冠心病中医证候与血清MCP-1、YKL-40水平相关性研究

【作者】 孙荣妍；

【导师】 胡元会；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2012， 硕士

【摘要】 背景：冠状动脉粥样硬化性心脏病,简称冠心病,是冠状动脉粥样硬化导致冠状动脉血管腔狭窄或阻塞,或因冠状动脉功能性改变导致心肌缺血缺氧、坏死而引起的心脏病。冠心病是动脉粥样硬化导致器官病变的常见类型之一。随着社会经济的飞速发展和人们生活方式的不断改变,冠心病的发病率逐年提高,是严重危害人类健康的常见病、多发病,是由于疾病导致人类死亡的首要病因。冠心病的预防和治疗已成为目前医学研究的热点之一。中医药在治疗冠心病方面显示出独特的理论和方法,具有一定的效果和良好的前景,尤其是采用辨证论治的个体化诊疗为其重要特点。辨证论治中的证,即指证候。证候在中医辨证论治中起着承上启下的作用,结合病因病机并承引诊断与治则,是疾病过程中某一阶段人体对内外致病因素做出的综合反应。然冠心病中医证候规律、客观量化指标尚缺乏统一认识,有待于进一步研究。本文采用酶联免疫吸附法检测冠心病不同中医证候和健康对照组间血清单核细胞趋化蛋白-1、人类软骨糖蛋白-39水平,并通过冠状动脉造影术明确病变程度,以期通过研究血清单核细胞趋化蛋白-1、人类软骨糖蛋白-39水平与冠心病心绞痛中医证候及冠脉病变程度的相关性,探讨冠心病中医证候客观化的量化指标,为冠心病的中医辨证分型提供客观依据,指导冠心病的中医辨证论治。目的：探讨冠心病心绞痛患者不同中医证候与单核细胞趋化蛋白-1、人类软骨糖蛋白-39水平及冠脉病变程度之间的相关性,探讨冠心病中医证候客观化的量化指标,为冠心病的中医辨证分型提供客观依据,指导冠心病的中医辨证论治。方法：选取124例心内科住院患者,经选择性冠状动脉造影术(SCAG)证实为冠心病患者,其中中医辨证为气阴两虚证24例、气虚血瘀证24例、气滞血瘀证25例、痰阻心脉证26例、痰热内蕴证25例。另选取21例健康体检者作为健康对照组。所有入选病例采用ELISA法测定血清MCP-1、YKL-40水平结果：1冠心病组血清MCP-1、YKL-40水平明显高于健康对照组,P<0.05,差异有统计学意义2不同冠脉病变支数组间,血清MCP-1水平呈现三支病变组>双支病变组>单支病变组的趋势；血清YKL-40水平呈现三支病变组>双支病变组>单支病变组的趋势。3不同冠脉Gensini积分组间,血清MCP-1水平呈现重度病变组>中度病变组>轻度病变组的趋势；血清YKL-40水平呈现重度病变组>中度病变组>轻度病变组的趋势。4冠心病中医证候组间,血清MCP-1水平呈现气滞血瘀证>痰阻心脉证>痰热内蕴证>气虚血瘀证>气阴两虚证的趋势,其中气滞血瘀证血清MCP-1水平显著高于其他证候,P<0.05,差异有统计学意义。冠心病中医证候组间,血清YKL-40水平呈现气虚血瘀证>痰热内蕴证>痰阻心脉证>气阴两虚证>气滞血瘀证的趋势,其中气虚血瘀证血清YKL-40水平显著高于其他证候,P<0.05,差异有统计学意义。5冠心病虚实证候组间,血清MCP-1水平实证组较虚证组、虚实夹杂证组明显升高,P<0.05,差异有统计学意义；血清YKL-40水平虚实夹杂证组较实证组、虚证组明显升高,P<0.05,差异有统计学意义。6冠心病中医证候与危险因素(性别、年龄、吸烟史、冠脉积分、血清MCP-1、血清YKL-40、冠脉病变支数等)的二值Logistic回归研究结果表明,血清YKL-40水平升高、冠脉Gensini积分增加及有吸烟史,出现气虚血瘀证风险会增加,出现气阴两虚证、痰热内蕴证风险会降低；血清MCP-1水平升高及没有饮酒史,出现气滞血瘀证风险会增加。结论：1冠心病患者血清MCP-1、YKL-40水平明显高于健康对照组,并且二者与冠脉病变程度呈正相关,随着冠脉病变支数和冠脉Gensini积分的增加而升高。2冠心病气滞血瘀证患者血清MCP-1水平较其他证候升高。血清MCP-1水平表现为实证组>虚实夹杂证组>虚证组3冠心病气虚血瘀证患者血清YKL-40水平较其他证候升高。血清YKL-40水平表现为虚实夹杂证>实证组>虚证组4冠心病中医证候与危险因素的二值Logistic回归研究结果表明：血清MCP-1水平升高、血清YKL-40水平升高、冠脉Gensini积分增加及有吸烟史,都属于冠心病发病的危险因素；并且血清YKL-40水平升高、冠脉Gensini积分增加及有吸烟史,出现气虚血瘀证风险会增加；血清MCP-1水平升高,出现气滞血瘀证风险会增加。本研究结果提示气滞血瘀证可能和MCP-1相关,气虚血瘀证可能和YKL-40相关,MCP-1和YKL-40可能作为冠心病辨证分型的客观指标,能为冠心病中医辨证论治、立法用药提供参考。MCP-I YKL-40与冠脉病变程度之间存在一定的相关性,可做为判断冠状动脉病变程度的临床检测指标。更多还原

