Fire syndrome, Qi deficiencysyndrome associated with the level of IL-1β, P<0.01, there was statistical significance.④Inflammatory factors of TGF-β were higherthan that of non-phlegm syndrome in phlegm syndrome，testing by tP<0.05，The difference was significant. Results of correlation analysis：Phlegm syndrome associated with the levels of TGF-β, P<0.01，Negative correlation between blood stasis syndrome and the level ofTGF-β, P<0.01had statistical significanc⑤Inflammatory factors andsICAM-1content in blood stasis syndrome was significantly higher thanthat of non blood stasis syndrome，By t P<0.05, the difference wassignificant，The content of sICAM-1is higher than that of non-phlegmsyndrome，Testing by t P<0.05, the difference was significant，Resultsof correlation analysis：Syndrome of blood stasis, phlegm syndromeand the level of sICAM-1positive correlation, P<0.01, there wasstatistical significance。⑥Inflammatory factors MMP-9, sEPCR contentin the blood were significantly higher than that of blood stasissyndrome，Testing by t P<0.05, the difference was significant，Resultsof correlation analysis：Positive correlation with MMP-9, sEPCR levelsin blood stasis syndrome P<0.01, there was statistical significance.
Conclusion:①The recent infection in patients with acute cerebralinfarction with Qi deficiency, phlegm, fire as the main symptoms,combination of syndrome elements of more complex， Moreperformance for the separate Qi, phlegm, fire or some type of syndrome combination；②Recent interleukin infection of acute cerebral infarctionin patients with (IL-lβ) there were significant correlations between thecontent changes and fire syndrome, Qi deficiency, may become one ofthe indexes for judging the fire syndrome, Qi deficiency syndrome;③Recent infection of acute cerebral infarction in patients withtransforming growth factorβ (TGF-β) were correlated with the changesof the content of phlegm syndro，Associated with blood stasis syndromenegative, may become one of the indexes for judging the phlegm andblood stasis.④The soluble cell adhesion infection in acute cerebralinfarction in patients with factor-1(sICAM-1) were significantlycorrelated with the content changes of blood stasis, phlegm, could beone of the index of blood stasis, phlegm syndrome⑤Recent infection ofacute cerebral infarction patients with blood compatibility of cell proteinC (sEPCR), matrix metalloproteinase9(MMP-9) content changes had asignificantcorrelation with blood stasis syndrome, blood stasis may beone of the index determination.
引文
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