缺血性脑卒中血脂异常患者不同证候的脑卒中分型及炎性因子水平特点研究

Study on stroke types and inflammatory factors levels of different syndromes in patients with ischemic stroke and dyslipidemia

[目的]探究缺血性脑卒中血脂异常患者不同证候间脑卒中病因分型(TOAST分型)特点及Toll样受体4(TLR4)、转化生长因子-β激活的激酶1(TAK1)、核转录因子-κB p65(NF-κB p65)、白介素-6(IL-6)炎症因子水平差异。[方法]纳入2019年1—12月北京中医药大学东直门医院及北京中医药大学东方医院门诊及住院符合血脂异常及缺血性脑卒中诊断的患者170例及健康体检者10例,比较不同中医证候间患者一般资料(包括年龄、性别)、证候分布、脑卒中病因分型及血清TLR4、TAK1、NF-κB p65、IL-6炎症因子水平差异的特点。[结果]中医证候分布以痰瘀互结证最多,气虚血瘀证其次,其余各证候分布较少。脑卒中病因分型的分布特点上,各证候组间存在差异(P<0.05),其中痰瘀互结证多表现为小动脉闭塞性脑卒中,而气虚血瘀证多表现为大动脉粥样硬化性脑卒中,其余各证候间脑卒中病因分型差异不大。各证候炎症因子比较,痰瘀互结证TLR4、TAK1、NF-κB p65表达量最多(P<0.05),气虚血瘀证其次(P<0.05)。肝阳上亢证和痰热腑实证间差异无统计学意义(P>0.05)。气虚血瘀证IL-6表达量最多(P<0.05)。[结论]缺血性脑卒中血脂异常患者的中医证候分布以痰瘀互结证和气虚血瘀证为主,不同证候间脑卒中病因分型存在差异,TLR4、TAK1、NF-κB p65、IL-6等炎症因子在不同中医证候中有不同的水平特点,可作为缺血性脑卒中血脂异常分型辨证的客观依据。

[Objective]To investigate the differences of stroke types(TOAST type),Toll-like receptor 4(TLR4),transforming growth factor-β-activated kinase 1(TAK1),nuclear factor-κB p65(NF-κB p65),interleukin 6(IL-6)levels of different traditional Chinese medicine(TCM)syndromes in patients with dyslipidemia complicated with ischemic stroke.[Methods]170 patients with ischemic stroke complicated with dyslipidemia and 10 healthy physical examinees were selected for analysis,and the general data(including age and gender),TOAST subtypes and levels of inflammatory factors including TLR4,TAK1,NF-κB p65,IL-6 were compared and the correlation were analized among different TCM syndromes.[Results]The TCM syndromes were mostly phlegm-stasis syndrome,followed by qi deficiency and blood stasis syndrome,and the other syndromes were less distributed.In terms of TOAST types,there were differences among various TCM syndromes(P<0.05),among which the syndromes of phlegm-stasis syndrome was mostly small artery occlusion stroke,while the syndromes of qi deficiency and blood stasis syndrome was mostly large artery atherosclerotic stroke,and the other syndromes showed little difference.The expressions of TLR4,TAK1 and NF-κB p65 were the highest in the phlegm-stasis syndrome(P<0.05),followed by qi deficiency and blood stasis syndrome(P<0.05).There was no significant difference between hyperactivity of liver yang syndrome and heat-phlegm and sthenic-fu syndrome(P>0.05).IL-6 expression level was the highest in qi deficiency and blood stasis syndrome(P<0.05).[Conclusion]Ischemic cerebral stroke complicated with dyslipidemia in patients with TCM syndrome distribution is given priority to phlegm-stasis syndrome.In the etiological classification of stroke,the phlegm-stasis syndrome is mainly manifested as small artery occlusion stroke,while the qi deficiency and blood stasis syndrome is mainly manifested as large artery atherosclerotic stroke.TLR4,TAK1,NF-κB p65,IL-6 and distribution in the different TCM syndrome types have certain regularity,which can be used as objective basis of classification in patients of ischemic stroke and dyslipidemia complicated.