摘要
目的：
研究北京地区汉族中老年原发性血脂异常患者的体质状况及中老年人原发性血脂异常与中医体质的相关性。从而为临床实践中辨体论治以及中医群体化防治中老年人原发性血脂异常提供理论和客观依据。
方法：
1、共研究符合亚临床组纳入标准的中老年原发性血脂异常患者250例及符合并发症组纳入标准的中老年原发性血脂异常患者250例。调查两组患者的个人史、既往史及中医体质类型,并检测患者的总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)等血脂指标。
2、将收集到的亚临床组与并发症组患者的相关数据进行统计学分析,采用Logistic多元回归分析作中老年人原发性血脂异常与患者饮食偏好的相关性,中老年人原发性血脂异常与患者中医体质的相关性。应用典型相关分析的方法分析体质与血脂指标的相关性,体质与体重指数(BMI)、运动情况等一般情况的相关性,体质与与饮食偏好的相关性,血脂指标与体重指数(BMI)、运动情况等一般情况的相关性,血脂指标与饮食偏好的相关性。
结果：
1.回收有效调查表442份,包括亚临床组226例,并发症组216例,有效回收率为88.4%。
2.中老年人原发性血脂异常亚临床组和并发症组两组患者在性别、年龄等基线水平上无差别。中老年人原发性血脂异常亚临床组和并发症期患者在体重指数、吸烟情况及运动情况上比较均无显著差异(p>0.05)；中老年人原发性血脂异常并发症组组内冠状动脉粥样硬化性心脏病(CAHD)组与动脉粥样硬化性血栓性脑梗死(ATCI)组患者的体重指数与吸烟情况均无统计学差异(p>0.05),而在运动情况的构成上存在差异(P<0.05)。
3.中老年人原发性血脂异常亚临床组与并发症组饮食偏好的组间比较,其中奶制品、禽兽肉、水产类、蔬菜、水果、干果、咖啡、茶的组间比较无统计学差异(P>0.05)。其中豆制品、甜点与煎炸食品三项组间比较存在差异(P<0.05)。以饮食偏好对中老年人原发性血脂异常并发症发病进行二值多元Logistic回归分析。结果显示：在P<0.05水平,最终进入回归方程的相关饮食偏好因素是：煎炸食品(x8),并得出Logistic回归方程：Logit (p)=1n (p/1-p)=-1.6376+1.0557 x 8(煎炸食品)。可认为食用煎炸食品是中老年人原发性血脂异常患者并发冠状动脉粥样硬化性心脏病、动脉粥样硬化性血栓性脑梗死的危险因素
4.中老年人原发性血脂异常亚临床组与并发症组的胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇血脂指标总体分布水平无差异(p>0.05)。中老年人原发性血脂异常并发症组中冠状动脉粥样硬化性心脏病组与动脉粥样硬化性血栓性脑梗死组胆固醇与低密度脂蛋白胆固醇的总体分布相同,无统计学差异(p>0.05)；而甘油三酯与高密度脂蛋白胆固醇总体分布不同(p<0.05)。
5.中老年人原发性血脂异常患者中,亚临床组患者中单一类型的血脂异常只有低高密度脂蛋白胆固醇血症(77例,占34.07%),最多见的是高胆固醇合并高甘油三酯合并高低密度脂蛋白胆固醇血症(88例,占38.94%),其次是高胆固醇合并高甘油三酯血症(48例,占21.24%)。并发症组患者中单一类型的血脂异常包括低高密度脂蛋白胆固醇血症(39例,占18.05%)与高低密度脂蛋白胆固醇血症(23例,占10.65%),高胆固醇合并高甘油三酯合并高低密度脂蛋白胆固醇血症同样是最常见血脂异常类型(69例,占31.94%),其次是高胆固醇合并低高密度脂蛋白胆固醇血症(41例,占18.98%),再次是高胆固醇合并高甘油三酯合并低高密度脂蛋白胆固醇血症患者(36例,占16.67%)。中老年人原发性血脂异常亚临床组与并发症组病例在血脂异常的构成上差异显著(P<.0001)。
