急性丘脑梗死病人中医证型与IL-6、hs-CRP、Lp-PLA 2水平及颈动脉硬化的关系探讨

Correlation between TCM Syndromes and IL-6,hs-CRP,Lp-PLA 2 Level and Carotid Arteriosclerosis in Patients with Acute Thalamic Infarction

目的从辅助检查角度分析急性丘脑梗死病人中医证型,了解其与血浆脂蛋白磷脂酶A 2(Lp-PLA 2)、白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)水平、颈动脉硬化程度及性质的关系。方法对103例病人进行实验室血液指标检测及颈动脉彩超检查,同时进行中医辨证分型,分析中医证型与IL-6、hs-CRP、Lp-PLA 2水平及颈动脉硬化程度的关系。结果急性丘脑梗死病人Lp-PLA 2、IL-6、hs-CRP水平明显高于对照组,风证、痰证和瘀证三型Lp-PLA 2、IL-6、hs-CRP水平明显高于其他证型,病例组内膜增厚及斑块检出率、不稳定斑块出现率、中重度狭窄病人明显高于对照组。瘀证内膜增厚及斑块检出率最高,其次为火证、风证及瘀证。病人不稳定斑块出现率风证出现率最高,其次为火证、痰证和瘀证,风证不稳定斑块出现率较痰证、瘀证和火证差异有统计学意义。结论丘脑梗死急性期病人颈动脉内膜中层厚度增厚、斑块形成与痰证和瘀证明显相关;风证、火证、痰证、瘀证等实证为急性丘脑梗死发病的关键因素,其中与风证的关系尤其密切。IL-6、hs-CRP、Lp-PLA 2水平的异常可能为急性丘脑梗死病人风火相煽、痰瘀并见等病理要素的理化基础之一。

Objective To analyze relationship between the traditional Chinese medicine(TCM)syndromes of patients with acute thalamic infarction plasma lipoprotein phospholipase A 2(Lp-PLA 2),interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP)levels,the degree and nature of carotid atherosclerosis.Methods One hundred and three patients were tested for laboratory blood index and carotid artery color Doppler ultrasound,and TCM syndrome analysis was conducted to analyze the correlation between TCM syndrome type and IL-6,hs-CRP,Lp-PLA 2 level,degree and nature of carotid atherosclerosis.Results The levels of Lp-PLA 2,IL-6 and hs-CRP in patients with acute thalamic infarction were significantly higher than those of normal control group.The levels of Lp-PLA 2,IL-6 and hs-CRP in patients with wind syndrome,phlegm syndrome and phlegm syndrome were significantly higher than those with other syndrome types.The intimal thickening and plaque detection rate,the incidence of unstable plaque,and moderate to severe stenosis in the patient group were significantly higher than those in the control group.The intimal thickening and plaque detection rate were the highest stasis syndrome,followed by phlegm syndrome,wind syndrome and fire syndrome.The occurrence rate of unstable plaques was the highest in patients with wind syndrome,followed by blood stasis,phlegm and fire syndrome.The occurrence rate of unstable plaques in patients with wind syndrome was significantly different from that in patients with phlegm,blood stasis and fire syndrome.Conclusion The intima-media thickness(IMT)in the carotid artery in patients with acute thalamic infarction and the formation of plaque are related to the evidence of sputum and stasis.The wind,fire,phlegm syndrome and stasis syndrome are the key factors in the pathogenesis of acute thalamic infarction,and these are particularly closely related to wind syndrome.Abnormal levels of IL-6,hs-CRP,and Lp-PLA 2 may be one of the physicochemical basis of pathological factors such as fire,phlegm and blood stasis in patients with acute thalamus infarction.