【目的】研究血脂异常痰浊阻遏证和脾肾阳虚证患者血清27-羟基胆固醇（27-HC）和肉碱棕榈酰转移酶1（CPT1）的浓度 水平特点及其典型相关性。【方法】采取横断面现场调查的流行病学研究方法，共纳入2021 年5 月至2025 年2 月就诊于北京 中医药大学东直门医院的血脂异常患者58 例，其中血脂异常痰浊阻遏证患者29 例，血脂异常脾肾阳虚证患者29 例；另纳入 正常体检者22 例（正常组），共计80 例。应用酶联免疫吸附法（ELISA）检测血清27-HC、CPT1 水平，应用中医证候评分量表 所得的证候评分评估患者的证候严重程度，分析血脂异常痰浊阻遏证和脾肾阳虚证患者各自的血清27-HC 和CPT1的浓度水 平特点，并分析上述氧化应激相关因子的浓度水平与中医证候的典型相关性。【结果】（1）血脂异常痰浊阻遏证和脾肾阳虚证 患者的一般情况（年龄、呼吸、心率、血压）及疾病相关指标[总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、 高密度脂蛋白胆固醇（HDL-C）、空腹血糖（FBG）]比较，差异均无统计学意义（P＞0.05）。（2）正常组人群的血清27-HC 水平明 显低于血脂异常痰浊阻遏证患者（P＜0.05），血清CPT1 水平均明显高于血脂异常痰浊阻遏证和脾肾阳虚证患者（P＜0.05）； 血脂异常痰浊阻遏证患者的血清27-HC 水平明显高于脾肾阳虚证患者（P＜0.05），血清CPT1 水平明显低于脾肾阳虚证患者 （P＜0.05）。（3）血脂异常痰浊阻遏证和脾肾阳虚证患者血清CPT1 水平均与中医证候评分呈负相关（P＜0.05）。（4）典型相关性 分析提示，血清CPT1 水平对中医证候评分的影响最为显著，血脂异常痰浊阻遏证患者的中医证候评分对氧化应激指标的浓 度水平影响最为显著。【结论】血脂异常痰浊阻遏证和脾肾阳虚证患者血清27-HC 和CPT1的浓度水平不同。血清CPT1的浓 度水平在一定程度上可以反映血脂异常患者中医证候的严重程度。氧化应激增强所致的血管内皮损伤是血脂异常痰浊阻遏 证的证候特点，巨噬细胞发挥了关键作用，其作用机制可能与代谢弹性失调所致氧化应激增强引起血管内皮损伤有关。

Objective To investigate the characteristics of serum 27-hydroxycholesterol（27-HC）and carnitine palmitoyltransferase 1（CPT1）levels and their canonical correlations in patients with dyslipidemia of phlegm dampness retention syndrome and spleen-kidney yang deficiency syndrome. Methods A cross-sectional field survey epidemiological study was conducted. A total of 58 patients with dyslipidemia who visited Dongzhimen Hospital，Beijing University of Chinese Medicine from May 2021 to February 2025 were enrolled，including 29 patients with phlegm-dampness retention syndrome and 29 patients with spleen-kidney yang deficiency syndrome. Additionally，22 healthy controls（normal group）were included，totaling 80 participants. Serum levels of 27-HC and CPT1 were measured using enzyme-linked immunosorbent assay（ELISA）. The severity of syndromes was assessed using TCM syndrome scores obtained from a TCM syndrome rating scale. The characteristics of serum 27- HC and CPT1 levels in patients with dyslipidemia of phlegm-dampness retention syndrome and spleen-kidney yang deficiency syndrome were analyzed，and the canonical correlations between the levels of these oxidative stress related factors and TCM syndromes were investigated. Results（1）There were no statistically significant differences in general characteristics（age，respiratory rate，heart rate，blood pressure）and disease-related indicators [total cholesterol（TC），triglycerides（TG），low-density lipoprotein cholesterol（LDL-C），high-density lipoprotein cholesterol（HDL-C），fasting blood glucose（FBG）] between patients with dyslipidemia of phlegm-dampness retention syndrome and spleen-kidney yang deficiency syndrome（P＞0.05）.（2）Serum 27-HC levels in the normal group were significantly lower than those in patients with dyslipidemia of phlegm-dampness retention syndrome（P＜0.05），while serum CPT1 levels were significantly higher（P＜0.05）. Serum 27-HC levels in patients with phlegm-dampness retention syndrome were significantly higher than those in patients with spleen kidney yang deficiency syndrome（P＜0.05），while serum CPT1 levels were significantly lower（P＜0.05）. （3）Serum CPT1 levels were negatively correlated with TCM syndrome scores in patients with dyslipidemia of both phlegm-dampness retention syndrome and spleen-kidney yang deficiency syndrome（P＜0.05）.（4）Canonical correlation analysis indicated that serum CPT1 level had the most significant impact on TCM syndrome scores，and TCM syndrome scores in patients with phlegm-dampness retention syndrome had the most significant impact on the levels of oxidative stress indicators. Conclusion Serum levels of 27-HC and CPT1 differ between patients with dyslipidemia of phlegm-dampness retention syndrome and spleen-kidney yang deficiency syndrome. Serum CPT1 levels may reflect the severity of TCM syndromes in patients with dyslipidemia to some extent. Vascular endothelial injury resulting from enhanced oxidative stress characterizes the syndrome of phlegm-dampness retention syndrome in dyslipidemia，with macrophages playing a key role. The underlying mechanism may involve vascular endothelial injury caused by enhanced oxidative stress due to metabolic elasticity dysregulation.

R259.892

国家自然科学基金青年科学基金项目（编号：82004237）；北京市自然科学基金面上项目（编号：7242233）；北京中医药大学中 央高校基本科研业务费（揭榜挂帅）项目（编号：2023-JYB-JBQN-044）；中央高水平中医医院临床科研业务费项目（编号：DZMG-ZLZX- 25021）；北京高层次创新创业人才支持计划（春蕾）项目（京卫人才[2025]2 号）；北京中医药新时代125 工程培训项目（京中医药科字[2025]2 号）；北京中医药大学第三附属医院精诚人才（精诚青苗）项目