[1]陈镇秋,何伟,魏秋实.股骨头坏死中医证型与血液学指标的关系研究[J].中医正骨,2013,25(03):35-40.
　CHEN Zhen-qiu*,HE Wei,WEI Qiu-shi..Study on the relationship between TCM syndromes of osteonecrosis of femoral head and hematological indexes[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2013,25(03):35-40.
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股骨头坏死中医证型与血液学指标的关系研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第25卷
期数:
2013年03期
页码:
35-40
栏目:
股骨头坏死
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:
陈镇秋1; 何伟1; 魏秋实2
1.广州中医药大学第一附属医院,广东 广州 510405;
2.中国人民解放军广州军区广州总医院,广东 广州 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
关键词:
股骨头坏死 证候 血液流变学 血脂异常
Keywords:
Femur head necrosis;  Symptom complex;  Hemorheology;  Dyslipidemias
摘要:
目的:探讨股骨头坏死中医证型与血液学指标的关系。方法:选取股骨头坏死患者74例,男45例,女29例。年龄13～75岁,中位数57.5岁。根据自拟分型标准,将74例患者分为3型,气滞血瘀型20例(Ⅰ组),肾虚血瘀型26例(Ⅱ组),痰瘀蕴结型28例(Ⅲ组)。患者入院后次日清晨空腹抽取肘静脉血,测定血液流变学指标及血脂指标,包括全血黏度、血浆黏度、血细胞比容、红细胞沉降率、红细胞聚集指数、红细胞变形指数、血沉方程K值、血液屈服应力、卡松黏度、红细胞电泳时间、全血高切还原黏度、全血中切还原黏度、全血低切还原黏度、刚性指数、总胆固醇、甘油三酯、载脂蛋白A、载脂蛋白B、高密度脂蛋白、低密度脂蛋白。结果:①血液流变学指标。3组患者全血高切黏度(200/s)比较,差异有统计学意义(F=7.654,P=0.001),Ⅱ组[(4.72±1.10)mPa·s]高于Ⅰ组[(3.96±0.61)mPa·s]和Ⅲ组[(3.83±0.83)mPa·s](P=0.014; P=0.005),Ⅰ组与Ⅲ组比较,差异无统计学意义(P=0.901); 3组患者全血中切黏度(30/s)比较,差异有统计学意义(F=6.913,P=0.002),Ⅱ组[(5.68±1.33)mPa·s]高于Ⅰ组[(4.77±0.74)mPa·s]和Ⅲ组[(4.68±0.98)mPa·s](P=0.016; P=0.009),Ⅰ组与Ⅲ组比较,差异无统计学意义(P=0.977); 3组患者全血低切黏度(3/s)比较,差异有统计学意义(F=7.046,P=0.002),Ⅱ组[(11.43±2.64)mPa·s]高于Ⅰ组[(9.61±1.50)mPa·s]和Ⅲ组[(9.39±2.02)mPa·s](P=0.016; P=0.008),Ⅰ组与Ⅲ组比较,差异无统计学意义(P=0.959); 3组患者红细胞聚集指数比较,差异有统计学意义(F=8.464,P=0.001),Ⅱ组(7.88±1.83)高于Ⅰ组(6.74±1.13)和Ⅲ组(6.27±1.27)(P=0.016; P=0.009),Ⅰ组与Ⅲ组比较,差异无统计学意义(P=0.977); 3组患者红细胞变形指数比较,差异有统计学意义(F=18.514,P=0.000),Ⅱ组(0.93±0.09)高于Ⅰ组(0.82±0.09)和Ⅲ组(0.76±0.13)(P=0.000; P=0.000),Ⅰ组与Ⅲ组比较,差异无统计学意义(P=0.102); 3组患者红细胞电泳时间比较,差异有统计学意义(F=7.760,P=0.001),Ⅱ组[(17.70±4.12)s]高于Ⅰ组[(14.84±2.27)s]和Ⅲ组[(14.08±3.59)s](P=0.014; P=0.004),Ⅰ组与Ⅲ组比较,差异无统计学意义(P=0.760); 3组患者全血高切还原黏度比较,差异有统计学意义(F=15.685,P=0.000),Ⅱ组(5.61±1.35)高于Ⅰ组(4.35±0.91)和Ⅲ组(3.88±1.13)(P=0.001; P=0.000),Ⅰ组高于Ⅲ组(P=0.000); 3组患者全血中切还原黏度比较,差异有统计学意义(F=6.573,P=0.002),Ⅱ组(7.27±1.61)高于Ⅰ组(5.75±1.09)和Ⅲ组(5.61±2.35)(P=0.001; P=0.004),Ⅰ组与Ⅲ组比较,差异无统计学意义(P=0.802); 3组患者全血低切还原黏度比较,差异有统计学意义(F=19.552,P=0.000),Ⅱ组(17.30±3.00)高于Ⅰ组(14.13±2.23)和Ⅲ组(12.71±2.81)(P=0.000; P=0.000),Ⅰ组与Ⅲ组比较,差异无统计学意义(P=0.066); 其余各项血液流变学指标组间比较,差异均无统计学意义。②血脂指标。3组患者总胆固醇比较,差异有统计学意义(F=5.235,P=0.008),Ⅲ组[(5.42±0.89)mmol·L-1]高于Ⅰ组[(4.56±0.77)mmol·L-1]和Ⅱ组[(4.97±1.03)mmol·L-1](P=0.001; P=0.022),Ⅱ组与Ⅰ组比较,差异无统计学意义(P=0.145); 3组患者甘油三酯比较,差异有统计学意义(F=3.123,P=0.050),Ⅲ组[(2.03±0.81)mmol·L-1]高于Ⅰ组[(1.51±0.74)mmol·L-1]和Ⅱ组[(1.64±0.74)mmol·L-1](P=0.018; P=0.032),Ⅱ组高于Ⅰ组(P=0.000); 3组患者载脂蛋白A比较,差异有统计学意义(F=3.733,P=0.029),Ⅲ组[(0.87±0.12)g·L-1]低于Ⅰ组[(0.98±0.18)g·L-1]和Ⅱ组[(0.96±0.14)g·L-1](P=0.019; P=0.022),Ⅱ组与Ⅰ组比较,差异无统计学意义(P=0.634); 3组患者载脂蛋白B比较,差异有统计学意义(F=4.336,P=0.017),Ⅲ组[(1.14±0.41)g·L-1]高于Ⅰ组[(0.92±0.16)g·L-1]和Ⅱ组[(0.90±0.30)g·L-1](P=0.048; P=0.039),Ⅱ组与Ⅰ组比较,差异无统计学意义(P=1.000); 3组患者高密度脂蛋白比较,差异有统计学意义(F=3.207,P=0.046),Ⅲ组[(0.90±0.17)mmol·L-1]低于Ⅰ组[(1.05±0.32)mmol·L-1]和Ⅱ组[(1.02±0.19)mmol·L-1](P=0.037; P=0.048),Ⅱ组与Ⅰ组比较,差异无统计学意义(P=0.975); 3组患者低密度脂蛋白[(2.78±0.46)mmol·L-1,(2.93±0.88)mmol·L-1,(3.27±0.96)mmol·L-1]比较,差异无统计学意义(F=2.302,P=0.107)。结论:肾虚血瘀型股骨头坏死患者以血液流变学指标异常升高为特点,痰瘀蕴结型股骨头坏死患者以血脂指标异常改变为特点。
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.

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备注/Memo

备注/Memo:
基金项目:广东省科技计划项目,广州市科技计划项目(2012J4300069)
更新日期/Last Update: 2013-03-20