不同证候颈椎病患者TCD指标的特点及与年龄、证候间的相关性研究  

The characteristics of TCD in patients with cervical spondylosis of different syndromes and their correlation with age and syndrome

作　　者：叶超[1] 陈婧 史永梅[1] 刘培燕[1] 刘向春[1] 曲弋[1] 李春根[1] 李鹏洋[1] YE Chao, CHENJing SHI Yongmei, LIU Peiyan , LIU Xiangehun , QU Yi , Li Chungen, LI Pengyang(1. Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing 100700, China; 2. The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100029, China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京中医药大学第三附属医院,北京100029

出　　处：《现代中西医结合杂志》2018年第22期2406-2411,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的探讨不同证候颈椎病患者证候类型、年龄与脑血流动力学指标的关系。方法选择97例颈椎病患者进行研究,通过中医证候辨识标准判断为气滞血瘀证51例、气血不足证46例。采用经颅多普勒超声(TCD)测定所用患者双侧大脑中动脉(MCA)、双侧大脑前动脉(ACA)、双侧颈内动脉末端(TICA)、双侧大脑后动脉(PCA)、双侧椎动脉(VA)、基底动脉(BA)的血流速度(PSV、EDV和MFV)以及搏动指数(PI)和阻力指数(RI)。结果气血不足证患者双侧MCA、双侧ACA、双侧TICA、双侧PCA的血流速度(PSV、EDV和MFV)和双侧VA的PSV和MFV、双侧BA的PSV均有快于气滞血瘀证的趋势,其中左侧MCA的PSV,双侧VA的PSV、MFV,BA的PSV均明显快于气滞血瘀证患者(P均<0.05)。气滞血瘀证患者左侧MCA的MFV、EDV及BA的EDV,气血不足证患者双侧ACA的MFV和右侧ACA、PCA的EDV,气血不足证和气滞血瘀证患者左侧TICA的MFV、EDV,双侧VA的PSV、MFV、EDV,BA的MFV、EDV,与年龄均呈负相关(P均<0.05);气滞血瘀证患者左侧和气血不足证患者双侧MCA的PI、RI,气血不足证患者双侧和气滞血瘀证患者右侧ACA的PI、RI,气血不足证患者双侧和气滞血瘀证患者左侧TICA的PI、RI,气血不足证患者左侧PCA的PI和右侧PCA的PI、RI,气血不足证和气滞血瘀证患者双侧VA和双侧BA的PI、RI与年龄均呈正相关(P均<0.05)。结论大脑中动脉、椎动脉、基底动脉频谱频数部分指标可以反映颈椎病患者证候的不同;不同证候颈椎病患者随年龄增大,TCD指标会出现相应的减退。上述变化特点与不同证候间中医病因病机分析相一致,丰富了中医辨证的内涵,为颈椎病标准化、客观化辨证提供了依据。Objective It is to explore the characteristics of cerebral hemodynamics in patients with different syndromes of cervical spondylosis,and to disuse their relationship with age and cerebral hemodynamic indexes. Methods 97 patients with cervical spondylosis were selected for this study. Through TCM syndrome identification standard,51 cases of syndrome of qi stagnation and blood stasis（ SQSBS） and 46 cases of syndrome of qi and blood deficiency（ SQBD） were identified.TCD was used to measured bilateral MCA,bilateral ACA,TICA on both sides,bilateral PCA,VA,BA on both sides of blood flow velocity（ PSV,EDV and MFV） and pulsation index（ PI） and resistance index（ RI） indicators in 97 patients with cervical spondylosis. Results The blood flow velocity（ PSV,EDV and MFV） of bilateral MCA,bilateral ACA,bilateral TICA,bilateral PCA,PSV and MFV of bilateral VA,and PSV of bilateral BA were faster in patients with SQBD than the ones with SQSBS,PSV of left MCA,PSV and MFV of bilateral VA,PSV of BA were significantly faster than those of SQSBS（ P〈0.05）. MFV,EDV of left MCA and EDV of BA in patients with SQSBS,MFV of bilateral ACA and EDV of right ACA and PCA in patients with SQBD,MFV,EDV of left TICA,PSV,MFV,EDV of bilateral VA,MFV,EDV of BA in the patients with SQSBS or SQBD were all negatively related with age（ P〈0.05）. The PI and RI of the left MCA,right ACA,left TICA,both VA and BA in the patients with SQSBS PI and RI of both MCA and ACA,TICA,VA and BA,left PCA and right ACA in the patients with SQBD were positively correlated with age（ P〈0.05）. Conclusion The frequency spectrum of middle cerebral artery,vertebral artery and basilar artery can reflect the difference of syndromes in patients with cervical spondylosis. The patients with cervical spondylosis with different syndromes will have corresponding decrease in TCD index with age. The above changes are consistent with the analysis of TCM pathogenesis and pathogenesis among different syndromes,can enrich the connotation of TCM syndrom

关 键 词：颈椎病 证候 经颅多普勒超声 年龄 

分 类 号：R681.55[医药卫生—骨科学]