6.中老年人原发性血脂异常亚临床组患者共226例,其中平和质67例,阳虚质31例,2种相兼体质30例,3种相兼体质25例。中老年人原发性血脂异常并发症组患者共216例,其中平和质23例,气虚质31例,2种相兼体质23例,3种相兼体质36例,5种相兼体质28例。中老年人原发性血脂异常亚临床组与并发症组在体质的构成上差异显著(P<.0001)。各偏颇体质都是以兼夹体质为主,单一体质构成比均≤50%。在亚临床组患者中表现出较多的体质因素是阳虚质(88例)、气虚质(68例)、与气郁质(61例)；单一体质所占比例较大的体质包括：阴虚质(37.14%)、阳虚质(35.23%)与血瘀质(21.88%)；而湿热质(6.45%)、痰湿质(6.52%)与气郁质(6.56%)是单一体质所占比例较小的体质。在并发症组患者中表现出较多的体质因素是气虚质(123例)、阳虚质(81例)与气郁质(77例)；单一体质所占比例较大的体质包括：阴虚质(31.91%)、气虚质(25.20%)与阳虚质(20.99%)；另一方面,湿热质(3.77%)、气郁质(3.90%)与痰湿质(5.88%)以兼夹体质为主。中老年人原发性血脂异常亚临床组与并发症组在阳虚质的单一体质构成比较上存在差异(p<0.05)。
7.以体质类型因素对中老年人原发性血脂异常并发症发病进行二值多元Logistic回归分析,在P<0.05水平,最终进入回归方程的中医体质类型是：气虚质(x2)与血瘀质(x7),得出Logistic回归方程:Logit(p)=ln(p/1-p)=-0.9711+0.5952x2(气虚质)+0.3582x7(血瘀质)。可认为气虚质与血瘀质为中老年人原发性血脂异常患者并发冠状动脉粥样硬化性心脏病、动脉粥样硬化性血栓性脑梗死的危险因素
8.对血脂指标与一般情况(包括体重指数(BMI)及运动情况)两组变量进行典型相关分析,得出标准化的第一组典型相关变量W1=0.5524X1+0.2324X2,V1=-0.3036Y1+0.3122Y2-0.4691Y3-0.1327Y4。由标准化的典型相关变量可知,W1主要受Xl(体重指数)的影响,V1在Y3(高密度脂蛋白胆固醇)与Y2(甘油三酯)上的权数较大。说明体重指数超标的中老年原发性血脂异常患者的甘油三酯水平较高,高密度脂蛋白胆固醇水平较低。
结论：
1.中老年人原发性血脂异常亚临床组患者常见单一体质包括：平和质及阳虚质,兼夹体质以2种及3种相兼较多见,但仍以单一体质构成为主；中老年人原发性血脂异常并发症组患者常见单一体质包括：气虚质及平和质,兼夹体质以3种及5种相兼较多见,而且以兼夹体质为主；中老年人原发性血脂异常亚临床组与并发症组体质构成差别显著。各类型偏颇体质都是以兼夹体质为主。在亚临床组患者中表现出较多的体质因素是阳虚质、气虚质与气郁质；而湿热质、痰湿质与气郁质以兼夹体质占绝大多数。在并发症组患者中表现出较多的体质因素是气虚质、阳虚质与气郁质；湿热质、气郁质与痰湿质以兼夹体质占绝大多数。中老年人原发性血脂异常亚临床组与并发症组除阳虚质外的各偏颇体质类型单一体质构成比较上无显著差异。
2.气虚质与血瘀质为中老年人原发性血脂异常患者并发冠状动脉粥样硬化性心脏病、动脉粥样硬化性血栓性脑梗死的危险因素。食用煎炸食品是中老年人原发性血脂异常患者并发冠状动脉粥样硬化性心脏病、动脉粥样硬化性血栓性脑梗死的危险因素。
3.体重指数超标的患者的甘油三酯水平较高,高密度脂蛋白胆固醇水平较低。
Purpose:To study the distribution of TCM constitution in middle-aged and elderly primary dyslipidemia patients of Han nationality living in Beijing.To investigate the correlation between primary dyslipidemia in middle-aged and elderly patients and their TCM constitutions.This clinical research would provide theoretical and clinical bases for middle-aged and elderly primary dyslipidemia patients treated by differentiation of individuals, and also supply group precaution and therapy of TCM for middle-aged and elderly primary dyslipidemia patients.
