儿童中医体质与血脂代谢的相关性:基于浦东新区儿童青少年生长发育及健康队列

Correlation between Traditional Chinese Medicine Constitution and Blood Lipid Metabolism in Children:Based on the Shanghai Child and Adolescent Health Cohort

背景随着社会高速发展,儿童血脂异常检出率逐步上升。目前针对儿童亚健康运用中医体质辨识的数据较少,缺乏临床关联性数据分析。目的观察儿童中医体质与血脂代谢的变化趋势,分析两者间的相关性,为后续连续监测研究提供相关依据。方法本研究数据来源于浦东新区儿童青少年生长发育及健康队列(SCAHC),选取上海市浦东新区2080名健康小学生(二年级、三年级)为研究对象,采用上海中医药大学自主研发的“昭明系统”收集学生2021年及2022年体质信息,中医体质辨识根据人体面色、舌象、症状体征、问卷信息等将儿童分为脾虚质、平和质、气郁质、虚热质、实热质5种体质(偏颇体质指除平和质外所有具有偏向的体质),抽血采集其三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)血脂四项信息。分析并比较不同性别儿童血脂异常率以及不同年龄、性别中医体质分布特点及转变情况。采用多因素Logistic回归分析法探讨中医体质与血脂异常的相关性。结果2080名儿童中男1122名(53.9%)、女958名(46.1%),平均年龄为(8.18±0.39)岁;血脂异常儿童522名,血脂异常率为25.09%,其中男272名(52.1%),女250名(47.9%)。2021年儿童中医体质中平和质815名(39.2%),偏颇体质1265名(60.8%);2022年儿童中医体质中平和质764名(36.7%),偏颇体质1316名(63.3%);2021年与2022年儿童中医体质分布比较,差异有统计学意义(χ^(2)=106.28,P<0.001)。男童的偏颇体质检出率高于女童(χ^(2)_(2021年)=14.073,P<0.001;χ^(2)_(2022年)=20.090,P<0.001)。多因素Logistic回归分析排除性别、年龄等人口学影响因素后结果显示,儿童HDL-C升高是平和质(OR=1.624,95%CI=1.258~2.097,P<0.001)、虚热质(OR=0.654,95%CI=0.499~0.858,P=0.002)发生的影响因素。结论观察SCAHC队列儿童中医体质与血脂代谢变化趋势后发现,儿童HDL-C升高可促进平和质的发生,抑制虚热质的发生。

Background With the rapid development of the society,the detection rate of dyslipidemia in children has gradually increased.At present,there are few data on the application of traditional Chinese medicine(TCM)constitution identification in sub-health of children,and there is a lack of clinical correlation data analysis.Objective To observe the trend of changes in TCM constitution and blood lipid metabolism in children,and to analyze the correlation between them,thus providing relevant basis for subsequent continuous monitoring research.Methods Sourced from the Shanghai Child and Adolescent Health Cohort(SCAHC),a total of 2080 healthy primary school students in the second and third grade from Pudong New Area,Shanghai were selected as the research subjects.Using the"Zhaoming System"that was independently developed by Shanghai University of Traditional Chinese Medicine,physical information of included subjects in 2021(first year)and 2022(second year)was collected.Based on the TCM constitution classification of facial complexion and tongue appearance,clinical symptoms and signs and questionnaire information,children were divided into five types of constitution,including the spleen-deficiency constitution,balanced constitution,Qi-stagnation constitution,deficiency-heat constitution,and excess heat constitution(unbalanced constitution referred to all constitutions except for the balanced constitution).Blood samples were collected to detect on triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),and total cholesterol(TC).To analyze and compare the incidence of blood lipid abnormalities in children of different genders,as well as the distribution characteristics and changes of TCM constitution in different ages and genders.Multivariate Logistic regression analysis was performed to explore the correlation between TCM constitution and dyslipidemia in children.Results Among the 2080 children,1122(53.9%)were males and 958(46.1%)were females,with an average age of(8.2±0.4)years.There were 522 children with dyslipidemia(25.09%),including 272 males(52.1%)and 250 females(47.9%).In 2021,there were 815(39.2%)cases of the balanced constitution and 1265(60.8%)cases of the unbalanced constitution.In 2022,764(36.7%)children had a balanced constitution and 1316(63.3%)had a unbalanced constitution.There was a statistically significant difference in the distribution of TCM constitution in children between 2021 and 2022(χ^(2)=106.28,P<0.001).The detection rate of unbalanced constitution in boys was significantly higher than that in girls(χ^(2)_(2021)=14.073,P<0.001;χ^(2)_(2022)=20.090,P<0.001).Multivariate Logistic regression analysis,after excluding demographic factors such as gender and age,showed that elevated HDL-C in children was a contributing factor to the occurrence of balanced constitution(OR=1.624,95%CI=1.258-2.097,P<0.001),and deficiency-heat constitution(OR=0.654,95%CI=0.499-0.858,P=0.002).Conclusion Through analyzing the changing trend in TCM constitution and blood lipid metabolism in children from the SCAHC cohort,an increased HDL-C promotes the occurrence of balanced constitution but inhibits the occurrence of deficiency-heat constitution.