缺血性中风病始发态痰热证与痰热伴气虚证的差异探索  

Exploration of the differences between phlegm-heat syndrome and phlegm-heat associated with qi deficiency syndrome in the initial state of ischemic stroke

作　　者：马鹏珍 古金晓 何丽丽 杜雨轩 梁笑笑 栾慧林 陈婷婷[2] 谢颖桢[1] MA Pengzhen;GU Jinxiao;HE Lili;DU Yuxuan;LIANG Xiaoxiao;LUAN Huilin;CHEN Tingting;XIE Yingzhen(Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China;Fangshan Hospital of Beijing University of Chinese Medicine,Beijing 102499,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京中医药大学房山医院,北京102499

出　　处：《现代中西医结合杂志》2023年第22期3079-3086,共8页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：国家重点研发计划资助项目(2017YFC1700101)。

摘　　要：目的以痰热是否伴有气虚要素为切入点,基于临床特征与代谢组学,探索缺血性中风病始发态痰热证与是否伴有气虚证的宏微观辨证依据。方法纳入2020年9月—2021年9月北京中医药大学东直门医院、北京中医药大学房山医院收治的缺血性中风病急性期(发病72 h以内)患者63例。依据《缺血性中风病证候要素诊断量表》各证候要素诊断成立的标准,将符合“痰湿+内火”且不伴有气虚要素的26例患者作为痰热组,将符合“痰湿+内火+气虚”要素的37例患者作为痰热+气虚组,比较2组患者临床特征,同时基于非靶向代谢组学及相应统计学方法筛选差异代谢物。结果2组患者基础疾病、病因分型、神经功能缺损程度、远期预后、血常规检查指标比较差异均无统计学意义(P均>0.05),在发病诱因、劳累诱因、颅内血管闭塞方面差异有统计学意义(P均<0.05)。痰热+气虚组患者具有诱发因素比例明显高于痰热组,以发病前存在劳累的诱因多见,且在影像方面更多地表现为颅内血管闭塞;在代谢组学方面,2组血清共筛选出9种具有统计学差异的代谢产物,分别为LysoPC(20∶5/0∶0)、LysoPC(18∶3/0∶0)、LysoPC(18∶1/0∶0)、LysoPC(18∶0/0∶0)、Choline、LysoPC(18∶2/0∶0)、2-Methyl-1,3-cyclohexadiene、Glycine、2-Ketobutyric acid。结论缺血性中风病痰热伴气虚证往往具有发病前劳累的诱因,且颅内血管多具有闭塞的基础情况,其差异代谢产物主要涉及能量代谢与氧化应激等通路。将临床特征及生物学指标串联应用,可为中医证候要素诊断的辨证及机制探索提供宏微观依据。Objective Taking whether phlegm heat is accompanied by qi deficiency element as the starting point,it is to explore the macro and micro syndrome differentiation evidences of phlegm heat syndrome and whether it is accompanied by qi deficiency syndrome in the initial state of ischemic stroke based on clinical characteristics and metabolomics.Methods A total of 63 patients with acute cerebral infarction within 72 hours treated in Dongzhimen Hospital of Beijing University of Chinese Medicine and Fangshan Hospital of Beijing University of Chinese Medicine were selected.According to the criteria for the diagnosis of various syndrome elements in the“Diagnosis Scale for Ischemic Stroke Syndrome Elements”,the patients including 26 cases who meet the criteria of“phlegm dampness+internal fire”and were not accompanied by qi deficiency elements were divided into the phlegm heat group,and the patients including 37 cases who meet the criteria of“phlegm dampness+internal fire+qi deficiency”were divided into the phlegm heat+qi deficiency group.The clinical features of patients were compared between the two groups,and their differential metabolites were screened based on non targeted metabolomics and corresponding statistical methods.Results There was no statistically significant difference in underlying diseases,etiological classification,neurological deficits,long-term prognosis,and blood routine examination between the two groups(all P>0.05),there were significant difference in predisposing factors for onset,fatigue,and intracranial vascular occlusion between the two groups(all P<0.05).The proportion of patients with inducing factors in the phlegm-heat+qi deficiency group was significantly higher than that in the phlegm-heat group,the inducing factor being fatigue before the onset of the disease was more common,and more commonly manifested as intracranial vascular occlusion in terms of imaging.In terms of metabolomics,a total of 9 metabolites with statistical differences were screened from the two serum groups,namel

关 键 词：证候要素 临床特征 代谢组学 痰热证 气虚证 

分 类 号：R743.3[医药卫生—神经病学与精神病学]