维吾尔族与汉族早发冠心病患者中医证型与血脂及纤维蛋白原相关性研究

目的探讨维吾尔族(维族)与汉族早发冠心病(premature coronary heart disease,PCHD)患者中医证型与血脂及纤维蛋白原(fibrinogen,FIB)的相关性。方法选择2010年10月-2011年8月新疆医科大学第一附属医院心脏中心和新疆医科大学附属中医医院首次确诊PCHD维族患者196例,汉族患者189例,另选择健康体检者60名为健康对照组。由医院心内科主治及以上医师进行中医辨证分型。采用氧化酶法检测各组患者甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)水平,采用化学修饰酶法检测高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)水平,采用选择性溶解法检测低密度脂蛋白胆固醇(low-densi-ty lipoprotein cholesterol,LDL-C)水平,采用Clauss凝固法原理检测血浆纤维蛋白原(fibrinogen,FIB)水平。结果维族证型比例依次为:秽浊痰阻证[82例(21.3%)]>气虚血瘀证[61例(15.84%)]>寒凝心脉证[39例(10.13%)]>心肾阴虚证[14例(3.63%)],汉族证型比例依次为:气虚血瘀证[69例(17.92%)]>秽浊痰阻证[67例(17.40%)]>寒凝心脉证[42例(10.91%)]>心肾阴虚证[11例(2.86%)],两组证型分布比较,差异无统计学意义(P>0.05)。与健康对照组比较,患者组秽浊痰阻证及气虚血瘀证患者TG、LDL-C、FIB水平均升高,HDL-C水平降低,维族心肾阴虚证患者HDL-C水平降低,差异均有统计学意义(P<0.01,P<0.05)。与汉族同证型比较,维族秽浊痰阻证患者TG水平升高,HDL-C水平降低,气虚血瘀证患者FIB水平升高,差异均有统计学意义(P<0.05)。维族患者秽浊痰阻证与TG(r=0.469)、FIB(r=0.464)呈正相关,与HDL-C呈负相关(r=-0.382);气虚血瘀证与FIB呈正相关(r=0.72),差异均有统计学意义(P<0.01,P<0.05)。汉族患者秽浊痰阻证与TG(r=0.445)、FIB(r=0.372)呈正相关,与HDL-C呈负相关(r=-0.37);气虚血瘀证与TG(r=0.471)、FIB(r=0.459)呈正相关,差异均有统计学意义(P<0.01,P<0.05)。结论维族、汉族PCHD患者中医证型与TG、HDL-C及FIB存在相关性。

Study on the Correlation between Chinese Medicine Syndrome Types of the Uighur and Han People and Levels of Blood Lipids and Fibrinogen in Premature Coronary Heart Disease Patients

Objective To study the correlation between the Chinese medicine(CM) syndrome types of the Uighur and Han people and levels of blood lipids and fibrinogen in premature coronary heart disease(PCHD) patients.Methods Recruited were 196 Uighur and 189 Han patients with PCHD first confirmed by coronary angiography at the Heart Center of First Affiliated Hospital of Xinjiang Medical University and Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University.Another 60 healthy volunteers were recruited as the healthy control group.CM syndromes were typed by physicians or those having higher professional titles at the cadiac internal medicine.The contents of triglyceride(TG) and total cholesterol(TC) were detected using oxidase method.The high-density lipoprotein cholesterol(HDL-C) level was detected using chemical modification enzymic method.The low-density lipoprotein cholesterol(LDL-C) level was detected using selective dissolution.The fibrinogen(FIB) level was detected using Clauss congeal principle.Results The CM syndrome types of Uighurs were sequenced as filthy turbidity and phlegm obstruction syndrome(82 cases,21.3%)>qi deficiency and blood stasis syndrome(61 cases,15.84%)>cold accumulation in Xin meridian syndrome(39 cases,10.13%)>Xin-Shen yin deficiency syndrome(14 cases,3.63%).The CM syndrome types of the Han nationality were sequenced as qi deficiency and blood stasis syndrome(69 cases,17.92%)>filthy turbidity and phlegm obstruction syndrome(67 cases,17.40%)>cold accumulation in Xin meridian syndrome(42 cases,10.91%)>Xin-Shen yin deficiency syndrome(11 cases,2.86%).There was no statistical difference in the syndrome type distribution between the two groups(P>0.05).Compared with the healthy control group,the levels of TG,LDL-C,and FIB increased,and the HDL-C level decreased in patients of filthy turbidity and phlegm obstruction syndrome and qi deficiency and blood stasis syndrome of the patient group.The HDL-C level decreased in the Uighur patients of Xin-Shen yin deficiency syndrome,showing statistical difference(P<0.01,P<0.05).Compared with the Han people of the same syndrome type,the TG level increased and the HDL-C level decreased in the Uighur patients of filthy turbidity and phlegm obstruction syndrome.The FIB level increased in the Uighur patients of qi deficiency and blood stasis syndrome with statistical difference(P<0.05).In the Uighur patients,filthy turbidity and phlegm obstruction syndrome was positively correlated with TG(r=0.469) and FIB(r=0.464),and negatively correlated with HDL-C(r=-0.382).Qi deficiency and blood stasis syndrome was positively correlated with FIB(r=0.72) with statistical difference(P<0.01,P<0.05).In the Han patients,filthy turbidity and phlegm obstruction syndrome was positively correlated with TG(r=0.445) and FIB(r=0.372),and negatively correlated with HDL-C(r=-0.37).Qi deficiency and blood stasis syndrome was positively correlated with TG(r=0.471) and FIB(r=0.459) with statistical difference(P<0.01,P<0.05).Conclusion CM syndrome types were correlated with TG,HDL-C,and FIB in PCHD Han and Uighur patients.