【Abstract】 Objective:Use the study of the correlation of the different Chinese medicine syndrome types of Coronary heart disease (CHD) with the serum level of Monocyte chemotactic protein-l(MCP-l), Human cartilage glycoprotein-39(YKL-40), and the severity of coronary artery stenosis, and to discuss CHD syndromes objective quantitative index, provide an objective reliance for CHD syndrome differentiation, guide the syndrome differentiation and treatments.Methods:Choose124Cardiovascular Dept. inpatients, proved to be CHD patients by SCAG. The124CHD cases are divided into5groups, according to the Chinese Medicine Syndrome Diagnostic Standards, namely qi deficiency and yin deficiency syndrome with24cases (A), qi deficiency with blood stasis syndrome with24cases (B), blood stasis due to qi stagnation syndrome with25cases (C), phlegm turbidity obstructing heart vessel syndrome with26cases (D) and internal harassment of phlegm-heat syndrome with25cases (E). Choose another21cases healthy check-up as healthy control group.Use ELISA to assay the serum levels of MCP-1and YKL-40.Results:1Serum levels of MCP-1, YKL-40are significantly higher in CHD groups than the control group, indicating significant statistic difference (p<0.05).2The serum levels of MCP-1descend from three-vessel lesion group, via two-vessel lesion group, to one-vessel lesion group trend. And the serum levels of YKL-40descend from three-vessel lesion group, via one-vessel lesion group, to two-vessel lesion group.3According to the coronary Gensini integral, the serum levels of MCP-1descend from severe disease group, via moderate disease group, to mild disease group trend. The serum levels of YKL-40descend from severe disease group, via moderate disease group, to mild disease group trend.4In CHD groups, the serum levels of MCP-1descend as follows:C>D>E>B> A, and are higher in group C than other groups showing statistic difference (p<0.05). The serum levels of YKL-40descend as follows:B>E>D>A>C, and the serum levels of YKL-40in B are higher than other groups, showing statistic difference (p<0.05). 5The serum levels of MCP-1are higher in excess syndrome group than deficiency-excess complex syndrome group and deficiency syndrome group, showing statistic difference(p<0.05). The serum levels of YKL-40are higher in deficiency-excess complex syndrome group than excess syndrome group and deficiency syndrome group, showing statistic difference(p<0.05).6The results of the different Chinese medicine syndrome types of CHD and risk factors (including gender, age, smoking history, the coronary Gensini integral, serum level of MCP-1, serum level of YKL-40, coronary lesion vessels, etc.) binary logistic regression show:The rise of serum levels of YKL-40and the coronary Gensini integral, and the smoking history will increase the possibility of qi deficiency with blood stasis syndrome and decrease the possibility of the qi deficiency and yin deficiency syndrome and internal harassment of phlegm-heat syndrome. The rise of serum levels of MCP-1with no drinking history will increase possibility of the blood stasis due to qi stagnation syndrome.Conclusion:The study shows relationship between the serum levels of MCP-1and the blood stasis due to qi stagnation syndrome, and relationship between the serum level of YKL-40and the qi deficiency with blood stasis syndrome. The MCP-1and YKL-40can be promising objective indexes for CHD syndrome differentiation, and serve as the reference of CHD diagnosis and medication. There’s correlation of serum levels of MCP-1, YKL-40with the severity of coronary artery stenosis, and thus the two can be used as clinical test index for the severity of CHD.更多还原