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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第25卷

期數(shù):

2013年03期

頁碼:

35-40

欄目:

股骨頭壞死

出版日期:

2013-03-20

文章信息/Info

Title:

Study on the relationship between TCM syndromes of osteonecrosis of femoral head and hematological indexes

作者:

陳鎮(zhèn)秋¹; 何偉¹; 魏秋實(shí)²

1.廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院,廣東 廣州 510405;
2.中國人民解放軍廣州軍區(qū)廣州總醫(yī)院,廣東 廣州 510010

Author(s):

CHEN Zhen-qiu^*; HE Wei; WEI Qiu-shi.

^*The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangzhou 510407,Guangdong,China

關(guān)鍵詞:

股骨頭壞死 證候 血液流變學(xué) 血脂異常

Keywords:

Femur head necrosis;  Symptom complex;  Hemorheology;  Dyslipidemias

摘要:

目的:探討股骨頭壞死中醫(yī)證型與血液學(xué)指標(biāo)的關(guān)系。方法:選取股骨頭壞死患者74例,男45例,女29例。年齡13～75歲,中位數(shù)57.5歲。根據(jù)自擬分型標(biāo)準(zhǔn),將74例患者分為3型,氣滯血瘀型20例(Ⅰ組),腎虛血瘀型26例(Ⅱ組),痰瘀蘊(yùn)結(jié)型28例(Ⅲ組)。患者入院后次日清晨空腹抽取肘靜脈血,測(cè)定血液流變學(xué)指標(biāo)及血脂指標(biāo),包括全血黏度、血漿黏度、血細(xì)胞比容、紅細(xì)胞沉降率、紅細(xì)胞聚集指數(shù)、紅細(xì)胞變形指數(shù)、血沉方程K值、血液屈服應(yīng)力、卡松黏度、紅細(xì)胞電泳時(shí)間、全血高切還原黏度、全血中切還原黏度、全血低切還原黏度、剛性指數(shù)、總膽固醇、甘油三酯、載脂蛋白A、載脂蛋白B、高密度脂蛋白、低密度脂蛋白。結(jié)果:①血液流變學(xué)指標(biāo)。3組患者全血高切黏度(200/s)比較,差異有統(tǒng)計(jì)學(xué)意義(F=7.654,P=0.001),Ⅱ組[(4.72±1.10)mPa·s]高于Ⅰ組[(3.96±0.61)mPa·s]和Ⅲ組[(3.83±0.83)mPa·s](P=0.014; P=0.005),Ⅰ組與Ⅲ組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.901); 3組患者全血中切黏度(30/s)比較,差異有統(tǒng)計(jì)學(xué)意義(F=6.913,P=0.002),Ⅱ組[(5.68±1.33)mPa·s]高于Ⅰ組[(4.77±0.74)mPa·s]和Ⅲ組[(4.68±0.98)mPa·s](P=0.016; P=0.009),Ⅰ組與Ⅲ組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.977); 3組患者全血低切黏度(3/s)比較,差異有統(tǒng)計(jì)學(xué)意義(F=7.046,P=0.002),Ⅱ組[(11.43±2.64)mPa·s]高于Ⅰ組[(9.61±1.50)mPa·s]和Ⅲ組[(9.39±2.02)mPa·s](P=0.016; P=0.008),Ⅰ組與Ⅲ組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.959); 3組患者紅細(xì)胞聚集指數(shù)比較,差異有統(tǒng)計(jì)學(xué)意義(F=8.464,P=0.001),Ⅱ組(7.88±1.83)高于Ⅰ組(6.74±1.13)和Ⅲ組(6.27±1.27)(P=0.016; P=0.009),Ⅰ組與Ⅲ組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.977); 3組患者紅細(xì)胞變形指數(shù)比較,差異有統(tǒng)計(jì)學(xué)意義(F=18.514,P=0.000),Ⅱ組(0.93±0.09)高于Ⅰ組(0.82±0.09)和Ⅲ組(0.76±0.13)(P=0.000; P=0.000),Ⅰ組與Ⅲ組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.102); 