40岁以上女性脑卒中高危人群腰臀比与颈动脉硬化相关性及中医证候研究

目的探讨40岁以上女性脑卒中高危人群腰臀比与颈动脉硬化的相关性及中医证候。方法选取40岁以上女性脑卒中高危人群629例,据腰臀比的四分位值将人群分为4组,比较4组的一般临床资料及颈动脉硬化发生率,并以第1组为参照,分析其余3组人群发生颈动脉硬化的危险度,然后用二元Logistic回归法探究腰臀比与颈动脉硬化发生率之间的关系。同时把人群分为绝经组与非绝经组,比较2组患者的腰臀比、颈动脉硬化的发生率以及中医症状及舌脉特征。结果 4组人群年龄、脑卒中家族史、绝经例数、体重指数、超重例数、血清甘油三酯及高密度脂蛋白水平差异有统计学意义(P0.05);4组人群颈动脉硬化发生率依次升高,差异存在统计学意义(P0.01);与第1组相比,其余3组发生颈动脉硬化的危险度依次是1.348倍、1.927倍、2.305倍,差异存在统计学意义(P0.01);在控制其他变量后,腰臀比与颈动脉硬化发生率有相关性(P0.01);与非绝经组比较,绝经组人群腰臀比值更高(P0.05),颈动脉硬化的发生率明显增高(P0.01);绝经组人群以气虚、阴虚、阳虚、血瘀证为主的症状高于非绝经组,差异具有统计学意义(P0.05或P0.01),脏腑辨证涉及肝、脾、肾三脏,病性虚实夹杂,以虚为主。结论 40岁以上女性脑卒中高危人群中,腰臀比越高发生颈动脉硬化的危险度越大,腰臀比可作为女性脑卒中高危人群颈动脉硬化的一个提示指标。对其中医证治则提示从肝、脾、肾辨证,病性虚实夹杂,以虚为主。

Correlation between waist hip ratio and carotid atherosclerosis in women aged over 40 with high risk of stroke and study on TCM pattern manifes-tations

Objective To investigate the correlation between waist hip ratio (WHR) and carotid atherosclerosis and TCM pattern manifestations in women aged over 40 with high risk of stroke. Methods The perimenopausal population with high risk of stroke (n=629) was chosen and divided, according to quartile of WHR,into 4 groups, and general clinical data and incidence of carotid atherosclerosis were compared among 4 groups. Taken group I as reference, risk of occurring carotid atherosclerosis was analyzed in other 3 group. The correlation between WHR and incidence of carotid atherosclerosis was studied by using binary Logistic regression analysis. Meanwhile, the population was divided into menopausal group and non-menopausal group, and WHR, incidence of carotid atherosclerosis, TCM symptoms and features of tongue and pulse were compared between 2 groups. Results The indexes of age, family history of stroke, menopausal cases, body mass index (BMI), overweight cases, triglyceride (TG) and high-density lipoprotein (HDL) had significant difference among 4 groups (P<0.05). The incidence of carotid atherosclerosis increased successively in 4 groups and difference had statistical significance (P<0.01). Compared with group I,risk of occurring carotid atherosclerosis was by 1.348 times,1.927 times and 2.305 times in other 3 groups(P<0.01). WHR was correlated to incidence of carotid atherosclerosis after controlled other variables (P <0.01). WHR was higher (P <0.05) and incidence of carotid atherosclerosis increased significantly (P <0.01) in menopausal group compared with non-menopausal group. The TCM pattern manifestations of qi deficiency, yin deficiency, yang deficiency and blood stasis were significantly more in menopausal group than those in non-menopausal group (P<0.05 or P<0.01). The pattern identification of viscera and bowels involved liver, spleen and kidney,and disease nature showed deficiency complicated by excessiveness and deficiency was the basis. Conclusion The risk of carotid atherosclerosis will be higher when WHR increases in women aged over 40 with high risk of stroke. WHR can be taken as an indicator of carotid atherosclerosis. The treatment with TCM is based on pattern identification of liver, spleen and kidney, and disease nature shows deficiency complicated by excessiveness and deficiency is the basis.