绝经后女性脑梗死急性期中医证候分布特点及其与生殖相关因素的关联性研究

Distribution of traditional Chinese medicine syndromes in postmenopausal women with acute cerebral infarction and their associations with reproductive factors

摘要:

目的 探讨绝经后女性脑梗死急性期中医证候分型分布规律，分析绝经状态对证型构成的影响，并探究绝经年龄、初潮年龄、孕次、产次与特定证型的关联。方法 选取2023年1月—2025年1月在北京中医药大学东方医院就诊的87例脑梗死急性期女性患者作为脑梗死组，另选取同期该院行健康体检女性50例作为对照组。收集研究对象的一般临床资料。分析脑梗死急性期女性患者绝经前后中医证型的差异。采用多因素一般Logistic回归模型分析脑梗死急性期女性患者中医证型的影响因素。结果 脑梗死组绝经年龄、初潮年龄及高密度脂蛋白均低于对照组（P <0.05），产次、入院时收缩压、入院时舒张压、空腹血糖水平、甘油三酯水平及同型半胱氨酸水平均高于对照组（P <0.05）。脑梗死组急性期患者单一证型22例，内风证兼血瘀证20例，痰湿证兼气虚证18例，内火证兼阴虚证15例，痰湿证兼血瘀证12例。绝经年龄>45岁患者中单一证型占比最高（63.21%），产次≥3次患者中痰湿证兼气虚证占比最高（53.33%）。初潮年龄>12岁患者不同中医证型比较，差异无统计学意义（P >0.05）。多因素一般Logistic回归分析结果显示，绝经年龄>45岁［O^R =0.105（95% CI：0.029，0.378）］是脑梗死急性期女性患者存在痰湿证兼气虚证的保护因素，产次≥3次［O^R =5.729（95% CI：1.416，23.185）］是其危险因素。绝经年龄>45岁［O^R =17.461（95% CI：2.198，138.709）］是脑梗死急性期女性患者存在单一证型的危险因素。结论 绝经后女性脑梗死急性期中医证型分布与绝经年龄、孕次、产次有关，而与初潮年龄无关，可为女性脑梗死的个体化中医防治提供生殖内分泌学依据。

Abstract:

Objective To explore the distribution pattern of traditional Chinese medicine syndrome types in female patients during the acute phase of cerebral infarction, analyze the influence of menopausal status on syndrome composition, and clarify the correlation between age at menopause, age at menarche, number of pregnancies and deliveries, and specific traditional Chinese medicine syndrome types.Methods A total of 87 female patients with acute cerebral infarction treated at Dongfang Hospital, Beijing University of Chinese Medicine, from January 2023 to January 2025 as the cerebral infarction group, and 50 healthy women undergoing physical examinations during the same period as the control group. General clinical data of the participants were collected. Differences in traditional Chinese medicine syndrome types between premenopausal and postmenopausal patients with acute cerebral infarction were analyzed. Multivariable logistic regression was used to identify factors associated with traditional Chinese medicine syndrome types in female patients with acute cerebral infarction.Results The cerebral infarction group had lower age at menopause, age at menarche, and high-density lipoprotein levels compared to the control group (P < 0.05), while the number of deliveries, admission systolic blood pressure, admission diastolic blood pressure, fasting blood glucose levels, triglyceride levels, and homocysteine levels were higher than those in the control group (P < 0.05). Among the acute-phase patients in the cerebral infarction group, there were 22 cases of single syndrome, 20 cases of internal wind syndrome combined with blood stasis syndrome, 18 cases of phlegm-dampness syndrome combined with qi deficiency syndrome, 15 cases of internal fire syndrome combined with yin deficiency syndrome, and 12 cases of phlegm-dampness syndrome combined with blood stasis syndrome. In the group with age at menopause > 45 years, single syndrome accounted for the highest proportion (63.21%). In the group with number of deliveries ≥ 3, phlegm-dampness syndrome combined with qi deficiency syndrome accounted for the highest proportion (53.33%). Comparison of different TCM syndrome types in the group with age at menarche > 12 years showed no statistically significant difference (P > 0.05). Logistic regression analysis showed that age at menopause > 45 years [O^R = 0.105 (95% CI: 0.029, 0.378) ] was a protective factor against phlegm-dampness syndrome combined with qi deficiency syndrome in female patients with acute cerebral infarction, while number of deliveries ≥ 3 [O^R = 5.729 (95% CI: 1.416, 23.185) ] was a risk factor for this syndrome. Age at menopause > 45 years [O^R = 17.461 (95% CI: 2.198, 138.709) ] was a risk factor for single syndrome.Conclusion The distribution of traditional Chinese medicine syndromes in postmenopausal women with acute cerebral infarction is associated with age at menopause, number of pregnancies, and number of deliveries, but not with age at menarche. These findings may provide a reproductive endocrinological basis for individualized traditional Chinese medicine prevention and treatment of cerebral infarction in women.