急性心肌梗死患者血脂水平变化与中医辨证分型的临床研究

目的：分析急性心肌梗死(AMI)患者血脂水平变化与中医辨证分型的关系。方法：AMI患者110例和冠心病组(对照组)100例进行总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)水平的测定，并按中医辨证分4型：心脉瘀阻型、痰热扰心型、气阴两虚型、心阳虚脱型。结果：在AMI急性期TC>6.2 mmol/L占17.3％，4.6～6.2 mmol/L占38.2％；TG>2.2 mmol/L占12.7％，1.7～2.2 mmol/L占13.6%；HDLC<0.8 mmol/L占18.2％；LDLC>3.5 mmol/L占19.1％。且心脉瘀阻型及痰热扰心型2组TC及LDLC升高，而HDLC下降，与对照组比较有显著性差异。死亡15例患者中有7例HDLC降低，占46.7％。心阳虚脱型HDLC下降及LDLC升高与对照组比较有显著差异。结论：高脂血症与AMI发生率有关，在AMI急性期可出现高脂血症。心脉瘀阻型及痰热扰心型易出现TC、LDLC升高和HDLC降低，尤以LDLC及HDLC改变更为突出。HDLC降低是AMI死亡危险因子之一。

Clinical studies on the relationship between the changes in plasma lipid level and the traditional Chinese medicine syndrome differentiation and typing in patients with acute myocardial infarction

Objective:To analyse the relationship between the changes in plasma lipid level and the traditional Chinese medicine (TCM) syndrome differentiation and typing in patients with acute myocardial infarction(AMI).Methods:The levels of plasma total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDLC),and high density lipoprotein cholesterol (HDLC) were measured in 110 cases with AMI(AMI group)and 100 cases with coronary heart disease (CHD) as control.Furthermore these patients were subdivided into 4 subgroups:heartpulse stasis (HPS,心脉瘀阻型),hot phlegm trouble heart (HPTH,痰热扰心型)，both Qi and Yin deficiency (QYD,气阴两虚型),and heart Yang deficiency(HYD,心阳虚脱型).Results:During acute phase of AMI the TC more than 6.2 mmol/L owned 17.3％ and among 4.66.2 mmol/L owned 38.2％,while TG more than 2.2 mmol/L owned 12.7％ and among 1.72.2 mmol/L owned 13.6％;HDLC less than 0.8 mmol/L owned 18.2％;and LDLC more than 3.5 mmol/L owned 19.1％.In HPS and HPTH group TC and LDLC were increased but HDLC reduced and in comparison with control group the differences were significant.Seven patients of 15 dead cases (46.7％) had decreased HDLC.In HYD group reduced HDLC and hightened LDLC possessed significant difference in comparison with control group.Conclusions:Hyperlipidemia is associated with accurance rate of AMI and during acute phase of AMI it may appear.Typing in HPS and HPTH,increased TC and LDLC and decreased HDLC are common to find,especially the changes in LDLC and HDLC are much more obvious.Reduced HDLC is one of risk factors to die.