股骨头坏死中医证型与相关理化指标关系的研究

Study on correlation between syndrome types of femoral head necrosis by TCM theory(中医证型) and related physicochemical indexes

目的:研究血浆脂蛋白及凝血异常在股骨头坏死中的变化规律,探讨其与股骨头坏死中医辨证各型的相关性。方法:将94例股骨头坏死患者进行中医辨证分型,气滞血瘀型21例(A组)、痰瘀阻络型25例(B组)、经脉痹阻型24例(C组)及肝肾亏虚型24例(D组),同时检测总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白AI(apoAI)、载脂蛋白B(apoB)以及血小板计数(PLT)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)等指标,统计、分析中医证型与血浆脂蛋白及凝血指标的关系。结果:组间比较发现,各中医证型组中血脂及凝血异常变化表现了一定的规律,在A组中,APTT最高,PT和FIB最低;在B组中,FIB最高,HDL-C、LDL-C及apoAI、apoB表现为最低;在C组中,TC、TG、LDL-C及apoB、PLT则表现最高;而D组以HDL-C、apoAI及PT表现最高,PLT及APTT最低。统计结果显示组间差异有显著性意义,P<0·05或0·01。结论:血管内凝血与脂质代谢紊乱是股骨头坏死的病理基础,“痰瘀同治”应当成为治疗股骨头坏死的最基本的治则。

Objective：To study changing regulation of the content of lipoprotein in plasrn and disturbance of blood coagulation during the whole processes of femoral head necrosis, so as to explore its correlation with syndrome types of femoral head necrosis by TCM theory（ 中医证型）. Methods：Of 94 patients with femoral head nerosis,21 were stagnancy of qi and blood stasis type（气滞血瘀型 ）（Group A）, 25 stagnation of phlegm and blood stasis in collateral branch of the large channel type（痰瘀阻络型）（Group B）, 24 numbness blockage of channels type（经脉痹阻型） （Group C）, and 24 deficiency of liver-yin and kidney-yin type（ 肝肾亏虚型 ） （Group D）. The physicochemical indexes, such as total cholesterol （T C）, triglyceride（TG）, high density lipoprotein cholesterol （ HDL- C ）, low density lipoprotein- cholesterol （ LDL- C ）, apoIipoprotein AI （ apoAI ） and apo-lipoprotein B （apoB） were detected with the automatism biochemical analysor of Olypas AU 400. Platelet （PLT） ,prothrombin time （PT）,activated partial thromboplastic time （APTT） and fibrinogen （FIB） were determined with the automatism biochemical analysor of stago. SPSS 10.0 statistics software was used. Re- sults：The ~ value was higher and PT,FIB values lower in Group A than those in other groups. The FIB value was highest and HDL-D, LDL-C,apoAI ,apoB values lowest in Group 13. In Group C, the values of TC, TG, LDL-C,apoB and PLT were highest. In Group D, the HDL-C, apoAI and PT values were highest, but PLT and APTT values were lowest（ P 〈 0.05 or 0.01 ）. Conclusion： Intra~ coaguation and metabolic disturbance of lipid are vregareded as pathologic factors of femoral head necrosis ,so treating phlegm and blood stasis at the same fime（痰瘀同治）should be basic treatment rule of his disease.