脑卒中高危伴颈动脉硬化人群内脏脂肪指数、脂质蓄积指数与中医证候的相关性研究

Correlation between visceral fat index,lipid accumulation index and syndromes of traditional Chinese medicine in high risk of stroke population with carotid atherosclerosis

关键词:  内脏脂肪指数  脂质蓄积指数  脑卒中高危人群  颈动脉硬化  中医证候

Key words:  VAI  LAP  high-risk stroke population  carotid atherosclerosis  TCM syndrome

摘要:

[目的] 内脏脂肪指数（VAI）、脂质蓄积指数（LAP）是反映内脏肥胖的新型指标，其与脑血管事件风险及中医证候之间关系的证据很少。旨在对脑卒中高危伴颈动脉硬化人群进行中医证候研究，探讨该部分人群中医证候分布规律及内脏肥胖与中医证候的关系。[方法] 研究依托于国家卫生健康委员会“国家医改重大专项-卫生部脑卒中筛查与防治工程”项目。病例来源为北京市丰台区8家社区医院筛查出的脑卒中高危人群9 215例。通过面对面问卷调查方式收集完整的人口学信息及中医证候量表。检测项目包括体格检查、血液检查和颈动脉超声检查。通过公式计算得出VAI、LAP两个指标。运用因子分析法对脑卒中高危伴颈动脉硬化人群进行中医证候研究。[结果] 对9 215名受试者[平均年龄（60±9）岁，61.5％为女性]进行了分析。动脉硬化的患病率为74.8％。颈动脉硬化组的内脏肥胖指标腰围（P<0.001）、腰高比（WHtR）（P<0.001）、LAP（P<0.001）水平显著高于无颈动脉硬化组；颈动脉硬化人群共提取出5个证候要素，包括：气虚、阴虚、痰湿、火热、瘀血。颈动脉硬化人群内火证（P<0.001）、血瘀证（P<0.001）、痰湿证（P<0.001）发生率显著高于无颈动脉硬化组；不同VAI组间阴虚证（P<0.001）、气虚证（P<0.001）发生率有显著差异，不同LAP组间内火证（P<0.05）、阴虚证（P<0.001）、气虚证（P<0.001）、痰湿证（P<0.001）发生率有显著差异。[结论] 脑卒中高危伴颈动脉硬化人群证候要素以痰湿、内火、瘀血等实证较为突出，脏腑定位肝、脾、肾3脏，该部分人群证候分布特征为既有气虚、阴虚的本虚之象，又有内火、痰湿、瘀血的标实之证，属于虚实夹杂，以实为主。

Abstract:

[Objective] Visceral adipose index (VAI) and lipid accumulation index (LAP) are new indicators that reflect visceral obesity,and there is little evidence for its relationship with the risk of cerebrovascular events. This study aimed to investigate the relationship between visceral fat index and lipid accumulation index and carotid atherosclerosis (CAS) in high-risk stroke patients.[Methods] Across-sectional study was performed from eight communities in urban areas of Northern China. A total of 9 215 high-risk of stroke participants were screened and basic information and traditional Chinese medicine (TCM) syndrome scale were collected. Two indicators including VAI and LAP,were calculated by formulas. TCM syndromes in patients with high risk of stroke and carotid atherosclerosis were analyzed by factor analysis.[Results] The 9 215 subjects[mean age (60±9) years,61.5% of women] were analyzed. The prevalence of CAS was 74.8%. Compared with the non-carotid arteriosclerosis group,the levels of waist circumference,WHtR,and LAP in the carotid arteriosclerosis group were significantly higher (P<0.001). A total of 5 syndrome elements were extracted from arteriosclerosis group including qi deficiency,yin deficiency,phlegm-dampness,fire heat,and blood stasis. Incidence of carotid atherosclerosis in fire heat syndrome,blood stasis syndrome and phlegm-dampness syndrome in the carotid arteriosclerosis group were higher than that in the non-carotid arteriosclerosis group (P<0.001). There was obvious difference in VAI incidence of carotid arteriosclerosis between yin deficiency syndrome and qi deficiency syndrome (P<0.001). There was obvious difference in LAP incidence of carotid arteriosclerosis between fire heat syndrome,yin deficiency,qi deficiency,and phlegm-dampness (P<0.001 or P<0.05).[Conclusion] In the high-risk stroke population with carotid arteriosclerosis,syndrome elements such as phlegm-dampness,fire heat,and blood stasis are more prominent. The internal organs are located in the liver,spleen,and kidney. The distribution of syndromes is characterized by deficiency syndromes such as qi deficiency and yin deficiency,and excess syndromes such as fire heat,phlegm-dampness,and blood stasis. The disease mechanism mainly belongs to mixture of deficiency and excess,mostly attributes to excess syndromes.