【作者】 王栋先；

【导师】 王新陆；

【作者基本信息】 山东中医药大学 ， 中医内科学， 2009， 博士

【摘要】 目的:从个体体质方面研究血浊的危险因素及血浊与脑梗塞、冠心病心绞痛和糖尿病的关系,为探讨血浊的形成机理、规范辨证施治和临床诊疗病证结合提供依据。方法:采用大样本病历资料回顾性研究的方法,调查612份脑梗塞、冠心病心绞痛和2型糖尿病病案的体质、病史、辨证分型、病程、病位(脑梗塞)和理化检查等资料,应用方差分析、因子分析、相关性分析等统计学方法,验证血浊的危险因素及其与疾病的相关性。结果:①高龄、形体肥胖、饮食偏嗜油腻及咸食、长期烟酒史、性格急躁易怒等均可使血浊的程度加重。②生气和既往高血压病史可使血浊的程度加重。③2型糖尿病和脑梗塞的血浊程度较冠心病心绞痛严重,尤其以2型糖尿病更为明显。④血浊兼加热毒、痰湿、气滞等标实者其程度较严重。⑤2型糖尿病病程较长者血浊程度明显加重,并且随着病程的进展,辨证为正虚血浊和痰湿血浊者其严重程度增加,而正虚血浊则与高龄呈显著相关性。在脑梗塞急性期和冠心病心绞痛发作期,血浊的辨证分型与病程无明显的相关性。⑥脑梗塞不同梗塞部位(颈内动脉系统与椎基底动脉系统血供部位及其具体部位)与血浊证型变化无显著相关性。⑦心肌缺血时血浊程度明显加重。⑧血常规各指标水平的高低与血浊的严重程度无明显相关性,空腹血糖升高时血浊程度显著加重。⑨血脂各指标的高低与血浊的严重程度呈显著相关性,其中TC、TG、LDL和apolB与血浊呈正相关性;HDL、apolA与血浊呈负相关性。⑩随着凝血各指标水平的增高血浊严重程度有加重的倾向,其中APTT和FIB与血浊呈显著(明显)相关性,即APTT和FIB水平越高血浊的程度越严重。结论:①体质因素与血浊具有明显的相关性,高龄、形体肥胖、饮食偏嗜油腻及咸食、长期烟酒史、性格急躁易怒等是血浊的危险因素。②生气和既往高血压病史可能是血浊的直接危险因素。③代谢综合征及动脉粥样硬化与血浊密切相关。④正虚血浊和痰湿血浊与2型糖尿病病程的进展呈显著(明显)相关性,其中正虚血浊主要与增龄因素有关,痰湿血浊可能与2型糖尿病的病程进展有关。脑梗塞急性期和冠心病心绞痛发作期随着病程的进展,各血浊证型演变无一定规律。⑤各种理化指标是血浊的重要诊断标准,并可帮助我们判定对其治疗的效果。更多还原

【Abstract】 Objects: To study the risk factors of blood turbidity from the aspect of individual physical constitution, and the relationship between turbid blood with cerebral infarction, angina pectoris of coronary artery disease and diabetes mellitus. In order to explore the formation mechanism of blood turbidity, standardize clinical diagnosis and treatment and provide the basic evidence for the combination of disease with syndrome.Methods: According to the retrospective study method of large sample medical records, 612 cases including cerebral infarction, angina pectoris of coronary heart disease and type 2 diabetes were surveyed. Used analysis of variance, factor analysis, correlation analysis and other statistical methods to analysis the constitution, medical history, syndrome type, course of disease, location(cerebral infarction), the physical and chemical inspection information. In order to verify the risk factors of blood turbidity and its relationship with diseases related to each other.Results:①The elder people, body fat, eating greasy and partial to salty food, long-term alcohol and tobacco history, personality impatient irritability, etc. can aggravate the degree of blood turbidity.②Angry and past history of hypertension can aggravate the degree of blood turbidity.③The blood turbid degree of 2 diabetes mellitus and cerebral infarction is more serious than angina pectoris, in particular type 2 diabetes becomes more apparent.④If it combine with toxic heat, dampness, qi stagnation, blood turbidity would become more serious.⑤2 diabetes duration longer significantly worsen the turbidity of blood, and with the progress of the course, blood turbidity combined with deficiency of vital qi and phlegm turbid blood become more serious. Turbid blood combined with deficiency of vital qi significantly relates to age. At the acute stage of cerebral infarction and onset period of coronary heart disease, the differentiation of blood turbidity syndromes has not obvious correlation with the course of disease.⑥The location of cerebral infarction in different parts (internal carotid artery system and the vertebrobasilar system)has not significant correlation with the different syndromes of blood turbidity.⑦Myocardial ischemia significantly aggravates the degree of blood turbidity.⑧Various common indexes of blood have not significant correlation with blood turbidity, but the high level of fasting blood glucose significantly aggravates the turbidity of blood.⑨The indexes of blood lipid significantly relate to blood turbidity, TC, TG, LDL and apolB have positive correlation with it; HDL, apolA negatively relate to blood turbidity.⑩The high level of clotting of blood increases the severity of blood turbidity, APTT and FIB have significant relevance with blood turbidity.Conclusions:①Constitution factor has obvious relevance with blood turbidity, age, the body fat, eating greasy and partial to salty food, long-term history of alcohol and tobacco, irritable personality are risk factors for blood turbidity.②Angry and past history of hypertension may be direct risk factors of blood turbidity.③Metabolic syndrome and atherosclerosis closely relate to blood turbidity.④Blood turbidity combined with deficiency of vital qi and phlegm blood turbidity have significantly relevance with the progress of type 2 diabetes. Blood turbidity combined with deficiency of vital qi mainly relates to age, while phlegm blood turbidity may associate with the progress of type 2 diabetes. Acute cerebral infarction and angina pectoris of coronary heart disease with a view to the progress of diseases, the syndrome changes of blood turbidity have not regularity.⑤Various physical and chemical indexes of blood are the essential diagnostic criteria for blood turbidity, and may help us to determine the effectiveness of treatment.更多还原