膏脂代谢紊乱可变生多种病邪,久之可改变血管形质,继而导致脑组织、神经细胞损害,最终导致认知功能下降。本文基于“膏脂生邪”的相关性理论,将血管性认知障碍的病机归纳为“阳气不足,气化失常,膏脂化浊,壅滞脑窍,诱发痴呆”。秦鉴教授首创的中医禁食疗法在防治脂质代谢异常的临床疗效已得到肯定,但对其作用机制的阐述仍不够详尽。在“膏脂生邪”理论指导下,试将中医禁食疗法、血管性认知障碍加以联系,阐述中医禁食疗法防治血管性认知障碍的机制,为中医药防治血管性认知障碍提供新思路。The metabolic disorders of fat can lead to a variety of diseases and evils, which in the long run can change the shape of blood vessels and then lead to the damage of brain tissues and nerve cells and ultimately lead to cognitive function decline. Based on the correlation theory of “fat producing pathogenic factors”, this article summarizes the pathogenesis of vascular cognitive impairment as “a deficiency of yang qi, dysfunction of qi and chemistry, the humidification of fat, and the stagnation of the brain orifices, which induces dementia”. The clinical efficacy of the Traditional Chinese medicine fasting therapy pioneered by Prof. Qin Jian in the prevention and treatment of lipid metabolism abnormalities has been affirmed, but the elaboration of its mechanism of action is still not detailed enough. Under the guidance of the theory that “fat producing pathogenic factors”, we try to link TCM fasting therapy and vascular cognitive impairment and elaborate the mechanism of TCM fasting therapy against vascular cognitive impairment to provide a new idea for the prevention and treatment of vascular cognitive impairment by Chinese medicine.
目的观察中医禁食疗法对代谢综合征(metabolic syndrome,MS)患者血浆致动脉粥样硬化指数(atherogenic index of plasma,AIP)、Framingham风险评分(Framingham risk score,FRS)的干预作用。方法选取2021年8月至2022年5月就诊于温州市中医院的MS患者90例,根据随机数字表法将其分为禁食组和对照组,每组各45例,同期选取90例健康体检者纳入正常组。对照组患者予正常饮食及运动处方干预,禁食组患者予中医禁食疗法干预,两组患者均干预10d。比较正常组体检时与禁食组、对照组干预前后体质量指数(body mass index,BMI)、血压、血脂、血糖指标、AIP和FRS,分析禁食组、对照组干预疗效,应用Pearson相关性分析探讨MS患者AIP、FRS与临床指标的关系。结果干预前后,禁食组、对照组患者的BMI、收缩压、舒张压、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、空腹血糖(fasting plasma glucose,FPG)、AIP、FRS均显著高于正常组,高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)水平显著低于正常组(P<0.05);干预后,禁食组患者的BMI、收缩压、舒张压、LDL-C、TG、TC、FPG、AIP、FRS均显著低于本组干预前和对照组(P<0.05),HDL-C水平显著高于本组干预前和对照组(P<0.05)。禁食组患者干预后的总有效率显著高于对照组(P<0.05)。MS患者的AIP与BMI、TG水平呈正相关,与HDL-C水平呈负相关(P<0.05),FRS与BMI、收缩压、舒张压、LDL-C、TC水平呈正相关,与HDL-C水平呈负相关(P<0.05)。结论MS患者的AIP、FRS显著增高,且与BMI、血脂等指标有关,应用中医禁食疗法可显著降低AIP、FRS,改善临床指标及疗效,有利于降低心血管疾病风险。
