血浆同型半胱氨酸和冠状动脉粥样硬化严重程度与中医证型的关系

Relationship of TCM Syndrome Type with Plasma Homocysteine and Severity of Coronary Atherosclerosis

目的 :探讨血浆同型半胱氨酸水平、冠状动脉粥样硬化严重程度与中医证型的关系。方法 :71例经冠状动脉造影 (简称冠脉造影 )确诊的冠心病患者及冠脉造影阴性者 ,2 8例健康体检者 ,采用全自动荧光偏振免疫法测定血浆同型半胱氨酸水平 ;将其中 5 4例冠脉造影阳性 (血管狭窄≥ 5 0 % )患者经中医辨证后分为心血瘀阻、痰浊壅塞和气阴两虚 3型 ,分析同型半胱氨酸水平、冠状动脉粥样硬化严重程度与中医证型的关系。结果 :冠脉造影阳性者血浆高同型半胱氨酸血症检出率显著高于健康人 (31 5 %与 2 2 % ,χ2 =14 1,P <0 0 1) ,冠脉造影阳性者血浆同型半胱氨酸水平显著高于冠脉造影阴性者 (P <0 0 1) ,且随着冠状动脉病变支数的增加 ,血浆同型半胱氨酸水平逐渐增高。在非重度狭窄者、重度狭窄者中心血瘀阻型血浆同型半胱氨酸水平均显著高于痰浊壅塞、气阴两虚两型 (P <0 0 5 ) ,而痰浊壅塞、气阴两虚两型之间差异无显著性。结论 :血浆同型半胱氨酸水平与冠状动脉粥样硬化病变支数、病变的严重性呈正相关。血瘀是导致冠脉粥样硬化的病理基础 。

Objective: To study the relationship of TCM syndrome type with plasma homocysteine (Hcy) and severity of coronary atherosclerosis. Methods: Plasma Hcy was determined by the automatic fluorescence polarization immunoassay in 71 patients with and without angiographically documented coronary heart disease (CHD) and 28 healthy persons. The TCM syndrome type of 54 patients with arterial stenosis ≥50% (showing by angiography) was classified into the Heart blood stasis type, phlegm stagnation type and Qi Yin deficiency type. Results: The incidence of hyperhomocysteinemia was significantly higher in patients with CHD than that in healthy persons (P<0 01). Level of plasma Hcy was higher in patients with positive angiographic image than that in those with negative image (P<0 01), and the level was increasing along with the increase of branches of injured coronary artery. Analysis on TCM syndrome type and level of Hcy showed that Hcy in Heart blood stasis type was higher than that in the other two types, no matter the coronary artery stenosis being severe or not, the difference between the latter two types was insignificant. Conclusion: Plasma Hcy is positively correlated with the branches of injured artery and severity of coronary atherosclerosis. Heart blood stasis is the pathological base of coronary atherosclerosis, and the level of Hcy could provide certain scientific basis for TCM syndrome typing of CHD.