The Relation of Dampness-Phlegm and Metabolic Syndrome in Acute Stroke Patients

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中風濕痰辨證

민인규¹, 김창현¹, 황재웅¹, 박주영¹, 이승엽¹, 최원우¹, 나병조³, 박성욱², 정우상¹, 문상관¹, 박정미², 고창남², 조기호¹, 김영석¹, 배형섭²

1경희대학교 한의과대학 심계내과학교실, ²경희대학교 동서신의학병원 중풍뇌혈관질환 센터, ³강남경희한방병원 내과학교실

Original Article

The Relation of Dampness-Phlegm and Metabolic Syndrome in Acute Stroke Patients

In-Kyu Min¹, Chang-Hyun Kim¹, Jae-Woong Hwang¹, Joo-Young Park¹, Seung-Yeop Lee¹, Won-Woo Choi¹, Byong-Jo Na³, Sung-Wook Park², Woo-Sang Jung¹, Sang-Kwan Moon¹, Jung-Mi Park², Chang-Nam Ko²,

Ki-Ho Cho¹, Young-Suk Kim¹, Hyung-Sup Bae²

1Department of Cardiocascular & Neurologic Disease(Stroke center), College of Oriental medicine, Kyunghee University, Seoul, Korea

2Stroke & Neurological Disorders Center, East-West Neo Medical Center, Kyung Hee University

3Department of Internal Medicine Kang-Nam Kyung-Hee Oriental Medicine Hospital, College of Oriental Medicine, Kyung-Hee University

Objectives: This study was aimed to clarify the relationship between the pattern of dampness-phlegm and metabolic syndrome in acute stroke patients.

Methods: Three hundred fifty-nine subjects were recruited from the patients admitted to the Internal Medical Department at Kyunghee University Oriental Medical Center, Dongguk University Ilsan Oriental Medical Center, Kyungwon University Songpa Oriental Medical Center and Kyungwon University Incheon Oriental Medical Center from April 2007 to March 2008. We diagnosed dampness-phlegm by Oriental medical diagnosis and analyzed their characteristics with type of stroke, blood test result, Sasang constitution, lifestyle and metabolic syndrome.

Results:

1. On the demographic variables of the patients, the weight and body mass index, the rate of hypertension, diabetes mellitus, hyperlipidemia, silent infarction were significantly higher in dampness-phlegm group than in the control.

2. There was no significant difference of stroke type between the dampness-phlegm group and the control.

3. According to the blood test, the dampness-phlegm group showed higher total cholesterol, triglyceride, fasting blood sugar and lower high density lipoprotein cholesterol than the control group with statistical significance.

4. According to the Sasang constitution distribution, the rate of Tae-Eum was significantly higher in dampness- phlegm group than in the control.

5. According to lifestyle, smoking and drinking were significantly lower in the dampness-phlegm group than in the control. Otherwise, exercise and dietary habits showed no significant difference between the two groups.

6. There were much more patients diagnosed with metabolic syndrome in the dampness-phlegm group than in the control.

7. Metabolic syndrome, silent infarction and obesity showed close relationship with dampness-phlegm pattern in multivariate analysis.

Conclusions: According to the analysis, the relationship between the patterns of dampness-phlegm and metabolic syndrome in acute stroke patients were clarified. These results can be utilized in the future as a basis material.

Key Words : Stroke, dampness-phlegm, metabolic syndrome

접수：2008년 8월 25일 수정：2008년 12월 23일 채택：2008년 12월 29일

교신저자：조기호(Ki-Ho Cho)

서울특별시 동대문구 회기동 1번지 경희의료원 한방병원 2내과학교실

Tel：+82-2-958-9124, Fax：+82-2-958-9132, E-mail：[email protected]

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연구대상 및 방법

1. 연구대상 1)

2007 4 2008 3

, ,

,

(Brain-CT) (Brain MR)

4 .

,

.

, .

2)

,

.

. 1

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2. 임상연구 증례기록지와 표준 작업 지침서 및

임상시험 심사위원회

(Case Report

Form, CRF) .

(Standard Operating Procedures, SOP) 2007 3 10 , 2007 7 28

,

8) . ,

(Institutional Review Board, IRB) .

3. 조사변수 1)

1 1 ⁷⁾ .

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. 2)

, , , , , ,

(body mass index, BMI), (waist circumference/hip circumference ratio, W/H ratio), National Institutes of Health Stroke Scale( NIHSS)

. BMI

weight(kg)/height(m ² ) .

.

,

.

, , ,

, , , ,

(silent infarction) ^9,10) . . Left Ventricular Hypertrophy

(LVH) Joint National Committee

(JNC) 7 ¹¹⁾ 140/90mmHg

, 2

,

.

1997 American Diabetes Association

(ADA) ¹²⁾ (Fasting

blood sugar: FBS)>126mg/dl, 2

(2 hours postprandial plasma glucose level: PP2)

>200mg/dl, HbA1c>7.0%

.