Methods:1. We investigated 250 cases who accorded with the subclinical group inclusive criteria and 250 cases who met the inclusive criteria of concurrent group.Specifically, to survey individual medical history, past medical history and types of TCM constitution of them.Then, to measure blood-lipid of them including TC, TG, HDL-C and LDL-C.
2. Then analyzed data collected from those two groups patients.We did the statistical analysis on the correlation between middle-aged and elderly patients and their taste preferences by Logistic multiple regression analysis. We also did the Logistic multiple regression analysis on the correlation between middle-aged and elderly patients and their TCM constitutions.On the other hand, we analyzed association between TCM constitutions of middle-aged and elderly patients and their blood-lipid, and the relativity of their TCM constitutions and their general condition like BMI and exercises, and the relevance of their TCM constitutions and their taste preferences, and the relationship of their blood-lipid and their general condition, and also their blood-lipid and their taste preferences by Canonical Correlation Analysis(CCA).
Results:1.We had retrieved 442 valid questionnaires, including 226 surveys of sub-clinical group and 216 questionnaires of concurrent group. The qualified retrieval rate was 88.4%.
2. There were no statistical differences at baselines of gender and age between sub-clinical group and concurrent group patients (P>0.05). There were also no discrepancies of BMI, smoking and exercise habit in these two groups(P>0.05). In the concurrent group we gathered two typical atherosclerotic diseases of middle-aged and elderly primary dyslipidemia patients including coronary atherosclerotic heart disease (CAHD) and atherothrombotic cerebral infaction (ATCI). We didn't find differences of BMI and smoking between CAHD group and ATCI group(P>0.05), while we foud discrepancy of exercise habit in these two groups(P<0.05).
3. To compare taste preferences of sub-clinical group patients with that of concurrent group patients, there were no differences of milk products, meat, aquatic products, vegetable, fruit, coffee and tea in these two groups(P>0.05), but, discrepancies were fond between these groups of bean products,dessert and fried foods(P>0.05). Then the Multiple Logistic regression analysis was carried out to analyze correlation in food preferences and concurrent diseases of middle-aged and elderly primary dyslipidemia patients. As the result, fried foods(x8) was the only factor taken into the multiple regression equation as the standard level was P<0.05, and the equation was Logit (p)=ln (p/1-p)=-1.6376+1.0557 x8(fried foods).That was to say, preferring fried foods was the risk factor of the occurrence of concurrent diseases(including CAHD and ATCI) in middle-aged and elderly primary dyslipidemia patients.
4. There were no statistical discrepancies of TC,'TG, HDL-C and LDL-C distribution levels between sub-clinical group patients and concurrent group patients(P>0.05). We didn't find statistical differences of TC and LDL-C distribution levels between CAHD group and ATCI group(P>0.05), while we foud distinction of TG and HDL-C distribution levels in these two groups(P<0.05).
5. In the sub-clinical group,reduced HDL-C was. the only simple type of dyslipidemia(n=77,account for 34.07%),and the most common type was that combined hyper TC, high TG with high LDL-C(n=88,account for 38.94%), the next was that mixed hyper TC with high TG(n=48,account for 21.24%). In the concurrent group, simple types of dyslipidemia were low HDL-C (n=39,account for 18.05%) and high LDL-C(n=23,account for 10.65%), and the commonest type was also that combined hyper TC, high TG with high LDL-C(n=69,account for 31.94%), and the next was that mixed hyper TC with low HDL-C(n=41,account for 18.98%), then,hyper TC combined with high TG and reduced HDL-C was the next type(n=36, account for 16.67%). There were significant discrepancies of constituent of dyslipidemia types between sub-clinical group patients and concurrent group patients (P<.0001).
