痰瘀阻络型缺血性中风与生化检验指标相关性分析

Study on the correlation between ischemic stroke of phlegm and blood stasis blocking collaterals and clinical laboratory index

目的探讨痰瘀阻络型缺血性中风与生化检验指标的关系。方法回顾性收集2021年1—12月首都医科大学附属北京中医医院针灸科收治的痰瘀阻络型缺血性中风患者71例(A组)、非痰瘀阻络型缺血性中风患者55例(B组),另选取同期本院治未病中心参与体检的70例健康受试者(C组)。测定分析3组受试者血清生化指标。绘制受试者工作特征曲线分析评价各检验指标的诊断价值。结果诊断痰瘀阻络型缺血性中风排名前5的曲线下面积(AUC)指标分别为总蛋白、白蛋白、载脂蛋白A1(ApoA1)、高密度脂蛋白胆固醇(HDL-C)和胱抑素C,曲线下面积(AUC)分别为0.930、0.912、0.811、0.802和0.754。诊断非痰瘀阻络型缺血性中风的排名前5的AUC指标分别为白蛋白、总蛋白、ApoA1、小而密低密度脂蛋白胆固醇(sdLDL-C)和胱抑素C,AUC分别为0.962、0.908、0.879、0.831和0.830。总胆固醇、低密度脂蛋白胆固醇(LDL-C)、sdLDL-C、总胆红素对非痰瘀阻络型缺血性中风的诊断价值显著高于对痰瘀阻络型缺血性中风的诊断价值(Z=-2.083,P=0.037;Z=-2.705,P=0.007;Z=-3.056,P=0.002;Z=-2.264,P=0.024)。结论总胆固醇、HDL-C、LDL-C、ApoA1、sdLDL-C、胱抑素C、总胆红素、总蛋白、白蛋白单个指标检测对缺血性中风的中医辨证分型具有一定的参考价值,但不建议将总胆固醇等脂类检验指标作为缺血性中风的中医辨证分型依据。总胆红素可能对缺血性中风痰瘀阻络型的辨证分型提供帮助和用药参考。

Objective To explore the relationship between ischemic stroke with phlegm and blood stasis blocking collaterals and biochemical indexes.Methods Totally 71 patients with ischemic stroke with phlegm and blood stasis blocking collaterals(group A)and 55 patients with non-phlegm and blood stasis ischemic stroke(group B)treated in the Department of Acupuncture and Moxibustion,Beijing Hospital of Traditional Chinese Medicine(TCM),Capital Medical University from January to December 2021 were collected retrospectively.Another 70 healthy subjects who took part in physical examination in the same period were selected(group C).The serum biochemical indexes of subjects were measured and analyzed.The diagnostic value of each test index was analyzed and evaluated by drawing the receiver operating characteristic curve.Results The top five areas under the curve(AUC)indexes for diagnosing ischemic stroke of phlegm and blood stasis type were total protein,albumin,apolipoprotein A1(ApoA1),high density lipoprotein cholesterol(HDL-C)and cystatin C,and AUC were 0.930,0.912,0.811,0.802 and 0.754,respectively.The top five AUC indexes for diagnosis of non-phlegm and blood stasis type ischemic stroke were albumin,total protein,ApoA1,small and dense low density lipoprotein cholesterol(sdLDL-C)and cystatin C,which the AUCs were 0.962,0.908,0.879,0.831 and 0.830,respectively.The diagnostic value of total cholesterol,low density lipoprotein cholesterol(LDL-C),sdLDL-C and total bilirubin in ischemic stroke of non-phlegm and blood stasis type was significantly higher than that of phlegm and blood stasis type(Z=-2.083,P=0.037;Z=-2.705,P=0.007;Z=-3.056,P=0.002;Z=-2.264,P=0.024).Conclusions The detection of total cholesterol,HDL-C,LDL-C,ApoA1,sdLDL-C,cystatin C,total bilirubin,total protein and albumin has a certain reference value for TCM syndrome differentiation of ischemic stroke,but it is not recommended to use total cholesterol and other lipids as the basis of TCM syndrome differentiation of ischemic stroke.Total bilirubin may provide help and medication reference for the dialectical classification of phlegm and blood stasis blocking collaterals in ischemic stroke.