基于“微型积证”理论分析颈动脉硬化患者中医证型特点

Analysis on Syndrome Characteristics of Patients with Carotid Atherosclerosis Based on “Micro-accumulation” Theory

目的：在“微型积证”理论基础上，分析颈动脉粥样硬化患者中医证候的分布特点，提高动脉粥样硬化辨证论治水平。方法：196例颈动脉粥样硬化患者通过四诊辨证为气滞痰瘀互结证、气虚痰瘀互结证、血虚痰瘀互结证、阴虚痰瘀互结证、阳虚痰瘀互结证证型。同时采集患者年龄、血脂水平、内膜．中膜厚度（IMT）以及斑块积分数据，进行统计学分析。结果：动脉粥样硬化患者各证型分布有差异，其中气虚痰瘀互结证比例最高，血虚痰瘀互结证比例最低。平均年龄存在差异，其中气虚痰瘀互结证平均年龄最大，阴虚痰瘀互结证次之。气滞痰瘀互结证平均年龄最小。各证型之间的血脂水平具有差距。其中气虚痰瘀互结型总胆固醇（CHO）水平最高，与气滞痰瘀互结、血虚痰瘀互结及阳虚痰瘀互结型比较，差异有统计学意义（P〈0．05）。气虚痰瘀互结证以及阴虚痰瘀互结证IMT均高于其他三种证型。差异均有统计学意义（P〈0．05）。气虚痰瘀互结证斑块积分较其他四个证型均高，差异有统计学意义（P〈0．05）。结论：痰瘀互结是动脉粥样硬化形成的病理基础，各证型在平均年龄、血脂水平、内膜-中层厚度及斑块积分方面存在差异。

Objective：To analyze the syndrome distributions of patients with carotid atherosclerosis based on ＂micro-accumulation＂ theory so as to improve the syndrome differentiation and treatment levels. Methods： Through the four diagnostic methods,total 196 patients with carotid atherosclerosis were divided into five types of syndrome including：qi stagnation and binding of phlegm and blood stasis type,qi deficiency and binding of phlegm and blood stasis type,blood deficiency and binding of phlegm and blood stasis type,yin deficiency and binding of phlegm and blood stasis type,yang deficiency and binding of phlegm and blood stasis type. The age,lipid levels,intima-media thickness,plaque scores were collected and analyzed. Results： Syndrome distributions of patients with carotid atherosclerosis were different,among which qi deficiency and binding of phlegm and blood stasis type has the highest ratio while blood deficiency and binding of phlegm and blood stasis type has the lowest ratio. The average age was different,among which qi deficiency and binding of phlegm and blood stasis type was the oldest followed by yin deficiency and binding of phlegm and blood stasis type and qi stagnation and binding of phlegm and blood stasis type was the youngest（P〈0.05）.There were statistical differences in blood lipid levels between the various syndromes. The highest level of total cholesterol（CHO） was in qi deficiency and binding of phlegm and blood stasis type with statistical difference compared to qi stagnation and binding of phlegm and blood stasis type,blood de- ficiency and binding of phlegm and blood stasis type,yang deficiency and binding of phlegm and blood stasis type. Intima-media thickness of qi deficiency and binding of phlegm and yin deficiency and binding of phlegm and blood stasis type were higher than that of other types with statistical differences（P〈0.05）. The plaque scores of qi deficiency and binding of phlegm and blood stasis type was higher than those of the other four syndromes. Conclusion：Binding of phlegm and blood stasis was the pathological basis for atherosclerosis. The age,intima-media thickness,blood lipid levels and plaque scores were different in various types.