代谢综合征中医证型与Lp(a)等代谢指标相关性探讨

Research on Relativity between Metabolic Syndrome's TCM Syndrome Differentiation and Lipoprotein( a) and Other Metabolic Components

目的:探讨代谢综合征(MS)中医证型与脂蛋白(a)[Lipoprotein(a),Lp(a)]等代谢指标的关系,为MS中医辨证分型寻求客观依据。方法:选取在黑龙江中医药大学附属第一医院心内一科住院的符合MS诊断标准的患者147例;对照组为门诊健康体检者109例。搜集详细病史及各项临床检查指标,根据血清Lp(a)浓度将入选患者分为两组:高Lp(a)组[Lp(a)≥300 mg/L]和Lp(a)正常组[Lp(a)<300 mg/L]。比较不同中医证型Lp(a)等代谢指标水平的差异。结果:1MS的中医证型分布以痰瘀互结型为主,其次为气滞湿阻型,其次为气阴两虚型,最后为脾肾气虚型。2MS痰瘀互结型较非痰瘀互结型的腹围、BMI、LDL-C和空腹血糖明显升高,差异有统计学意义(P<0.05)。虽然两组在SBP、DBP、TC、TG上无统计学差异,但是从趋势上看,痰瘀互结型比非痰瘀互结型升高。3Lp(a)正常组以痰瘀互结型最多(65例),其次为气滞湿阻型(25例),其次为脾肾气虚型(15例),最后为气阴两虚型(13例)。高Lp(a)组以痰瘀互结型最多(17例),其次为脾肾气虚型(5例),其次为气阴两虚型(4例),最后为气滞湿阻型(3例)。结论:1痰瘀互结型为MS的常见证型,MS痰瘀互结型较非痰瘀互结型腹围、BMI、LDL-C和空腹血糖明显升高,提示痰、瘀是MS患者肥胖、血脂异常等的病理关键。2Lp(a)与MS密切相关,可能是衡量MS患者脂代谢异常的重要指标和代谢异常聚集状态的常用指标,但Lp(a)尚不能作为MS中医辨证分型的临床指标。

Objective ：To investigate the relationship between traditional Chinese medicine syndrome （TCM） syndromes and Lipopretein（a） [ Lp（a） ] and other metabolic components to seek an objective evidence for differentiation of TCM syndromes of metabolic syndrome （MS）. Methods：In First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine No. 1 Cardiology Department, 147 patients who conformed to MS diagnosis standard were selected and the control group 109 healthy peo- ple. Collect their detailed disease history and clinical examination indicators. The selected MS patients were also divided into two groups based on serum Lp（a） concentrations：high Lp（a） level group [ Lp（a） ≥1300 mg/L] and normal Lp（a） level group [ Lp （a） 〈 300 mg/L]. Compare the relation of different TCM syndromes and Lp（a） concentration and other metabolic components. Results ： ①The major TCM syndrome of MS was phlegm and blood stasis, followed by Qi stagnation dampness, and then Qi and Yin weakness,and the final one was spleen and kidney deficiency. ②Phlegm and blood stasis has higher abdominal circumference, BMI, LDL - C and fasting blood glucose than non - phlegm and blood stasis and the differences were statistically significant （ P 〈 0.05）. Although these two groups had no significant differences in SBP, DBP,TC and TG. Phlegm and blood stasis was higher than non- phlegm and blood stasis in these aspects according to the trend. ③Among the normal Lp（a） level group,phlegm and blood stasis was the most,containing 65 cases,and then 25 cases of Qi stagnation dampness,15 cases of spleen and kidney defi- ciency and 13 cases of Qi and Yin weakness, in high Lp（a） level group, phlegm and blood stasis was the most, which contained 17 cases,and then 5 cases of spleen and kidney deficiency,4 cases of Qi and Yin weakness and 3 cases of Qi stagnation damp- ness. Conclusion：（j）Phlegm and blood stasis group is the most common TCM syndrome of MS and phlegm and blood stasis plays an important role in the pathological period of obesity and dyslipidemia. ②Lp（a） is closely related with MS and it can be used as an indicator of MS patients with abnormal lipid metabolism and many metabolic abnormalities. But Lp（a） can not be used as MS＇ s clinical indicator of TCM syndrome.