不同中医证候类型血脂异常患者血脂、γ-谷氨酰转肽酶分布特点研究

The distribution characteristics study of blood lipid and γ-glutamyl transpeptidase in dyslipidemia patients with different TCM syndrome

目的探讨血脂异常患者中医证候分型与胆固醇(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)、γ-谷氨酰转肽酶(GGT)的关系。方法将155例血脂异常患者根据中医证候诊断标准分为痰浊阻遏组、脾肾阳虚组、肝肾阴虚组、阴虚阳亢组、气滞血瘀组。另外收集15例健康体检者作为对照组。观察血脂异常患者中医证候类型分布情况;比较各组TC,TG,HDL-C,LDL-C;比较各组GGT;分析血脂异常患者GGT与TC,TG,HDL-C,LDL-C的相关性。结果 155例血脂异常患者中,痰浊阻遏证40例(25.8%),气滞血瘀证39例(25.2%),脾肾阳虚证36例(23.2%),肝肾阴虚证21例(13.5%),阴虚阳亢证19例(12.3%)。各组TC,TG,HDL-C,LDL-C比较差异均有统计学意义(P<0.05)。TC痰浊阻遏组较对照组升高,差异有统计学意义(P<0.05)。TC痰浊阻遏组、气滞血瘀组较阴虚阳亢组升高,差异均有统计学意义(P<0.05)。TG痰浊阻遏组、气滞血瘀组、脾肾阳虚组、肝肾阴虚组、阴虚阳亢组较对照组升高,差异均有统计学意义(P<0.05)。痰浊阻遏组TG最高,气滞血瘀组、脾肾阳虚组、肝肾阴虚组、阴虚阳亢组与痰浊阻遏组比较差异均有统计学意义(P<0.05)。TG气滞血瘀组较阴虚阳亢组升高,差异有统计学意义(P<0.05)。HDL-C痰浊阻遏组、气滞血瘀组、脾肾阳虚组、肝肾阴虚组、阴虚阳亢组较对照组降低,差异均有统计学意义(P<0.05)。LDL-C痰浊阻遏组、气滞血瘀组较对照组升高,差异均有统计学意义(P<0.05)。GGT痰浊阻遏组、气滞血瘀组、脾肾阳虚组、肝肾阴虚组、阴虚阳亢组较对照组升高,差异均有统计学意义(P<0.05),痰浊阻遏组较脾肾阳虚组升高,差异有统计学意义(P<0.05)。相关性分析显示,GGT与TG呈正相关(r=0.224,P<0.05)。GGT与HDL-C呈负相关(r=-0.167,P<0.05)。结论痰浊阻遏证、气滞血瘀证、脾肾阳虚证是血脂异常的主要证候类型。研究提示TG升高可以作为痰浊阻遏证的微观辨证指标。GGT与TG,HDL-C有一定相关性。

Objective To study the relationship between TCM syndrome and TC,TG,HDL-C,LDL-C,and GGT in patients with dyslipidemia. Methods 155 patients suffering dyslipidemia were divided into phlegm stasis group,yang deficiency of spleen and kidney group,yin deficiency of liver and kidney group,hyperactivity of yang due to yin deficiency group,and qi stagnation and blood stasis group according to the diagnostic criteria of TCM syndrome. Another 15 healthy people were collected as control group. The distribution of TCM syndrome in patients with dyslipidemia was observed; and TC,TG,HDL-C,LDL-C,as well as GGT in all groups were compared. The correlation between GGT and TC,TG,HDL-C,LDL-C in patients with dyslipidemia was analysed. Results In 155 cases of patients with dyslipidemia,40 cases（25. 8%） showed phlegm stasis syndrome,39 cases（25. 2%） showed qi stagnation and blood stasis syndrome,36 cases（23. 2%） showed yang deficiency syndrome of spleen and kidney,21 cases（13. 5%） showed yin deficiency syndrome of liver and kidney,and 19 cases（12. 3%）showed the syndrome of hyperactivity of yang due to yin deficiency. TC,TG,HDL-C,LDL-C were significantly different in each group（P 0. 05）. TC in phlegm stasis group was higher than control group,the difference was statistically significant（P 0. 05）. TC in phlegm stasis group and qi stagnation and blood stasis group were higher than that in hyperactivity of yang due to yin deficiency group,the difference was statistically significant（P 0. 05）. TG in phlegm stasis group,qi stagnation and blood stasis group,spleen and kidney yang deficiency group,yin deficiency of liver and kidney group and hyperactivity of yang due to yin deficiency group were significantly higher than that in control group（P 0. 05）.The highest TG was shown in phlegm stasis group,TG in qi stagnation and blood stasis group,spleen and kidney yang deficiency group,liver and kidney yin deficiency group,and hyperactivity of yang due to yin deficiency group were significantly different from phlegm stasis group（P 0. 05）. TG in qi stagnation and blood stasis group was higher than hyperactivity of yang due to yin deficiency group（P 0. 05）.HDL-C in phlegm stasis group,qi stagnation and blood stasis group,spleen and kidney yang deficiency group,yin deficiency of liver and kidney group and hyperactivity of yang due to yin deficiency group were significantly lower than control group（P 0. 05）. LDL-C in phlegm stasis group and qi stagnation and blood stasis group were higher than control group,the difference was statistically significant（P 0. 05）.GGT in phlegm stasis group,qi stagnation and blood stasis group,spleen and kidney yang deficiency group,liver and kidney yin deficiency group,and hyperactivity of yang due to yin deficiency group were significantly higher than control group（P 0. 05）. GGT in phlegm stasis group was higher than that in spleen and kidney yang deficiency group,the difference was statistically significant（P 0. 05）. Correlation analysis showed that GGT was positively correlated with TG（r = 0. 224,P 0. 05）,and GGT was negatively correlated with HDL-C（r =-0. 167,P 0. 05）. Conclusion Phlegm stasis syndrome,qi stagnation and blood stasis syndrome,and spleen and kidney yang deficiency syndrome are the main syndrome types of dyslipidemia. The study suggestes the increase of TG could be used as the microcosmic differentiation index of phlegm stasis syndrome. GGT has correlation with TG and HDL-C.