中风病痰证与血脂代谢、自由基损伤及神经功能缺损的关系研究
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摘要
背景：目前中风病痰证的诊断仍缺乏客观性的标准。
目的：通过观测中风病患者的临床神经功能缺损积分值、血清三酰甘油(TG)、胆固醇(TC)、低密度脂蛋白(LDL-C)水平及丙二醛(MDA)含量、超氧化物歧化酶同工酶(包括T-SOD、Mn-SOD、CuZn-SOD)活性，探讨中风病痰证与临床神经功能缺损、血脂代谢及自由基损伤三方面多指标的关系。
资料与方法：临床收集既符合急性脑血管病的诊断要点，又能根据《中风病诊断与疗效评定标准》辨证的中风病人63例，其中男41例，女22例，平均年龄63.40±11.31岁(45-84岁)。分为痰证组(32例)，非痰证组(31例)，按照“脑卒中临床神经功能缺损程度评分标准”评分。于发病72小时内检测其血清TC(CHOD酶法)、TG(GPO-PAP酶法)、LDL-C(PVC沉淀法)水平及MDA(硫代巴比妥酸法)含量、SOD同工酶活性(黄嘌呤氧化酶法，包括T-SOD、Mn-SOD、CuZn-SOD)。并选择门诊健康体检者30例作为正常对照组，其中男16例，女14例，平均年龄62.37+9.82。
结果：1、中风病痰证患者的临床神经功能缺损积分高于非痰证患者，差异非常显著(P＜0.01)。
2．中风病患者血清TG、TC、LDL-C水平，MDA含量均较正常对照组显著升高(P＜0.01)，SOD同工酶活性则明显下降(P＜0.01)。
3、中风病患者临床神经功能缺损积分与血清MDA含量呈正相关、与SOD同工酶活性呈负相关，相关性均显著(P＜0.05，P＜0.01)；与血清TG、TC、LDL-C水平无显著相关(P＞0.05)。
4、中风病痰证组及非痰证组血清TG，TC，LDL-C水平比正常对照组升高，差异显著(P＜0.05，P＜0.01)，痰证组亦较非痰证组明显升高，差异显著(P＜0.05，P＜0.01)。
5、中风病痰证组血清MDA含量比非痰证组及正常对照组显著升高(P＜0.01)，
SOD同工酶活性明显下降，以T一SOD、CuznSOD活性最为显著(P<0 .01)，痰证组与非
痰证组间Mn一SOD活性差异不显著(P>0 .05);非痰证组血清MDA含量亦较正常对照
组明显升高，SOD同工酶活性显著降低(P(0.01，P(0.05)。
6.以痰证、非痰证为因变量，以临床神经功能缺损积分值和血清TG、TC、LDL一C
水平，MDA含量、T-SOD、Cuzn一SOD为自变量，进行判别分析，得出的判别方程回
代正确率为81.0%，基本符合临床实际。
结论:1、中风病患者存在严重的血脂代谢紊乱及自由基损伤。
2、血清MDA含量、SOD同工酶活性可以反映中风病病情的严重程度，TG、TC、
LDL一C水平则与病情无明显相关。
3、临床神经功能缺损积分值、血清TG，TC，LDL一C水平、MDA含量及T-SOD、
CuZn一SOD活性从不同角度反映了中风病痰证的实质。
4、中风病痰证可根据临床神经功能缺损积分值，血脂代谢(TG，TC，LDL一C水
平)、
断。
自由基损伤(MDA含量，T-SOD、Cuzn一SOD活性)三个方面多指标进行客观诊
血清Mn一SOD活性不能作为中风病痰证的客观指标。
Background: There has never been an objective standard of diagnosing the phlegm TCM-syndrome (PTS) of stroke disease ( SD) .
Objectives: To detect the serum level of triglyceride(TG), total cholesterol(TC), low-density-lipoprotein-cholesterol(LDL-C), content of malondialdehyde (MDA) and activity of superoxide dismutase isozymes (including T-SOD, CuZn-SOD, Mn-SOD) and calculate the score of nervous impairment (SNI) of SD patients; so as to investigate into the relationship between PTS of SD and the three aspects indexes: the scores of nervous impairment, blood lipids and free radical injury.
Materials and methods: 63 patients with SD were collected and divided into two groups: PTS group and non-phlegm TCM-syndrome (NPTS) group. All were accord with the diagnosing points of acute cerebral vascular disease and must be able to be diagnosed as one of the six TCM-syndromes based on the differentiation standards of TCM, among which 41 were male and 21 were female. The average age was 63.40+11.31years(aged 43-84 years). 30 healthy people were taken as normal control group, among which 16 were male and 14 were female, the average age was 62.37 ?9.82 years (aged 49~73years).
To calculate SNI of patients with SD.
To detect serum level of TG (CHOD enzyme method), TC (GPO-PAP enzyme method), LDL-C (PVC precipitation method).
