大动脉粥样硬化脑梗死中医证素与新血栓四项分析  

Analysis of the elements of Chinese medicine evidence of atherosclerotic cerebral infarction in large arteriesrs and the new four thrombotic markers

作　　者：孙蕾 杨思宇 雷瑞宁 孟江涛 赵晓霞[3] Sun Lei;Yang Siyu;Lei Ruining;Meng Jiangtao;Zhao Xiaoxia(Shanxi University of Chinese Medicine,Taiyuan 030023,China;Shanxi Medical University,Taiyuan 030012,China;Department of Neurology,Shanxi Provincial People's Hospital,Taiyuan 030012,China)

机构地区：[1]山西中医药大学,太原030023 [2]山西医科大学,太原030012 [3]山西省人民医院神经内科,太原030012

出　　处：《国际中医中药杂志》2025年第2期157-164,共8页International Journal of Traditional Chinese Medicine

基　　金：山西省中医药管理局项目(2022ZYYC070)。

摘　　要：目的探讨大动脉粥样硬化(LAA)脑梗死中医证素与新血栓四项及脑血管病危险因素的相关性。方法回顾性分析2022年8月-2023年9月山西省人民医院神经内科174例LAA脑梗死住院患者的基线资料、四诊信息,将其分为内风、气虚、内火、血瘀、阴虚、痰湿6个基本证素,于24 h内行血栓调节蛋白(TM)、纤溶酶-α2抗纤溶酶抑制物复合物(PIC)、凝血酶-抗凝血酶原复合物(TAT)、组织型纤溶酶原激活物-纤溶酶原激活物抑制剂复合物(t-PAIC)检测,将LAA脑梗死患者中医证素分型与基线资料及血栓四项检测结果进行相关性分析。结果174例LAA脑梗死患者中属内风证素49例(28.16%)、痰湿证素37例(21.26%)、气虚证素37例(21.26%)、内火证素16例(9.20%)、阴虚证素18例(10.35%)、血瘀证素17例(9.77%)。各中医证素血浆TM(P=0.003)、PIC(P=0.022)、TAT(P<0.001)、t-PAIC(P=0.007)水平比较差异有统计学意义(P<0.05)。Logistic回归分析显示,以内风证素为参考值,其中性别是中医内风证素和气虚证素[OR(95%CI)为0.140(0.037~0.536)]、血瘀证素[OR(95%CI)为0.185(0.042~0.820)]的影响因素;TM是内风证素和阴虚证素[OR(95%CI)为0.617(0.423~0.900)]、血瘀证素[OR(95%CI)为0.693(0.496~0.968)]的影响因素;TAT是内风证素、痰湿证素[OR(95%CI)为2.143(1.364~3.367)]、气虚证素[OR(95%CI)为1.937(1.221~3.073)]、内火证素[OR(95%CI)为2.949(1.796~4.842)]、血瘀证素[OR(95%CI)为2.118(1.246~30600)]的影响因素;t-PAIC是内风证素、气虚证素[OR(95%CI)为1.140(1.033~1.258)]的影响因素(P<0.05)。ROC曲线提示TM水平为8.05 TU/ml时,对阴虚证素的诊断性能为71.8%;TAT水平为2.45μg/L时,对内风证素的诊断性能为71.2%;TAT水平为1.65μg/L时,对内火证素的诊断性能为72.6%;t-PAIC水平为17.55μg/L时,对气虚证素的诊断性为70.4%。结论血浆TM、TAT、t-PAIC水平是LAA脑梗死患者不同证素的独立危险因素,可作为早期判断不同证素的标志物。Objective To study the correlation of TCM syndrome elements of large artery atherosclerosis(LAA)cerebral infarction with the new four thrombotic markers and cerebrovascular disease risk factors.Methods Retrospective analysis was conducted for the baseline data and four diagnosis of 174 patients with LAA cerebral infarction in Department of Neurology,Shanxi Provincial People's Hospital from August 2022 to September 2023.These patients were classified into six TCM syndrome elements:internal wind,qi deficiency,internal fire,blood stasis,yin deficiency,and phlegm-dampness.Thrombomodulin(TM),fibrin-α2 antifibrinolytic inhibitor complex(PIC),thrombin-antithrombinogen complex(TAT),and tissue-type plasminogen activator-plasminogen activator inhibitor complex(t-PAIC)tests were performed in 24 h.Correlation analysis was conducted between the TCM syndrome typing of LAA stroke patients and baseline data,as well as the results of four thrombotic tests.Results Among the 174 patients with LAA cerebral infarction,49(28.16%)were in the internal wind type,37(21.26%)in the phlegm-dampness type,37(21.26%)in the qi deficiency type,16(9.20%)in the internal fire type,18(10.35%)in the yin deficiency type,and 17(9.77%)in the blood stasis type.Comparison of plasma TM(P=0.003),PIC(P=0.022),TAT(P<0.001)and t-PAIC(P=0.007)levels of each TCM syndrome element showed statistically significant differences(P<0.05).Logistic regression analysis showed that gender was an influencing factor for the internal wind syndrome element and qi deficiency syndrome element[OR(95%CI)=0.140(0.037-0.536)]and blood stasis syndrome element[OR(95%CI)=0.185(0.042-0.820)]in TCM;TM was an influencing factor for the internal wind syndrome element and yin deficiency syndrome element[OR(95%CI)=0.617(0.423-0.900)],and blood stasis syndrome element[OR(95%CI)=0.693(0.496-0.968)];TAT was an influencing factor for internal wind syndrome element and phlegm-dampness syndrome element[OR(95%CI)=2.143(1.364-3.367)],qi deficiency syndrome element[OR(95%CI)=1.937(1.221-3.073)],and i

关 键 词：动脉粥样硬化 脑梗塞 中医证素 血栓调节蛋白 纤溶酶-α2抗纤溶酶抑制物复合物 凝血酶-抗凝血酶原复合物 组织型纤溶酶原激活物-纤溶酶原激活物抑制剂复合物 诊断 

分 类 号：R74[医药卫生—神经病学与精神病学]