6. In the sub-clinical group,the total cases was 226,including 67 cases of Peace-constitution,31 cases of Yang-deficiency constitution,30 cases of 2 kinds of TCM constitutions accompanied,25 cases of 3 kinds of TCM constitutions accompanied. In the concurrent group, the total cases was 216,including 23 cases of Peace constitution,31 cases of Qi-deficiency constitution,23 cases of 2 kinds of TCM constitutions accompanied,36 cases of 3 kinds of TCM constitutions accompanied,28 cases of 5 kinds of TCM constitutions accompanied. There were remarkable differences of constituent of TCM constitutions between sub-clinical group patients and concurrent group patients (P<.0001).All the lopsided constitutions were mainly consisted of accompanied constitutions, and constituent ratio of simple constitutions were all less than 50 percent. In the sub-clinical group, Yang-deficiency constitution (n=88), Qi-deficiency constitution (n=68) and Qi-stagnation constitution (n=61) were common TCM constitution factors.The top three proportion of simple TCM constitution in the lopsided TCM constitution were Yin-deficiency constitution (37.14%), Yang-deficiency constitution (35.23%) and Blood-stasis constitution(21.88%), while the last three were Damp-heat constitution(6.45%), Phlegm-damp constitution(6.52%) and Qi-stagnation constitution(6.56%).In the concurrent group, Qi-deficiency constitution (n=123), Yang-deficiency constitution (n=81) and Qi-stagnation constitution (n=77) were common TCM constitution factors.The top three proportion of simple TCM constitution in the lopsided TCM constitution were Yin-deficiency constitution (31.91%), Qi-deficiency constitution (25.20%) and Yang-deficiency constitution (20.99%), while the last three were Damp-heat constitution (3.77%), Qi-stagnation constitution(3.9%)and Phlegm-damp constitution (5.88%). The difference of the simple constitution of Yang-deficiency constitution was found between sub-clinical group patients and concurrent group patients (P<0.05).
7. We did the Multiple Logistic regression analysis to analyze correlation between TCM constitutions and concurrent diseases of middle-aged and elderly primary dyslipidemia patients. The result was Qi-deficiency constitution (x2) and Blood-stasis constitution (x7) were factors taken into the multiple regression eauation as the standard level was P<0.05, and the equation was Logit (p)=ln (p/1-p)=-0.9711+0.5952x2 (Qi-deficiency constitution)+0.3582x7 (Blood-stasis constitution). We could say Qi-deficiency constitution and Blood-stasis constitution were risk factors of the occurrence of concurrent diseases(including CAHD and ATCI) in middle-aged and elderly primary dyslipidemia patients.
8. We analyzed association between blood-lipid of middle-aged and elderly patients and their and their general condition (including BMI and exercises) by Canonical Correlation Analysis, and we got the first group of standard Canonical Correlation variables:W1=0.5524X1+0.2324X2, Vl=-0.3036Y1+0.3122Y2-0.4691Y3-0.1327Y4. Therefrom we concluded that W1 was mainly affected by X1(BMI), top two weights of V1 were Y3 (HDL-C) and Y2 (TG). That indicated that higher level of TG and lower level of HDL-C were existed in middle-aged and elderly patients with elevated BMI level.
Conclusion:1.In the sub-clinical group, Peace-constitution and Yang-deficiency constitution were familiar simple TCM constitutions, and 2 types and 3 types combined constitutions were common mixed TCM constitutions, but they were still mainly consisited by simple TCM constitutions. In the concurrent group, Qi-deficiency constitution and Peace-constitution were common simple TCM constitutions, and 3 types and 5 types combined constitutions were common mixed TCM constitutions, and the foremost TCM constitutions were consisited by mixed TCM constitutions.There were remarkable differences of constituent of TCM constitutions between sub-clinical group patients and concurrent group patients. All the lopsided constitutions were mainly consisted of combined constitutions. In the sub-clinical group, Yang-deficiency constitution, Qi-deficiency constitution and Qi-stagnation constitution were common TCM constitution factors.But Damp-heat constitution, Phlegm-damp constitution and Qi-stagnation constitution were predominantly existed in combined constitutions.In the concurrent group, Qi-deficiency constitution, Yang-deficiency constitution and Qi-stagnation constitution were common TCM constitution factors. However, Damp-heat constitution, Qi-stagnation constitution and Phlegm-damp constitution were predominantly consisted in combined constitutions.There were no differences of the simple constitution of each lopsided constitution was found between sub-clinical group patients and concurrent group patients except Yang-deficiency constitution.
2. Qi-deficiency constitution and Blood-stasis constitution were risk factors of the occurrence of concurrent diseases(including CAHD and ATCI) in middle-aged and elderly primary dyslipidemia patients, and preferring fried foods was the risk factor of the occurrence of concurrent diseases(including CAHD and ATCI) in middle-aged and elderly primary dyslipidemia patients.
3. Higher level of TG and lower level of HDL-C were existed in middle-aged and elderly patients with elevated BMI level.
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