摘要
目的:通过测定脑梗死后热休克蛋白70(HSP70)的表达水平,结合传统中医的理论,分析HSP70表达水平与中医证型的相关性;研究HSP70表达水平与患者年龄、性别、NIHSS评分的相互关系;探索脑梗死中医证型与NIHSS评分的关系。为中医辨证提供科学依据,并将HSP70作为临床判断患者病情严重程度、评估预后的一项参考指标。方法:依据实用内科学第14版关于脑梗死的诊断标准[1],选择2013年11月—2014年11月新入院的脑梗死患者91例,按照中医证型辨证量化标准分为中经络证型组和中脏腑证型组,同时选取30例符合入组标准的健康人做为正常对照组。采用酶联免疫吸附测定(ELISA)法检测所有入组样本血清中的HSP70表达水平,并记录患者的年龄、性别、既往病史、个人史、体质量指数(BMI)、以及CT或MRI等检查结果。结果:(1)中经络组脑梗死患者中NIHSS评分为轻型(NIHSS≤4分)的占22.22%,中型(5≤NIHSS<20分)占75%,重型(NIHSS≥20分)占2.78%;而中脏腑患者评分为中型(5≤NIHSS<20分)的占15.79%,重型(NIHSS≥20分)的占84.21%。两组患者在各型NIHSS评分中相互比较,差异有统计学意义(P<0.05)。(2)脑梗死患者NIHSS评分为轻、中、重型的HSP70表达水平两两比较,轻型组与中型组、重型组相比较,差异均有统计学意义(P<0.05),中型组与重型组相比较,差异无统计学意义(P>0.05)。(3)与正常对照组相比较,脑梗死组患者HSP70表达量明显升高,差异均具有统计学意义(P<0.05);两组脑梗死患者相比较,中经络组HSP70表达量较中脏腑组高,差异具有统计学意义(P<0.05)。(4)不同年龄段脑梗死患者HSP70表达水平存在差异,有统计学意义(P<0.05),且随年龄的增加,Hsp70水平逐渐降低。HSP70水平与年龄呈显著的负相关关系(P<0.01),而与性别没有相关关系(P=0.407)。结论:(1)脑梗死好发于中老年男性患者,体质量指数≥28 kg/m2、高血压病史、冠心病病史是脑梗死发病的危险因素,与中医证型相关,且与脑梗死患者病情的严重程度密切相关。(2)HSP70表达水平与中医证型相关,与NIHSS评分、患者的年龄呈负相关关系。
Objective： Through detecting HSP70 expression levels after cerebral infarction,combined with traditional Chinese medicine theory,to analyze the correlation between the expression levels of HSP70 and TCM syndrome types; relationship between HSP70 expression and age,gender,neurological deficits; relationship between TCM syndromes and NIHSS score to provide an objective basis for TCM. On the other hand,HSP70 can be regarded as an objective reference index for clinical diagnosis of cerebral infarction and an objective index for assess prognosis of the patients. Methods： According to the diagnostic criteria and exclusion criteria provided by Practice of Internal Medicine 14 thEdition,91 patients with cerebral infarction admitted in November 2013 to November 2014,according to the TCM syndrome standards,were divided into meridian syndrome group and organs syndrome group,at the same time 30 healthy people who met the inclusion criteria were as a control group. All samples＇ serum HSP70 levels were detected by ELISA,recording the patients＇ age,gender,past medical history,personal history,body mass index（ BMI）,blood lipid,serum homocysteine（ HCY）,and CT or MRI and so on. Results：（ 1） NIHSS score of patients in meridian syndromes group： light（ NIHSS ≤4） accounted for22. 22%; medium（ 5≤NIHSS 20） accounted for 75%; severe（ NIHSS≥20） accounted for 2. 78%. The NIHSS score in organs syndromes group： medium（ 5 ≤ NIHSS 20） accounted for 15. 79%; severe（ NIHSS ≥ 20） accounted for84. 21%. The two groups＇ neurological impairment score was statistically significant（ P 〈0. 05）.（ 2） For cerebral infarction patients with light,medium and heavy NIHSS score,the expression level of HSP70 of the light group compared with that of medium and heavy groups,the difference was statistically significant（ P 〈0. 05）. The medium group compared with heavy group,the difference was not statistically significant（ P 〉0. 05）.（ 3） Compared with the control group,the expression of HSP70 was significantly higher in patients with cerebral infarction group and the differences were statistically significant（ P 〈0. 05）. Cerebral infarction patients in the two groups were compared and the expression of HSP70 in meridian syndromes group was higher than that of organs syndromes group and the difference was statistically significant（ P 〈0. 05）.（ 4） Differences in the level of expression of HSP70 in patients with cerebral infarction in different age groups had statistical significance（ P 〈0. 05） and with the increase of age,the level of HSP70 decreased gradually.HSP70 levels and age had a significant negative correlation（ P〈0. 01） but there was no correlation with gender（ P =0. 407）. Conclusions：（ 1） The TCM syndrome types of cerebral infarction are dominated by meridian syndromes group.Cerebral infarction occurred in elderly male patients. BMI ≥28 kg / m2,history of hypertension and history of coronary heart disease are the risk factors of cerebral infarction,associated with the syndrome types of TCM and closely related to the severity of the disease in patients with cerebral infarction.（ 2） The expression level of HSP70 was related with the syndrome types of TCM and was negatively related to the NIHSS score,the age of the patients.
出处
《中华中医药学刊》
CAS
北大核心
2016年第1期49-53,共5页
Chinese Archives of Traditional Chinese Medicine
基金
国家自然科学基金项目(81460209)
