3种中医证型股骨头坏死患者的脂代谢特征对比研究
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摘要
目的:比较3种中医证型股骨头坏死患者的脂代谢特征。方法:对符合要求的97例股骨头坏死患者进行中医辨证分型,抽取外周静脉血,测定并对比不同中医证型股骨头坏死患者的血清总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDLC)、载脂蛋白(apolipoprotein,Apo)-A1、Apo-B含量。结果:纳入研究的97例患者中,痰瘀蕴结证32例、肾虚血瘀证45例、气滞血瘀证20例。3种证候类型患者的血清HDL-C、Apo-A1、Apo-B含量比较,差异均无统计学意义[HDL-C:(0. 99±0. 42) mmol·L~(-1),(1. 14±0. 34) mmol·L~(-1),(0. 88±0. 41) mmol·L~(-1),F=0. 182,P=0. 834; Apo-A1:(1. 18±0. 27) g·L~(-1),(1. 15±0. 22) g·L~(-1),(1. 08±0. 23) g·L~(-1),F=0. 919,P=0. 402; Apo-B:(0. 84±0. 22) g·L~(-1),(0. 82±0. 21) g·L~(-1),(0. 72±0. 20) g·L~(-1),F=0. 167,P=0. 846]。3种证候类型患者的血清TC、TG、LDL-C含量比较,差异均有统计学意义[TC:(4. 77±0. 97) mmol·L~(-1),(4. 34±0. 81) mmol·L~(-1),(4. 00±1. 25) mmol·L~(-1),F=6. 211,P=0. 003; TG:(2. 13±1. 49) mmol·L~(-1),(1. 54±0. 98) mmol·L~(-1),(1. 83±1. 27) mmol·L~(-1),F=3. 107,P=0. 049; LDL-C:(2. 95±1. 01) mmol·L~(-1),(2. 86±0. 77) mmol·L~(-1),(2. 39±1. 14) mmol·L~(-1),F=3. 589,P=0. 031];痰瘀蕴结证患者的血清TC、LDL-C含量均高于气滞血瘀证患者(P=0. 007; P=0. 039),痰瘀蕴结证患者和气滞血瘀证患者的血清TC、LDL-C含量与肾虚血瘀证患者比较,组间差异均无统计学意义(TC:P=0. 061,P=0. 192; LDL-C:P=0. 662,P=0. 068);痰瘀蕴结证患者的血清TG含量高于肾虚血瘀证患者(P=0. 040),痰瘀蕴结证患者和肾虚血瘀证患者的血清TG含量与气滞血瘀证患者比较,组间差异均无统计学意义(P=0. 407,P=0. 367)。结论:股骨头坏死3种中医证型中,痰瘀蕴结证患者的脂代谢与其他2种证候类型患者的脂代谢存在较大差异。
Objective: To compare the lipid metabolism characteristics of patients with three types of TCM syndrome of femur head necrosis( FHN). Methods: Ninety-seven patients with FHN enrolled in the study were classified according to TCM syndrome differentiation,and their blood was drawn from peripheral vein. The serum contents of total cholesterol( TC),triglyceride( TG),high density lipoprotein cholesterol( HDL-C),low density lipoprotein cholesterol( LDL-C),apolipoprotein( Apo)-A1 and Apo-B were measured and compared between patients with different types of TCM syndrome of FHN. Results: Phlegm-stagnation syndrome( 32 cases),kidney-deficiency-blood-stasis syndrome( 45 cases) and qi-stagnation-blood-stasis syndrome( 20 cases) were found in the 97 patients. There was no statistical difference in the serum contents of HDL-C,Apo-A1 and Apo-B between the patients with three types of TCM syndrome( HDL-C: 0. 99 +/-0. 42,1. 14 +/-0. 34,0. 88 +/-0. 41 mmol/L,F = 0. 182,P = 0. 834; Apo-A1: 1. 18 +/-0. 27,1. 15 +/-0. 22,1. 08 +/-0. 23 g/L,F = 0. 919,P = 0. 402; Apo-B: 0. 84 +/-0. 22,0. 82 +/-0. 21,0. 72 +/-0. 20 g/L,F = 0. 167,P = 0. 846). There was statistical difference in the serum contents of TC,TG and LDL-C between the patients with three types of TCM syndrome( TC: 4. 77 +/-0. 97,4. 34 +/-0. 81,4. 00 +/-1. 