小动脉硬化性脑小血管病性血管认知功能障碍与血脂异常及中医证型的相关性研究

Study on the Relationship between Vascular Cognitive Impairment and Dyslipidemia and Syndrome Type of Traditional Chinese Medicine in Patients with Arteriosclerosis Cerebral Microvascular Disease

目的系统探究小动脉硬化性脑小血管病性血管认知功能障碍与血脂异常及中医证型的相关性。方法选取2017年6月至2019年6月收治于我院的小动脉硬化性脑小血管病性血管认知功能障碍患者80例,其中非痴呆性血管认知障碍40例,血管性痴呆患者40例(其中非痴呆性血管认知障碍组以及血管性痴呆组统称为治疗组),并同时选取同阶段健康观察组40例作为对照。通过测量三组间总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)以及甘油三酯(TG)等指标的差异评估小动脉硬化性脑小血管病性血管认知功能障碍与血脂异常之间的关系。另一方面,本研究参照《血管性痴呆的中医辨证量表》对患者进行中医证型分型,以期探究不同认知障碍组之间各个症候的分布规律。最后,运用二分类logistic回归分析小动脉硬化性脑小血管病性血管认知功能障碍的影响因素以充分为预防及治疗小动脉硬化性脑小血管病性血管认知功能障碍提供理论依据。结果与健康对照组相比,治疗组的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)以及甘油三酯(TG)等指标均有升高,差异具有统计学意义(P<0.05),而高密度脂蛋白胆固醇(HDL-C)显著下降(P<0.05)。从不认知障碍组之间各个中医证型的分布规律分析,血瘀血阻络证是非痴呆性血管认知障碍组的主要中医证型,其百分占比高达40%,显著高于血管性痴呆组(25%)(P<0.05)。而对于血管性痴呆组而言,肾精亏虚是其主要中医证型,百分占比高达60%,显著高于非痴呆性血管认知障碍组(30%)(P<0.05)。此外,以患者是否发生认知功能障碍为因变量,以有意义的单因素为自变量进行logistic回归分析,结果发现总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)以及甘油三酯(TG)是小动脉硬化性脑小血管病性血管认知功能障碍的独立影响因素,并且差异具有统计学意义(P<0.05)。结论小动脉硬化性脑小血管病性血管认知功能障碍与血脂异常相关,血脂异常是小动脉硬化性脑小血管病性血管认知功能障碍的独立影响因素,对其威胁因素进行预防,有利于延缓或减少小动脉硬化性脑小血管病性血管认知功能障碍的发生。此外,不同中医证型在血管性认知障碍的演变中存在一定的规律,对患者中医证型进行准确判定,有利于对小动脉硬化性脑小血管病性血管认知功能障碍进行更为针对性地治疗。

Objective To investigate the relationship between vascular cognitive impairment and dyslipidemia and syndrome type of traditional Chinese medicine(TCM)in patients with arteriosclerosis.Methods From June 2017 to June 2019,80 patients with small arteriosclerotic cerebral vascular cognitive dysfunction in our hospital were selected,including 40 non-dementia vascular cognitive disorders,40 patients with vascular dementia(in which the non-dementia vascular cognitive impairment group and the vascular dementia group were collectively referred to as the treatment group)were selected,and 40 cases of the same stage health observation group were selected as the control.The relationship between the three groups of total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)and triglyceride(TG)was measured to evaluate the arteriosclerotic Relationship between vascular cognitive impairment and dyslipidemia in patients with cerebral microvascular disease.On the other hand,according to the TCM Syndrome differentiation scale of Vascular dementia,the patients were classified into TCM syndrome types in order to explore the distribution of symptoms among different cognitive impairment groups.Finally,two-classification logistic regression analysis was used to analyze the influencing factors of vascular cognitive dysfunction in arteriosclerosis cerebral microvascular disease in order to provide theoretical basis for the prevention and treatment of vascular cognitive dysfunction in arteriosclerosis cerebral microvascular disease.Results Compared with the healthy control group,the total cholesterol(TC),low density lipoprotein cholesterol(LDL-C)and triglyceride(TG)in the treatment group were significantly higher than those in the healthy control group(P<0.05),while the high density lipoprotein cholesterol(HDL-C)was significantly decreased(P<0.05).The distribution of each TCM syndrome type among the non-cognitive impairment group was analyzed.Blood stasis and blood stasis syndrome was the main TCM syndrome type in the non-dementia vascular cognitive impairment group,the percentage of which was as high as 40%,which was significantly higher than that in the vascular dementia group(25%)(P<0.05).And for vascular dementia,The percentage of kidney essence deficiency was 60%,which was significantly higher than that of non-dementia vascular cognitive impairment group(30%)(P<0.05).In addition,logistic regression analysis was carried out with cognitive impairment as dependent variable and meaningful single factor as independent variable.The results showed that total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and glycerol(TG)were independent influencing factors of vascular cognitive impairment in arteriosing cerebral microvascular disease.And the difference was statistically significant(P<0.05).Conclusion Vascular cognitive impairment of arteriosclerosis cerebral microvascular disease is related to dyslipidemia.Dyslipidemia is an independent influencing factor of vascular cognitive dysfunction of arteriosclerosis cerebral microvascular disease.Prevention of its threatening factors is helpful to delay or reduce the occurrence of vascular cognitive dysfunction of arteriosclerosis cerebral microvascular disease.In addition,there are some laws in the evolution of vascular cognitive impairment in different TCM syndromes.Accurate determination of TCM syndromes is beneficial to the treatment of vascular cognitive dysfunction of arteriosclerosis cerebral microvascular disease.