中风急性期腑气不通证候组合及与垂体-肾上腺轴激素关系的研究

目的探讨中风急性期腑气不通的症候组合及其与垂体-肾上腺轴激素[促肾上腺皮质激素（ACTH）、皮质醇（CS）]的关系。方法对278例中风急性期患者进行证候评分,并根据便秘诊断标准分为腑气不通组与非腑气不通组,比较两组间证候组合差别。放射免疫分析（RIA）法测定血中ACTH、CS含量,对比腑气不通组不同证型间ACTH、CS水平,并与非腑气不通组相比较。结果腑气不通组患者风＋火＋痰组合所占比例远高于其他组合;非腑气不通组以痰、阴虚、气虚组合为主。ACTH、CS含量水平比较：腑气不通组ACTH、CS比非腑气不通组高（P〈0.01）;腑气不通组证候组合间比较,风＋火＋痰、痰＋火组合较其他组合高,以风＋火＋痰组合升高最为明显,与其他组合比较具有统计学意义（P〈0.05或P〈0.01）。结论中风腑气不通患者血浆中ACTH、CS升高明显,腑气不通患者血浆中ACTH、CS含量水平与其中医证候组合特点之间存在一定的联系。

Relationship between the Syndrome Element Combination and Pituitary-adrenal Axis Hormone in Costive Patiens with Acute Stroke

Objective To investigate the relationship between the syndrome element combination and pituitary-adrenal axis hormone in costive patiens with acute stroke.Methods Two hundred and seventy-eight patients in acute stage of stroke were classified according to the syndrome differentiation,and divided into costive group and non-costive group by evaluation tables.The concentrations of plasma adrenocorticotropic hormone（ACTH） and corticosteroid（CS） were detected by radioimmunoassay.Results The main syndrome element combination was the combination of wind,fire-heat and phlegm in costive group.The main syndrome elements included wind,fire-heat and phlegm in costive group while it included phlegm,yin-deficiency and qi-deficiency in non-costive group.The concentrations of plasma ACTH and CS in costive group were higher than that in non-costive group（P0.01）.The concentrations of plasma ACTH and CS in the combination of wind,fire-heat,phlegm and fire-heat,phlegm were higher than that of other combinations in costive group（P0.05 or P0.01）,especially in the combination of wind,fire-heat,phlegm.Conclusion The levels of plasma ACTH and CS in costive group were significantly higher in patiens with acute stage of stroke.The levels of plasma ACTH and CS were associated with the combination characteristics of TCM syndrome.