National Cholesterol Education Program

(NECP) ¹³⁾ (total cholesterol:

T-chol) > 240mg/dl

(low density lipoprotein-cholesterol: LDL- chol)>160mg/dl (triglyceride: TG)

>200mg/dl

. 3)

, Design of the Trial of Org 10172 in Acute Stroke Treatment( TOAST) ¹⁴⁾

Large Artery Atherosclerosis( LAA), Cardioem- bolism( CE), Small Vessel Occlusion( SVO), Stroke of Other determined Etiology( SOE), Stroke of Undetermined Etiology( SUE)

. 4)

10 8

6 . (Homocy-

steine), B12(Vitamin B12), (Folic acid),

T-chol, TG, (high density

lipoprotein-cholesterol: HDL-chol), (total lipid: TL), FBS, PP2, (Fibrinogen),

(Hematocrit) .

5)

(Questionnaire for the Sasang Constitution Classification : QSCC )

. 6)

, ,

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, ^15-16) .

7)

2001 National Cholesterol Education Program Adult Treatment Panel III(NECP-ATP ) ²⁾

2005 American Heart Association/National

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Heart Lung and Blood Institute(AHA/NHLBI)

3) 5 3

. , ³⁰⁾

140mmHg, 90mmHg

. .

: 90cm, 85cm

: 150mg/dl

: <40mg/dl,

<50mg/dl

: 140mmHg

90mmHg

: 100mg/dl 2

4. 통계분석

Statistical Program for Social Science(SPSS) 12.0 for Windows ,

Mean±standard deviation(SD)

Number(%) .

Student T-test, Chi-square test Fisher’s exact test

.

, p 0.2

Multiple Logistic Regression

(odds ratio, OR) 95% (confi-

dence interval, CI) . P value

0.05 .

p (p<0.2)

, , , ,

. , ,

.

65 , BMI 25kg/m ²

17) .

연구결과

1. 대상 환자들의 일반적 특성

359 ,

136 . , ,

, BMI

( p<0.001). ,

, .

NIHSS .

, ,

( p=0.015, 0.047, 0.014).

, , ,

.

(p<0.001),

, ,

(p=0.033)(Table 1).

2. 濕痰辨證에 따른 중풍유형의 분포

18 (13.2%),

22 (9.9%) .

TOAST ,

SVO (Table 2).

3. 濕痰辨證에 따른 혈액검사결과

, B12

, , ,

. T-chol, TG

, HDL-chol ( p=

(5)

0.035, 0.041, <0.001).

FBS (p=

0.012), PP2 (Table 3).

4. 濕痰辨證에 따른 사상체질의 분포

4 (14.3%), 13

(46.4%), 11 (39.3%),

30 (33.7%), 19 (21.4%),

40 (44.9%) ,

,

(p=0.020)(Table 4).

5. 濕痰辨證에 따른 생활습관의 분포

25 (18.7%), 35 (26.1%) 66 (30.4

%), 87 (39.7%) , ( p=0.015, 0.009).

(Table 5).

6. 濕痰辨證에 따른 대사증후군환자 분포

98

Variables

Oriental Medical Diagnosis

p-value^* Dampness-Phlegm

(n=136)

Not Dampness-Phlegm (n=223)

Age, y 66.90±12.00 65.79±12.00 0.393

Male Gender 69(50.7) 133(59.6) 0.099

Height(cm) 161.21±8.03 161.87±8.01 0.462

Weight(kg) 64.34±10.58 60.11±10.20 <0.001

BMI(kg/m²) 24.73±3.05 22.96±2.86 <0.001

WC(cm) 87.58±9.69 85.38±9.36 0.061

HC(cm) 92.72±9.25 91.28±9.50 0.218

W/H ratio 0.94±0.05 0.94±0.08 0.621

NIHSS 3.27±3.89 3.77±4.27 0.283

History

Hypertension 92(67.6) 119(54.6) 0.015

DM 47(34.8) 55(25.0) 0.047

Hyperlipidemia 30(22.6) 27(12.5) 0.014

Af 8(6.3) 17(8.0) 0.545

IHD 15(11.2) 19(8.8) 0.462

Migraine 2(1.5) 9(4.1) 0.216

Stroke 32(23.7) 52(23.6) 0.988

Silent infarction 78(66.1) 84(42.4) <0.001

Final diagnosis

Hypertension 97(71.3) 150(67.3) 0.421

DM 48(35.3) 63(28.3) 0.161

Hyperlipidemia 43(31.6) 48(21.5) 0.033

Values are Mean±SD or number(%)

BMI, body mass index; WC, waist circumference; HC, hip circumference; W/H ratio, waist circumference/hip circumference ratio; NIHSS, National Institutes of Health Stroke Scale; DM, diabetes mellitus; Af, arterial fibrilation; IHD, ischemic heart disease; TIA, transient ischemic attack

*

: Statistical significant was calculated by Student T-test for continuous variables, Chi square and Fisher's exact test for categorical variables.

