急性腔隙性脑梗死肝阳上亢证相关生物学客观指标的临床分析

目的分析并总结急性腔隙性脑梗死肝阳上亢证患者的证候临床客观指标变化，为辨证论治提供客观依据。方法2010年5月—2012年7月于中国中医科学院西苑医院脑病科符合诊断标准的患者50例为急性腔隙性脑梗死肝阳上亢证组（GYSK组），另选健康志愿者作为健康对照组40名。采用全自动血液分析和比色法检测血常规［包括WBC、RBC、Hb、中性粒细胞百分比（NEUT%）、淋巴细胞百分比（LY%）］、肝、肾功能［ALT、AST、总胆红素（TBIL）、总蛋白（TP）、白蛋白（ALB）、Cr、尿素氮（BUN）］；比色法检测血糖［包括空腹血糖（Glu）和糖化血红蛋白（HbA1c）］、血脂［包括总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）和极低密度脂蛋白胆固醇（VLDL-C）］、凝血功能［包括抗凝血酶Ⅲ（AT-Ⅲ）活性、凝血酶原时间（PT）、活动度（PTA）和凝血酶原国际化标准比率（INR）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）， 纤维蛋白原浓度（FBG）及其反应时间］、肾素、血管紧张素Ⅱ（AngⅡ）、高敏C反应蛋白（hs-CRP）及血浆同型半胱氨酸（Hcy）水平；电化学发光法检测甲状腺功能［包括游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、三碘甲状腺原氨酸（T3）、甲状腺素（T4）与促甲状腺激素（TSH）］；ELISA法检测肿瘤坏死因子（tumor necrosis factor， TNF）-α；放免法检测 IL-1和IL-6。结果与健康对照组比较，GYSK组患者RBC、LY%、ALT、TP、ALB、HDL-C、AT-Ⅲ活性、PTA及FT4含量明显下降，而TBIL、BUN、Glu、HbA1c、TSH、hs-CRP、肾素、AngⅡ、TNF-α、IL-1及IL-6水平明显上升（P〈0.05或P〈0.01）。结论急性腔隙性脑梗死肝阳上亢证病理过程与甲状腺功能，肾素－血管紧张素－醛固酮系统，内、外源性凝血系统以及炎症反应

Clinical Analysis of Syndrome-relative Biological Indices in Acute Lacuna Encephalon Infarction Patients of Upper Hyperactivity of Gan Yang Syndrome

Objective To analyze and summarize changes of syndrome-related biological indices in acute lacuna encephalon infarction patients of upper hyperactivity of Gan yang syndrome （UHGYS）, thus providing objective evidence for syndrome typing and disease identification. Methods Recruited were 50 patients at Department of Encephalopathy, Xiyuan Hospital, China Academy of Chinese Medical Sciences, who were in line with diagnostic criteria of UHGYS as the experimental group in this study. Another 40 healthy volunteers were recruited as the control group from May 2010 to July 2012. Blood routines （including WBC, RBC, Hb, NEUT%, and LY%）, hepatic and renal functions tests （including ALT, AST, TBIL, TP, ALB, Cr, and BUN） were performed by automatic whole blood analyzer and colorimetric technique. The levels of fasting blood glucose, HbAlc, blood lipids （including TC, TG, HDL-C, LDL-C,and VLDL-C）, and coagulation functions （including AT-III, PT, PTA, INR, I-F, APTI＇, and FBG, reaction time）, renin, angiotensin II, hs-CRP, and Hcy were also measured. The thyroid functions （including FT3, FT4, T3, T4, and TSH） were detected by electrochemiluminescence immunoassay. The levels of tumor necrosis factor α （TNF-α）, IL-6 and IL-1 in serum were measured by ELISA and radioimmunoassay respectively. Results Compared with the control group, RBC, LY%, ALT, TP, ALB, HDL-C, AT-Ill activities, contents of PTA and FT4 obviously decreased, TBIL, BUN, Glu, HbA1 c, rSH, hs-CRP, renin, Ang II, TNF-α, IL-1 and IL-6 significantly increased in the experimental group （P 〈0.05, P 〈0.01 ）. Conclusion The pathological process of acute lacuna encephalon infarction patients of UHGYS was closely correlated with thyroid functions, the renin-angiotensin-aldosterone system, the extrinsic and intrinsic coagulation systems, as well as inflammation reaction.