3組患者紅細(xì)胞電泳時(shí)間比較,差異有統(tǒng)計(jì)學(xué)意義(F=7.760,P=0.001),Ⅱ組[(17.70±4.12)s]高于Ⅰ組[(14.84±2.27)s]和Ⅲ組[(14.08±3.59)s](P=0.014; P=0.004),Ⅰ組與Ⅲ組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.760); 3組患者全血高切還原黏度比較,差異有統(tǒng)計(jì)學(xué)意義(F=15.685,P=0.000),Ⅱ組(5.61±1.35)高于Ⅰ組(4.35±0.91)和Ⅲ組(3.88±1.13)(P=0.001; P=0.000),Ⅰ組高于Ⅲ組(P=0.000); 3組患者全血中切還原黏度比較,差異有統(tǒng)計(jì)學(xué)意義(F=6.573,P=0.002),Ⅱ組(7.27±1.61)高于Ⅰ組(5.75±1.09)和Ⅲ組(5.61±2.35)(P=0.001; P=0.004),Ⅰ組與Ⅲ組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.802); 3組患者全血低切還原黏度比較,差異有統(tǒng)計(jì)學(xué)意義(F=19.552,P=0.000),Ⅱ組(17.30±3.00)高于Ⅰ組(14.13±2.23)和Ⅲ組(12.71±2.81)(P=0.000; P=0.000),Ⅰ組與Ⅲ組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.066); 其余各項(xiàng)血液流變學(xué)指標(biāo)組間比較,差異均無統(tǒng)計(jì)學(xué)意義。②血脂指標(biāo)。3組患者總膽固醇比較,差異有統(tǒng)計(jì)學(xué)意義(F=5.235,P=0.008),Ⅲ組[(5.42±0.89)mmol·L^-1]高于Ⅰ組[(4.56±0.77)mmol·L^-1]和Ⅱ組[(4.97±1.03)mmol·L^-1](P=0.001; P=0.022),Ⅱ組與Ⅰ組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.145); 3組患者甘油三酯比較,差異有統(tǒng)計(jì)學(xué)意義(F=3.123,P=0.050),Ⅲ組[(2.03±0.81)mmol·L^-1]高于Ⅰ組[(1.51±0.74)mmol·L^-1]和Ⅱ組[(1.64±0.74)mmol·L^-1](P=0.018; P=0.032),Ⅱ組高于Ⅰ組(P=0.000); 3組患者載脂蛋白A比較,差異有統(tǒng)計(jì)學(xué)意義(F=3.733,P=0.029),Ⅲ組[(0.87±0.12)g·L^-1]低于Ⅰ組[(0.98±0.18)g·L^-1]和Ⅱ組[(0.96±0.14)g·L^-1](P=0.019; P=0.022),Ⅱ組與Ⅰ組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.634); 3組患者載脂蛋白B比較,差異有統(tǒng)計(jì)學(xué)意義(F=4.336,P=0.017),Ⅲ組[(1.14±0.41)g·L^-1]高于Ⅰ組[(0.92±0.16)g·L^-1]和Ⅱ組[(0.90±0.30)g·L^-1](P=0.048; P=0.039),Ⅱ組與Ⅰ組比較,差異無統(tǒng)計(jì)學(xué)意義(P=1.000); 3組患者高密度脂蛋白比較,差異有統(tǒng)計(jì)學(xué)意義(F=3.207,P=0.046),Ⅲ組[(0.90±0.17)mmol·L^-1]低于Ⅰ組[(1.05±0.32)mmol·L^-1]和Ⅱ組[(1.02±0.19)mmol·L^-1](P=0.037; P=0.048),Ⅱ組與Ⅰ組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.975); 3組患者低密度脂蛋白[(2.78±0.46)mmol·L^-1,(2.93±0.88)mmol·L^-1,(3.27±0.96)mmol·L^-1]比較,差異無統(tǒng)計(jì)學(xué)意義(F=2.302,P=0.107)。結(jié)論:腎虛血瘀型股骨頭壞死患者以血液流變學(xué)指標(biāo)異常升高為特點(diǎn),痰瘀蘊(yùn)結(jié)型股骨頭壞死患者以血脂指標(biāo)異常改變?yōu)樘攸c(diǎn)。