25 mmol/L,F = 6. 211,P = 0. 003; TG: 2. 13 +/-1. 49,1. 54 +/-0. 98,1. 83 +/-1. 27 mmol/L,F = 3. 107,P = 0. 049; LDL-C: 2. 95 +/-1. 01,2. 86 +/-0. 77,2. 39 +/-1. 14 mmol/L,F = 3. 589,P = 0. 031). The serum contents of TC and LDL-C were higher in patients with phlegm-stagnation syndrome compared to patients with qi-stagnation-blood-stasis syndrome( P =0. 007; P = 0. 039),and there was no statistical difference in the serum contents of TC and LDL-C between patients with phlegm-stagnation syndrome and patients with kidney-deficiency-blood-stasis syndrome and between patients with qi-stagnation-blood-stasis syndrome and patients with kidney-deficiency-blood-stasis syndrome( TC: P = 0. 061,P = 0. 192; LDL-C: P = 0. 662,P = 0. 068). The serum contents of TG were higher in patients with phlegm-stagnation syndrome compared to patients with kidney-deficiency-blood-stasis syndrome( P = 0. 040),and there was no statistical difference in the serum contents of TG between patients with phlegm-stagnation syndrome and patients with qi-stagnation-blood-stasis syndrome and between patients with kidney-deficiency-blood-stasis syndrome and patients with qi-stagnation-blood-stasis syndrome( P = 0. 407,P = 0. 367). Conclusion: Lipid metabolism of patients with phlegm-stagnation-type FHN is significantly different from that of patients with kidney-deficiency-blood-stasis-type FHN and patients with qi-stagnation-blood-stasis-type FHN.
Objective: To compare the lipid metabolism characteristics of patients with three types of TCM syndrome of femur head necrosis( FHN). Methods: Ninety-seven patients with FHN enrolled in the study were classified according to TCM syndrome differentiation,and their blood was drawn from peripheral vein. The serum contents of total cholesterol( TC),triglyceride( TG),high density lipoprotein cholesterol( HDL-C),low density lipoprotein cholesterol( LDL-C),apolipoprotein( Apo)-A1 and Apo-B were measured and compared between patients with different types of TCM syndrome of FHN. Results: Phlegm-stagnation syndrome( 32 cases),kidney-deficiency-blood-stasis syndrome( 45 cases) and qi-stagnation-blood-stasis syndrome( 20 cases) were found in the 97 patients. There was no statistical difference in the serum contents of HDL-C,Apo-A1 and Apo-B between the patients with three types of TCM syndrome( HDL-C: 0. 99 +/-0. 42,1. 14 +/-0. 34,0. 88 +/-0. 41 mmol/L,F = 0. 182,P = 0. 834; Apo-A1: 1. 18 +/-0. 27,1. 15 +/-0. 22,1. 08 +/-0. 23 g/L,F = 0. 919,P = 0. 402; Apo-B: 0. 84 +/-0. 22,0. 82 +/-0. 21,0. 72 +/-0. 20 g/L,F = 0. 167,P = 0. 