基于气相色谱质谱联用对冠心病“痰”“瘀”证候血清代谢组学的研究

Serum Metabonomics Analysis of Phlegm and Blood Stasis Syndrome in Patients with Coronary Heart Disease by Gas Chromatography-Mass Spectrometry Combined with Liquid Chromatography-Mass Spectrometry

目的研究冠心病痰证、瘀证病人血清代谢组学特征。方法选择冠心病稳定期病人102例,其中痰证52例、瘀证50例,31名健康者,利用核磁共振谱(GCMS)和色谱/质谱(LC/MS)联用、模式识别技术等现代分析技术,比较痰证、瘀证冠心病病人和健康人的代谢物组谱差异,对同病异证病人间代谢物组谱差异进行分析。结果在多种氨基酸、有机酸、长链脂肪酸类、溶血磷脂类、磷脂类、鞘磷脂等代谢物方面,冠心病组相对于健康对照组表现出明显的差异,其中大部分的差异代谢物也是痰浊组和血瘀组的共性代谢物。冠心病组有机酸、麦芽糖、多种氨基酸较健康对照组明显升高,而多种不饱和脂肪酸及衍生物、维生素E、胆固醇等显著降低。痰浊组和血瘀组的特性差异代谢物主要有苹果酸和琥珀酸,果糖和葡萄糖,甘氨酸和丙氨酸以及棕榈烯酸等。其中7,10-顺十六碳二烯酸和DPA在痰浊组中降低,其余则在血瘀组中浓度升高。结论冠心病有特异性的代谢组特征,痰浊和血瘀既有特性差异性代谢物,也有共性代谢物,二者异中有同,同中有异。痰浊和血瘀有共同的物质基础,这与中医理论的"痰瘀同源"是一致的,作为致病因子,二者在体内可以相互转化,共同致病,亦即"痰瘀同病",因而在治疗时可以考虑痰瘀同治,提高疗效。

Objective To investigate the serum metabonomics characteristics of phlegm and blood stasis syndrome in patients with coronary heart disease（ CHD）.Methods Metabolites spectral differences were compared between 102 patients with CHD（ 52 patients with phlegm syndrome and 51 with blood stasis syndrome） and 31 healthy individuals by analysis techniques of gas chromatography ! mass spectrometry（ GC-MS）,liquid chromatography-mass spectrometry（ LC/MS） and pattern recognition technology.Results CHD group compared to healthy controls showed obvious difference in the metabolites including many kinds of amino acids,organic acids,long chain fatty acids,lysophospholipids,phospholipids,sphingomyelin;the most different metabolites also were common metabolites of phlegm and blood stasis group.The contents of organic acids,maltose,a variety of amino acids in CHD patients obviously increased than that in healthy control;while the contents of a variety of unsaturated fatty acids,derivatives,Vit E,and cholesterol obviously decreased in CHD patients.Characteristic different metabolites in phlegm group and blood stasis group were mainly malic acid and succinic acid,fructose and glucose,glycine and alanine and palmitoleic acid.Among them,in phlegm group the contents of 7,10-Hexadecadienoic acid and DPA reduced,while the rest of them in blood stasis group increased.Conclusion CHD had specific metabolic group characteristics,phlegm and blood stasis had both characteristic different metabolites,also had common metabolites,which had important significance in improving identification ability of phlegm and blood stasis syndrome of coronary heart disease,also provided objective basis for CHD syndrome essence research.Phlegm and blood stasis had common material basis,which was coincident with Chinese medicine phlegm and blood stasis homologous theory.As pathogenic factors,both in the body could change into each other,and caused disease commonly,so treating phlegm and blood stasis simultaneously could improve curative effect.