Abstract:

Objective:To explore the relationship between TCM syndromes of osteonecrosis of femoral head(ONFH)and hematological indexes.Methods:Seventy-four patients with ONFH were selected,male 45 cases,while femal 29 cases,ranging in age from 13 to 75 years with a median of 57.5 years.According to the self-designed classification criteria,all the patients were divided into 3 types as 20 cases with QI STAGNATION BLOOD STASIS type(groupⅠ),26 cases with KIDNEY DEFICIENCY BLOOD STASIS type(groupⅡ)and 28 cases with PHLEGM STAGNATION type(groupⅢ).The blood was drawn from the fasting patient's ulnar vein in the following morning after hospital admission,and such hemorheology indexes and serum lipid indexes were measured as blood viscosity,plasma viscosity(ηp),hematocrit(HCT),erythrocyte sedimentation rate(ESR),red blood cell aggregation index(Arbe),red blood cell deformation index(TK),sedimentation equation K value(K),blood yield stress(γc),casson viscosity(ηc),red blood cell electrophoresis time(EPT),high shear whole blood reduced viscosity(HRV),medium shear whole blood reduced viscosity(MRV),low shear whole blood reduced viscosity(LRV),red blood cell rigidity index(IR),cholesterol total(CHOL),triglyceride(TG),apolipoprotein A(ApoA),apolipoprotein B(ApoB),high density lipoprotein(HDL)and low density lipoprotein(LDL).Results:①Hemorheology indexes:there was statistical difference in high shear whole blood viscosity(HV)(200/s)among the 3 groups(F=7.654,P=0.001),HV of groupⅡ((4.72±1.10)mPa·s)was higher than that of groupⅠ((3.96±0.61)mPa·s)and groupⅢ((3.83±0.83)mPa·s)respectively(P=0.014; P=0.005),while there was no statistical difference between groupⅠand groupⅢ(P=0.901).There was statistical difference in medium shear whole blood viscosity(MV)(30/s)among the 3 groups(F=6.913,P=0.002),MV of groupⅡ((5.68±1.33)mPa·s)was higher than that of groupⅠ((4.77±0.74)mPa·s)and groupⅢ((4.68±0.98)mPa·s)respectively(P=0.016; P=0.009),while there was no statistical difference between groupⅠand groupⅢ(P=0.977).There was statistical difference in low shear whole blood viscosity(LV)(3/s)among the 3 groups(F=7.046,P=0.002),LV of groupⅡ((11.43±2.64)mPa·s)was higher than that of groupⅠ((9.61±1.50)mPa·s)and groupⅢ((9.39±2.02)mPa·s)respectively(P=0.016; P=0.008),while there was no statistical difference between groupⅠand groupⅢ(P=0.959).There was statistical difference in Arbe among the 3 groups(F=8.464,P=0.001),Arbe of groupⅡ(7.88±1.83)was higher than that of groupⅠ(6.74±1.13)and groupⅢ(6.27±1.27)respectively(P=0.016; P=0.009),while there was no statistical difference between groupⅠand groupⅢ(P=0.977).There was statistical difference in TK among the 3 groups(F=18.514,P=0.000),TK of groupⅡ(0.93±0.09)was higher than that of groupⅠ(0.82±0.09)and groupⅢ(0.76±0.13)respectively(P=0.000; P=0.000),while there was no statistical difference between groupⅠand groupⅢ(P=0.102).There was statistical difference in EPT among the 3 groups(F=7.760,P=0.001),EPT of groupⅡ((17.70±4.12)s)was higher than that of