下肢动脉硬化闭塞症肱动脉血管内皮功能、内膜-中层厚度与中医证型的相关性研究

A Research on Correlations of Brachial Artery Endothelial Function, Intima-media Thickness and TCM Syndrome Types in Patients with Lower Extremity Arteriosclerosis Obliterans

目的探讨不同中医证型的下肢动脉硬化闭塞症(ASO)与肱动脉血管内皮功能、内膜-中层厚度(IMT)、踝臂指数(ABI)及体质指数(BMI)等的相关性。方法将123例ASO患者中医辨证分为血瘀证、湿热证及脾肾阳虚证,并将40例同龄健康查体者作为对照组。采用彩色多普勒超声检测不同证型ASO患者与对照组的肱动脉血流介导的血管舒张功能(FMD)、颈总动脉IMT、股总动脉IMT,并且测量其ABI与BMI。结果 ASO患者的肱动脉FMD和ABI降低,颈总动脉IMT、股总动脉IMT和BMI均增加。其中湿热证组肱动脉FMD、ABI低于其他两证型组(P<0.05);湿热证组股总动脉IMT和BMI高于其他两证型组(P<0.05);血瘀证组次之。脾肾阳虚证组颈总动脉IMT最厚(P<0.05),湿热证组次之。结论 ASO患者各指标在3组中医证型之间存在明显不同,湿热证肱动脉血管内皮功能障碍及股总动脉IMT增厚最为严重,且ABI最低;血瘀证和脾肾阳虚证则各指标病变相对较轻。

Objective To research the correlations of brachial arte ry endothelial function, intima-media thickness（ IMT）, anklebrachial index（ ABI）, body mass index（ BMI） and TCM syndrome types of lower extremity arteriosclerosis obliterans（ ASO）.Methods 123 cases of patients with ASO were divided into three syndrome groups based on syndrome differentiation, and taking 40 cases of the healthy voluntary persons as the control group. Testing brachial artery Flow-mediated dilation（FMD）, common carotid artery IMT and common femoral artery IMT on color Doppler ultrasound, and measuring ABI, BMI was made. Results In the ASO patients, the brachial artery FMD and ABI was decreased; common carotid artery IMT, femoral artery IMT and the BMI was increased. Brachial artery FMD and ABI of dampness-heat syndrome group were significantly lower than other groups（P0.05）, but femoral artery IMT and BMI of dampness-heat syndrome group were higher than other groups（ P 0.05）, blood stasis syndrome group took second place. Common carotid artery IMT of spleen-kidney yang deficiency syndrome group was thickest in three syndrome groups（ P 0.05）, dampness-heat syndrome group was the second. Conclusion With respect to all indexes, there were significant differences between the three groups of TCM syndrome types in ASO patients. For dampness-heat syndrome group, the vascular endothelial dysfunction of the brachial artery and the femoral artery IMT were the most serious and the ABI was the lowest.Blood stasis syndrome group and spleen-kidney yang deficiency syndrome group were relatively mild.