卒中急性期并发胃肠功能紊乱中医证型与脑肠肽胃动素、胃泌素的相关性研究

Correlation between TCM Symptom Type and Brain-gut Peptides Motilin and Gastrin in Acute Stage of Ischemic Stroke Complicated with Gastrointestinal Dysfunction

目的探讨缺血性卒中急性期并发胃肠功能紊乱中医证型与脑肠肽胃动素(MTL)、胃泌素(GAS)的关系,以期为中风急性期胃肠并发症的预测及证型判定提供实验依据和理论支持。方法选取卒中急性期中经络患者并发胃肠功能紊乱者100例纳入病例组,未并发胃肠功能紊乱者30例作为对照组。病例组入院24 h内完成中医辨证分型。入院次日清晨采集两组患者空腹静脉血标本,使用酶联免疫吸附法测定血浆MTL、GAS。结果100例缺血性卒中患者并发胃肠功能紊乱,其中医证型分布为肝阳暴亢证23例、痰热腑实证29例、风痰阻络证13例、气虚血瘀证19例,阴虚风动证16例。胃肠症状发生频率从高到低依次为:便秘(46.00%)、呕吐(40.00%)、恶心(31.00%)、腹胀纳差(12.00%)、腹泻腹痛(5.00%)、烧心(4.00%)、呃逆泛酸(3.00%)。病例组MTL、GAS含量均高于对照组(均P<0.05)。病例组各证型MTL总体分布存在统计学差异(P<0.01);其中痰热腑实证和肝阳暴亢证MTL含量均高于阴虚风动证、风痰阻络证、气虚血瘀证(均P<0.01)。各证型GAS总体分布存在统计学差异(P<0.01);其中肝阳暴亢证、痰热腑实证、阴虚风动证GAS含量均较风痰阻络证升高(均P<0.01或P<0.05)。MTL、GAS之间的相关系数差异无统计学意义(P>0.05),尚不能认为MTL与GAS相关。结论脑肠肽MTL、GAS参与了卒中急性期胃肠并发症的发病过程,且与其中医证型相关,尤其是痰热腑实证与肝阳暴亢证。卒中并发胃肠功能紊乱之证候状态以“痰、热、瘀、虚”相兼并存为特点,此与脑肠肽水平的异常表达密切相关。脑肠肽MTL、GAS的检测可能对中风急性期胃肠并发症的预测及辨证分型具有一定的临床价值。

Objective:To investigate the correlation between TCM symptom types and brain-gut peptides motilin(MTL)and gastrin(GAS)in acute ischemic stroke complicated with gastrointestinal dysfunction,in order to predict gastrointestinal complications in acute stroke and syndrome type judgment provides experimental basis and theoretical support. Methods:Patients with apoplexy involving channel and collateral in the acute stage of stroke were selected,and 100 cases complicated with gastrointestinal dysfunction were chosen as the case group,and 30cases without gastrointestinal dysfunction as the control group. In the case group,TCM syndrome differentiation was completed within 24 hours of admission. Fasting venous blood samples were collected from the two groups of patients in the morning the next day after admission,and plasma MTL and GAS were determined by enzymelinked immunosorbent assay. Results:The most common TCM symptoms in the case group were phlegm-heat with fu-solid syndrome,liver-yang hyperactivity syndrome,Qi deficiency with blood-stasis syndrome. The MTL content in the case group was higher than that in the control group,with a significant difference(P < 0.001);the GAS content in the case group was higher than that in the control group,with a statistical difference(P < 0.05).The MTL content of phlegm-heat with fu-solid syndrome and liver-yang hyperactivity syndrome were significantly higher than those of the other three syndromes(all P < 0.001);the GAS content of liver-yang hyperactivity syndrome and phlegm-heat with fu-solid syndrome were significantly higher than wind-phlegm blocking vessels syndrome,with a significant difference(P < 0.001). Conclusion:The brain-gut peptides MTL and GAS are involved in the pathogenesis of gastrointestinal complications in the acute phase of stroke,and are related to the formation of TCM syndromes,especially the phlegm-heat with fu-solid syndrome and the liver-yang hyperactivity syndrome.The syndrome state of stroke complicated with gastrointestinal dysfunction is characterized by the coexistence of "phlegm,heat,blood stasis,and deficiency",which is closely related to the abnormal expression of brain-gut peptide levels. The detection of brain-gut peptides MTL and GAS may have certain clinical value in the prediction and syndrome differentiation of gastrointestinal complications in the acute phase of stroke.