groupⅠ((14.84±2.27)s)and groupⅢ((14.08±3.59)s)respectively(P=0.014; P=0.004),while there was no statistical difference between groupⅠand groupⅢ(P=0.760).There was statistical difference in HRV among the 3 groups(F=15.685,P=0.000),HRV of groupⅡ(5.61±1.35)was higher than that of groupⅠ(4.35±0.91)and groupⅢ(3.88±1.13)respectively(P=0.001; P=0.000),and HRV of groupⅠwas higher than that of groupⅢ(P=0.000).There was statistical difference in MRV among the 3 groups(F=6.573,P=0.002),MRV of groupⅡ(7.27±1.61)was higher than that of groupⅠ(5.75±1.09)and groupⅢ(5.61±2.35)respectively(P=0.001; P=0.004),while there was no statistical difference between groupⅠand groupⅢ(P=0.802).There was statistical difference in LRV among the 3 groups(F=19.552,P=0.000),LRV of groupⅡ(17.30±3.00)was higher than that of groupⅠ(14.13±2.23)and groupⅢ(12.71±2.81)respectively(P=0.000; P=0.000),while there was no statistical difference between groupⅠand groupⅢ(P=0.066).There was no statistical difference in the other hemorheology indexes among the 3 groups respectively.②Serum lipid indexes:there was statistical difference in CHOL among the 3 groups(F=5.235,P=0.008),CHOL of groupⅢ((5.42±0.89)mmol/L)was higher than that of groupⅠ((4.56±0.77)mmol/L)and groupⅡ((4.97±1.03)mmol/L)respectively(P=0.001; P=0.022),while there was no statistical difference between groupⅡand groupⅠ(P=0.145).There was statistical difference in TG among the 3 groups(F=3.123,P=0.050),TG of groupⅢ((2.03±0.81)mmol/L)was higher than that of groupⅠ((1.51±0.74)mmol/L)and groupⅡ((1.64±0.74)mmol/L)respectively(P=0.018; P=0.032),and TG of groupⅡ was higher than that of groupⅠ(P=0.000).There was statistical difference in ApoA among the 3 groups(F=3.733,P=0.029),ApoA of groupⅢ((0.87±0.12)g/L)was lower than that of groupⅠ((0.98±0.18)g/L)and groupⅡ((0.96±0.14)g/L)respectively(P=0.019; P=0.022),while there was no statistical difference between groupⅡand groupⅠ(P=0.634).There was statistical difference in ApoB among the 3 groups(F=4.336,P=0.017),ApoB of groupⅢ((1.14±0.41)g/L)was higher than that of groupⅠ((0.92±0.16)g/L)and groupⅡ((0.90±0.30)g/L)respectively(P=0.048; P=0.039),while there was no statistical difference between groupⅡand groupⅠ(P=1.000).There was statistical difference in HDL among the 3 groups(F=3.207,P=0.046),HDL of groupⅢ((0.90±0.17)mmol/L)was lower than that of groupⅠ((1.05±0.32)mmol/L)and groupⅡ((1.02±0.19)mmol/L)respectively(P=0.037; P=0.048),while there was no statistical difference between groupⅡand groupⅠ(P=0.975).There was no statistical difference in LDL among the 3 groups((2.78±0.46)mmol/L,(2.93±0.88)mmol/L,(3.27±0.96)mmol/L))(F=2.302,P=0.107).Conclusion:ONFH patients with KIDNEY DEFICIENCY BLOOD STASIS type is characterized by abnormal increase of hemorheology indexes,while ONFH patients with PHLEGM STAGNATION type is characterized by abnormality of serum lipid indexes.

備注/Memo

備注/Memo:

基金項(xiàng)目:廣東省科技計(jì)劃項(xiàng)目,廣州市科技計(jì)劃項(xiàng)目(2012J4300069)

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更新日期/Last Update: 2013-03-20