apoB、apoB/A1对急性心肌梗死痰瘀互结证的预测价值  

Predictive Value of apoB and apoB/A1 in Acute Myocardial Infarction of Phlegm Blended with Blood Stasis Syndrome

作　　者：陈广美 袁康 陈景利[2] 赵丹丹 黄娜 杨勇明 毕莹 CHEN Guangmei;YUAN Kang;CHEN Jingli;ZHAO Dandan;HUANG Na;YANG Yongming;BI Ying(The Eighth Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510006 Guangdong,China;Foshan Hospital of Traditional Chinese Medicine,Foshan 528000 Guangdong,China)

机构地区：[1]广州中医药大学第八临床医学院,广东广州510006 [2]佛山市中医院,广东佛山528000

出　　处：《广州中医药大学学报》2025年第3期546-551,共6页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：佛山市科技局科研项目(编号:2220001004579);佛山市卫生健康局科研项目(编号:20230382);佛山市高水平医院建设“登峰计划”实施方案项目(编号:佛卫函【2021】73号)。

摘　　要：【目的】探讨载脂蛋白B(apoB)及其与载脂蛋白A1(apoA1)的比值(apoB/A1)对急性心肌梗死(AMI)痰瘀互结证的预测价值。【方法】收集试验周期内就诊于佛山市中医院的经冠脉造影确诊为AMI的患者共200例,收集患者的性别、年龄、既往病史(高血压病、冠心病、糖尿病)、吸烟史等基本信息以及四诊资料和血脂、冠脉病变支数、Gensini评分等相关指标,通过单因素和多因素Logistic回归分析以及绘制受试者工作特征(ROC)曲线等统计学方法探讨apoB、apoB/A1对AMI痰瘀互结证的预测价值。【结果】(1)中医证型分布方面:200例AMI患者中,痰瘀互结证74例,气虚血瘀证41例,气滞血瘀证36例,其他证型49例(包括寒凝心脉证16例、气阴两虚证22例、正虚阳脱证11例)。(2)不同中医证型的冠脉病变情况方面:不同中医证型的Gensini评分比较,差异有统计学意义(H=43.735,P=0.000<0.001),其中,气虚血瘀证、气滞血瘀证、痰瘀互结证的Gensini评分较高,分别为60.0(43.0,87.0)、70.0(48.5,84.0)、65.0(40.0,95.0)分,均高于其他证型的44.0(32.0,64.0)分,组间比较,差异均有统计学意义(P<0.05);而不同中医证型的病变支数比较,差异无统计学意义(H=1.180,P=0.758>0.05)。(3)相关性分析结果显示,冠脉病变支数、Gensini评分与apoB/A1呈显著性正相关(r=0.140,P=0.049<0.05;r=0.205,P=0.004<0.01)。(4)单因素和多因素Logistic回归分析结果显示,apoB、apoB/A1是痰瘀互结证的独立危险因素(P<0.01)。ROC曲线分析结果显示,apoB/A1对AMI痰瘀互结证有较高的预测价值,其敏感性和特异性均较高。【结论】apoB/A1可以作为临床中预测痰瘀互结型AMI的客观指标。Objective To analyze the predictive value of apolipoprotein B(apoB)and apoB to apolipoprotein A1(apoA1)ratio(apoB/A1)in acute myocardial infarction(AMI)of phlegm blended with blood stasis syndrome.Methods A total of 200 patients with AMI confirmed by coronary angiography in Foshan Hospital of Traditional Chinese Medicine during the trial period were collected.Data collection covered the basic information of gender,age,medical history of hypertension,coronary heart disease and diabetes mellitus,and smoking history,the information of four diagnostic methods of traditional Chinese medicine(TCM),and relevant indicators of blood lipids,the number of lesioned branches of coronary arteries and the Gensini scores.The predictive value of apoB and apoB/A1 for AMI of phlegm blended with blood stasis syndrome was explored by univariate Logistic regression analysis and multivariate Logistic regression analysis as well as by plotting the Receiver Operating Characteristic(ROC)curves.Results(1)Among the 200 AMI patients,41 cases were differentiated as qi deficiency and blood stasis syndrome,36 cases as qi stagnation and blood stasis syndrome,74 cases as phlegm blended with blood stasis syndrome,and 49 cases as other syndromes(including 16 cases of cold accumulation in heart vessels syndrome,22 cases of qi and yin deficiency syndrome,and 11 cases of healthy-qi deficiency and yang collapse syndrome).(2)The difference of Gensini scores among the patients with various TCM syndrome types were statistically significant(H=43.735,P=0.000<0.001).And the Gensini scores in the patients with syndromes of qi deficiency and blood stasis,qi stagnation and blood stasis,and phlegm blended with blood stasis were relatively high,being 60.0(43.0,87.0),70.0(48.5,84.0)and 65.0(40.0,95.0)points,respectively,which were higher than that of the other TCM syndrome types[44.0(32.0,64.0)points].The pairwise comparison between various TCM syndrome types showed that the differences were statistically significant(P<0.05).However,there was no statistically sign

关 键 词：急性心肌梗死 痰瘀互结证 载脂蛋白 预测价值 

分 类 号：R259.414[医药卫生—中西医结合]