846). There was statistical difference in the serum contents of TC,TG and LDL-C between the patients with three types of TCM syndrome( TC: 4. 77 +/-0. 97,4. 34 +/-0. 81,4. 00 +/-1. 25 mmol/L,F = 6. 211,P = 0. 003; TG: 2. 13 +/-1. 49,1. 54 +/-0. 98,1. 83 +/-1. 27 mmol/L,F = 3. 107,P = 0. 049; LDL-C: 2. 95 +/-1. 01,2. 86 +/-0. 77,2. 39 +/-1. 14 mmol/L,F = 3. 589,P = 0. 031). The serum contents of TC and LDL-C were higher in patients with phlegm-stagnation syndrome compared to patients with qi-stagnation-blood-stasis syndrome( P =0. 007; P = 0. 039),and there was no statistical difference in the serum contents of TC and LDL-C between patients with phlegm-stagnation syndrome and patients with kidney-deficiency-blood-stasis syndrome and between patients with qi-stagnation-blood-stasis syndrome and patients with kidney-deficiency-blood-stasis syndrome( TC: P = 0. 061,P = 0. 192; LDL-C: P = 0. 662,P = 0. 068). The serum contents of TG were higher in patients with phlegm-stagnation syndrome compared to patients with kidney-deficiency-blood-stasis syndrome( P = 0. 040),and there was no statistical difference in the serum contents of TG between patients with phlegm-stagnation syndrome and patients with qi-stagnation-blood-stasis syndrome and between patients with kidney-deficiency-blood-stasis syndrome and patients with qi-stagnation-blood-stasis syndrome( P = 0. 407,P = 0. 367). Conclusion: Lipid metabolism of patients with phlegm-stagnation-type FHN is significantly different from that of patients with kidney-deficiency-blood-stasis-type FHN and patients with qi-stagnation-blood-stasis-type FHN.
引文
[1]惠银银,刘又斌,王晶,等.非创伤性股骨头坏死病因的研究进展[J].中医正骨,2018,30(2):33-36.
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[4]国家中医药管理局医政司. 22个专业95个病种中医诊疗方案[M].北京:中国中医药出版社,2010:93.
[5]范薇.高脂血症痰瘀证型机理研究[D].成都:成都中医药大学,2003.
[6]宋剑南.从生物化学角度看痰及痰瘀相关[J].中国中医基础医学杂志,2000,6(3):40-43.
[7]鲁会田,岳保红,李捷.瘦素、脂联素与血脂异常对非创伤性股骨头坏死的影响[J].河南科技大学学报(医学版),2016,34(1):25-27.
[8]毕海迪.血脂水平与股骨头坏死的相关性分析[D].南昌:南昌大学,2018.
[9]陈镇秋,何伟,魏秋实.股骨头坏死中医证型与血液学指标的关系研究[J].中医正骨,2013,25(3):35-40.
[10]陈跃平,高辉,陈亮,等.乙醇对股骨头髓内脂肪细胞的作用[J].中国组织工程研究,2013,17(35):6221-6227.
[11]尹良军,王爱民,蒋祖言,等.家兔激素性股骨头坏死的血液流变学改变及意义[J].中国微循环,2001,5(3):218-220.
[12]梁笃,陈群群,王海彬,等.痰瘀蕴结型股骨头坏死脂代谢异常实验与临床研究[J].辽宁中医药大学学报,2013,15(5):69-72.
[13]陈群群,王海彬,周驰,等.痰瘀蕴结型股骨头坏死与PPARγ信号转导途径的相关性分析[J].辽宁中医杂志,2013,40(10):1960-1962.
[14]朱燕,陈凯云.不同降血脂药物预防激素诱导股骨头坏死的实验研究[J].现代诊断与治疗,2016,27(20):3876-3878.
[15]赵红星,黄媛霞,徐海斌,等.他汀类药物治疗激素性股骨头坏死的效果及机制研究[J].西北药学杂志,2017,32(3):359-363.
[16]吴崇颖,林晓琪,丁欲晓,等.辛伐他汀治疗早期激素所致缺血性股骨头坏死的临床效果[J].深圳中西医结合杂志,2018,28(16):18-19.
[17]丁志清,郭小平,潘珊珊,等.补肾活血法和痰瘀同治法治疗股骨头坏死的研究进展[J].中国民族民间医药,2015,24(4):39-40.