To detect serum content of MDA (thiobarbiturtic acid method) and activity of SOD isozymes (including T-SOD, CuZn-SOD, Mn-SOD) (xanthine oxidase method).
Results: 1. There was significantly different in SNI between PTS group and NPTS group (P<0.01).
2.Serum level of TG, TC, LDL-C and serum content of MDA in patients with SD were obviously higher than that of normal control group(P<0.01),while activity of SOD isoenzymes descended strikingly(P<0.01).
3. Correlation between SNI and serum level of TG, TC, LDL-C was not significant in patients with SD, while there was positive correlation between the scores and serum content
of MDA, and negative correlation between the scores and serum activity of SOD isoenzymes (P<0.05.P<0.01).
4. Serum level of TG, TC, LDL-C in PTS group and NPTS group was significant higher than that of normal control group (P<0.05, P<0.01) . And TG, TC, LDL-C in PTS group was notably higher than that of the NPTS group ( P<0.05, P<0.01).
5. Compared with normal control group and NPTS group, serum content of MDA in PTS group increased notably (P<0.01) but activity of SOD isozymes decreased markedly especially T-SOD and CuZn-SOD (P<0.01) . And there was no significant different in serum activity of Mn-SOD between PTS group and NPTS group (P>0.05).Serum content of MDA in NPTS group increased strikingly (P<0.01) but activity of SOD isoenzymes decreased markedly (P<0.01) when compared with normal control group.
6. We choose PTS, NPTS as dependent variables,and SNI, level of TG, TC, LDL-C,content of MDA, activity of T-SOD, CuZn-SOD as independent variables to take discriminant analysis. Correct rate of equations we got was 81.0%, which accorded with clinical situation.
Conclusion: 1. There was serious lipids disturbance and free-radical injury in PTS patients with SD.
2. Content of MDA, activity of SOD isozymes in serum can reflect the severity of stroke disease while serum level of TG, TC, LDL-C cannot.
3. The score of nervous impairment and serum level of TG, TC, LDL-C and content of MDA, activity of T-SOD, CuZn-SOD can reflect the substance of PTS of SD by different P<0ints of view.
4. The PTS of SD can be diagnosed standardly based on SNI, lipids metabolism (serum level of TG, TC, LDL-C) and free radical injury (serum content of MDA and activity of T-SOD, CuZn-SOD) as well. Activity of Mn-SOD cannot be an objective index for PTS of SD.
目的：通过观测中风病患者的临床神经功能缺损积分值、血清三酰甘油(TG)、胆固醇(TC)、低密度脂蛋白(LDL-C)水平及丙二醛(MDA)含量、超氧化物歧化酶同工酶(包括T-SOD、Mn-SOD、CuZn-SOD)活性，探讨中风病痰证与临床神经功能缺损、血脂代谢及自由基损伤三方面多指标的关系。
资料与方法：临床收集既符合急性脑血管病的诊断要点，又能根据《中风病诊断与疗效评定标准》辨证的中风病人63例，其中男41例，女22例，平均年龄63.40±11.31岁(45-84岁)。分为痰证组(32例)，非痰证组(31例)，按照“脑卒中临床神经功能缺损程度评分标准”评分。于发病72小时内检测其血清TC(CHOD酶法)、TG(GPO-PAP酶法)、LDL-C(PVC沉淀法)水平及MDA(硫代巴比妥酸法)含量、SOD同工酶活性(黄嘌呤氧化酶法，包括T-SOD、Mn-SOD、CuZn-SOD)。并选择门诊健康体检者30例作为正常对照组，其中男16例，女14例，平均年龄62.37+9.82。
结果：1、中风病痰证患者的临床神经功能缺损积分高于非痰证患者，差异非常显著(P＜0.01)。
2．中风病患者血清TG、TC、LDL-C水平，MDA含量均较正常对照组显著升高(P＜0.01)，SOD同工酶活性则明显下降(P＜0.01)。
3、中风病患者临床神经功能缺损积分与血清MDA含量呈正相关、与SOD同工酶活性呈负相关，相关性均显著(P＜0.05，P＜0.01)；与血清TG、TC、LDL-C水平无显著相关(P＞0.05)。
4、中风病痰证组及非痰证组血清TG，TC，LDL-C水平比正常对照组升高，差异显著(P＜0.05，P＜0.01)，痰证组亦较非痰证组明显升高，差异显著(P＜0.05，P＜0.01)。
5、中风病痰证组血清MDA含量比非痰证组及正常对照组显著升高(P＜0.01)，
SOD同工酶活性明显下降，以T一SOD、CuznSOD活性最为显著(P<0 .01)，痰证组与非
痰证组间Mn一SOD活性差异不显著(P>0 .05);非痰证组血清MDA含量亦较正常对照
组明显升高，SOD同工酶活性显著降低(P(0.01，P(0.05)。
6.以痰证、非痰证为因变量，以临床神经功能缺损积分值和血清TG、TC、LDL一C
水平，MDA含量、T-SOD、Cuzn一SOD为自变量，进行判别分析，得出的判别方程回
代正确率为81.0%，基本符合临床实际。
结论:1、中风病患者存在严重的血脂代谢紊乱及自由基损伤。
2、血清MDA含量、SOD同工酶活性可以反映中风病病情的严重程度，TG、TC、
LDL一C水平则与病情无明显相关。
3、临床神经功能缺损积分值、血清TG，TC，LDL一C水平、MDA含量及T-SOD、
CuZn一SOD活性从不同角度反映了中风病痰证的实质。
4、中风病痰证可根据临床神经功能缺损积分值，血脂代谢(TG，TC，LDL一C水
平)、
断。
自由基损伤(MDA含量，T-SOD、Cuzn一SOD活性)三个方面多指标进行客观诊
血清Mn一SOD活性不能作为中风病痰证的客观指标。
Background: There has never been an objective standard of diagnosing the phlegm TCM-syndrome (PTS) of stroke disease ( SD) .