Table 1.

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(79.0%), 95 (53.1%) (p<0.001)(Table 6).

7. 濕痰군의 제특성에 대한 다변량 로지스틱

회귀분석

(OR=

2.68, p=0.009), (OR=2.62, p=0.001),

(OR=2.11, p=0.020) .

고찰 및 결론

, .

. ,

18) .

Stroke type Oriental Medical Diagnosis

p-value^*

Dampness-Phlegm Not Dampness-Phlegm

Inf

LAA 24(17.6) 40(17.9)

0.951

CE 9(6.6) 15(6.7)

SVO 85(62.5) 143(64.1)

SOE 0 1(0.3)

SUE 0 2(0.9)

Hrr 18(13.2) 22(9.9) 0.325

Values are number(%)

Inf, infarction; Hrr, hemorrhage; LAA, Large Artery Atherosclerosis; CE, Cardioembolism; SVO, Small Vessel Occlusion; SOE, Stroke of other determined etiology; SUE, Stroke of Undetermined etiology

*

: Statistical significant was calculated by Chi square and Fisher's exact te

Table 2.

Variables Oriental Medical Diagnosis

p-value*

HCY(nmol/ml) 10.32±3.50 10.80±3.29 0.289

VB12(pg/ml) 674.22±377.35 670.19±376.63 0.938

Folic acid(ng/ml) 7.48±4.40 6.66±4.03 0.158

T-chol(mg/dl) 182.36±41.36 172.71±40.82 0.035

TG(mg/dl) 148.52±90.70 128.47±84.22 0.041

HDL-chol(mg/dl) 36.43±10.81 41.18±13.60 <0.001

TL(mg/dl) 554.55±153.81 526.76±117.67 0.103

FBS(mg/dl) 120.15±36.35 108.89±36.08 0.012

PP2(mg/dl) 175.35±72.91 159.80±58.53 0.070

Fibrinogen(mg/dl) 335.02±106.17 310.30±87.88 0.055

Hematocrit(%) 39.10±4.46 39.74±4.61 0.206

Values are Mean±SD

HCY, homocysteine; VB12, Vitamin B12; T-chol, total cholesterol; TG, triglyceride; HDL-chol, high density lipoprotein cholesterol; TL, total lipid; FBS, fasting blood sugar; PP2, 2 hours postprandial plasma glucose level

*: Statistical significant was calculated by Student T-test

Table 3.

(7)

‘

’ ^5-6)

.

, ,

,

(OR=2.68) .

19) .

1998 23.6% 2001 28.0%

.

‘ ’

,

.

2-3) .

.

Sasang constitution

(n=28)

So-Eum 4(14.3) 30(33.7)

0.020

Tae-Eum 13(46.4) 19(21.4)

So-Yang 11(39.3) 40(44.9)

Values are number(%)

*

: Statistical significant was calculated by Chi square test

Table 4.

Variables Oriental Medical Diagnosis

p-value*

Habit

Smoking 25(18.7) 66(30.4) 0.015

Drinking 35(26.1) 87(39.7) 0.009

Exercise 45(41.7) 77(39.7) 0.737

Preference

Meat 65(48.5) 96(43.4) 0.352

Sea food 64(47.8) 109(49.3) 0.776

Fast food 11(8.2) 20(9.1) 0.776

Values are number(%)

*

: Statistical significant was calculated by Chi square test

Table 5.

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.

- (p=0.017)

-

.

4) ,

.

117 .

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“ ”

20) .

21) .

“ ”, “

”, “

”

22-24)

.

25-27)

.

,

.

,

. ,

(n=124)

MS 98(79.0) 95(53.1) <0.001

Values are number(%) MS, metabolic syndrome

*

: Statistical significant was calculated by Chi square test

Table 6.

Risk factors Odds ratio 95% CI p-value

Older age^† 1.39 0.75-2.59 0.292

Male Gender 1.14 0.56-2.30 0.722

MS 2.68 1.29-5.58 0.009

Silent infarction 2.62 1.45-4.74 0.001

Obesity^‡ 2.11 1.12-3.98 0.020

Hypertension 0.64 0.33-1.24 0.185

DM 1.02 0.55-1.89 0.951

Hyperlipidemia 0.88 0.46-1.69 0.701

Drinking 0.75 0.36-1.57 0.446

Smoking 1.00 0.47-2.13 0.992

CI, confidence interval; MS, metabolic syndrome; DM, diabetes mellitus

†

: Age ≥65 years

‡

: BMI ≥25

Table 7.

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감사의 글

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The Relation of Dampness-Phlegm and Metabolic Syndrome in Acute Stroke Patients

Original Article