[18]范武.中药骨蚀灵胶囊对早期激素性股骨头坏死脂质代谢影响的研究[D].南昌:南昌大学,2018.
[19]刘华,魏爱淳,秦广珍,等.双合汤对酒精性股骨头坏死兔血脂及凝血指标的影响[J].世界中西医结合杂志,2016,11(5):640-643.
[20]陈凯云,吕岫华,刘贞,等.激素诱导下股骨头坏死兔模型血浆中三酰甘油代谢及中药干预作用的研究[J].实用医学杂志,2017,33(2):206-209.
[2]王雁,孙波,龚晓菊.股骨头坏死脂代谢紊乱状况分析[J].检验医学与临床,2014,11(16):2285-2286.
[3]中华医学会骨科分会显微修复学组.成人股骨头坏死诊疗标准专家共识(2012年版)[J].中国医学前沿杂志:电子版,2012,32(11):51-56.
[4]国家中医药管理局医政司. 22个专业95个病种中医诊疗方案[M].北京:中国中医药出版社,2010:93.
[5]范薇.高脂血症痰瘀证型机理研究[D].成都:成都中医药大学,2003.
[6]宋剑南.从生物化学角度看痰及痰瘀相关[J].中国中医基础医学杂志,2000,6(3):40-43.
[7]鲁会田,岳保红,李捷.瘦素、脂联素与血脂异常对非创伤性股骨头坏死的影响[J].河南科技大学学报(医学版),2016,34(1):25-27.
[8]毕海迪.血脂水平与股骨头坏死的相关性分析[D].南昌:南昌大学,2018.
[9]陈镇秋,何伟,魏秋实.股骨头坏死中医证型与血液学指标的关系研究[J].中医正骨,2013,25(3):35-40.
[10]陈跃平,高辉,陈亮,等.乙醇对股骨头髓内脂肪细胞的作用[J].中国组织工程研究,2013,17(35):6221-6227.
[11]尹良军,王爱民,蒋祖言,等.家兔激素性股骨头坏死的血液流变学改变及意义[J].中国微循环,2001,5(3):218-220.
[12]梁笃,陈群群,王海彬,等.痰瘀蕴结型股骨头坏死脂代谢异常实验与临床研究[J].辽宁中医药大学学报,2013,15(5):69-72.
[13]陈群群,王海彬,周驰,等.痰瘀蕴结型股骨头坏死与PPARγ信号转导途径的相关性分析[J].辽宁中医杂志,2013,40(10):1960-1962.
[14]朱燕,陈凯云.不同降血脂药物预防激素诱导股骨头坏死的实验研究[J].现代诊断与治疗,2016,27(20):3876-3878.
[15]赵红星,黄媛霞,徐海斌,等.他汀类药物治疗激素性股骨头坏死的效果及机制研究[J].西北药学杂志,2017,32(3):359-363.
[16]吴崇颖,林晓琪,丁欲晓,等.辛伐他汀治疗早期激素所致缺血性股骨头坏死的临床效果[J].深圳中西医结合杂志,2018,28(16):18-19.
[17]丁志清,郭小平,潘珊珊,等.补肾活血法和痰瘀同治法治疗股骨头坏死的研究进展[J].中国民族民间医药,2015,24(4):39-40.
[18]范武.中药骨蚀灵胶囊对早期激素性股骨头坏死脂质代谢影响的研究[D].南昌:南昌大学,2018.
[19]刘华,魏爱淳,秦广珍,等.双合汤对酒精性股骨头坏死兔血脂及凝血指标的影响[J].世界中西医结合杂志,2016,11(5):640-643.
[20]陈凯云,吕岫华,刘贞,等.激素诱导下股骨头坏死兔模型血浆中三酰甘油代谢及中药干预作用的研究[J].实用医学杂志,2017,33(2):206-209.