Objectives: To detect the serum level of triglyceride(TG), total cholesterol(TC), low-density-lipoprotein-cholesterol(LDL-C), content of malondialdehyde (MDA) and activity of superoxide dismutase isozymes (including T-SOD, CuZn-SOD, Mn-SOD) and calculate the score of nervous impairment (SNI) of SD patients; so as to investigate into the relationship between PTS of SD and the three aspects indexes: the scores of nervous impairment, blood lipids and free radical injury.
Materials and methods: 63 patients with SD were collected and divided into two groups: PTS group and non-phlegm TCM-syndrome (NPTS) group. All were accord with the diagnosing points of acute cerebral vascular disease and must be able to be diagnosed as one of the six TCM-syndromes based on the differentiation standards of TCM, among which 41 were male and 21 were female. The average age was 63.40+11.31years(aged 43-84 years). 30 healthy people were taken as normal control group, among which 16 were male and 14 were female, the average age was 62.37 ?9.82 years (aged 49~73years).
To calculate SNI of patients with SD.
To detect serum level of TG (CHOD enzyme method), TC (GPO-PAP enzyme method), LDL-C (PVC precipitation method).
To detect serum content of MDA (thiobarbiturtic acid method) and activity of SOD isozymes (including T-SOD, CuZn-SOD, Mn-SOD) (xanthine oxidase method).
Results: 1. There was significantly different in SNI between PTS group and NPTS group (P<0.01).
2.Serum level of TG, TC, LDL-C and serum content of MDA in patients with SD were obviously higher than that of normal control group(P<0.01),while activity of SOD isoenzymes descended strikingly(P<0.01).
3. Correlation between SNI and serum level of TG, TC, LDL-C was not significant in patients with SD, while there was positive correlation between the scores and serum content
of MDA, and negative correlation between the scores and serum activity of SOD isoenzymes (P<0.05.P<0.01).
4. Serum level of TG, TC, LDL-C in PTS group and NPTS group was significant higher than that of normal control group (P<0.05, P<0.01) . And TG, TC, LDL-C in PTS group was notably higher than that of the NPTS group ( P<0.05, P<0.01).
5. Compared with normal control group and NPTS group, serum content of MDA in PTS group increased notably (P<0.01) but activity of SOD isozymes decreased markedly especially T-SOD and CuZn-SOD (P<0.01) . And there was no significant different in serum activity of Mn-SOD between PTS group and NPTS group (P>0.05).Serum content of MDA in NPTS group increased strikingly (P<0.01) but activity of SOD isoenzymes decreased markedly (P<0.01) when compared with normal control group.
6. We choose PTS, NPTS as dependent variables,and SNI, level of TG, TC, LDL-C,content of MDA, activity of T-SOD, CuZn-SOD as independent variables to take discriminant analysis. Correct rate of equations we got was 81.0%, which accorded with clinical situation.
Conclusion: 1. There was serious lipids disturbance and free-radical injury in PTS patients with SD.
2. Content of MDA, activity of SOD isozymes in serum can reflect the severity of stroke disease while serum level of TG, TC, LDL-C cannot.
3. The score of nervous impairment and serum level of TG, TC, LDL-C and content of MDA, activity of T-SOD, CuZn-SOD can reflect the substance of PTS of SD by different P<0ints of view.
4. The PTS of SD can be diagnosed standardly based on SNI, lipids metabolism (serum level of TG, TC, LDL-C) and free radical injury (serum content of MDA and activity of T-SOD, CuZn-SOD) as well. Activity of Mn-SOD cannot be an objective index for PTS of SD.
引文
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[2]“中风病证侯学与临床诊断的研究”科研协作组．《中风病证侯诊断标准》的临床验证研究[J]．北京中医学院学报，1994，17(6)：11-13
[3]梁伟雄，黄培新，刘茂才，等．中风病中医证候分布规律的研究[J]．广州中医药大学学报，1997，14(2)：71-75
[4]陈可冀主编．中国传统医学发展的理性思考[M]．第一版．北京：人民卫生出版社．1997，15-24
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