基于络病学说辨证分型对缺血性脑卒中TOAST分型及侧支代偿情况的分析  

Analysis of TOAST Subtype and Collateral Compensation of Ischemic Stroke Based on the Syndrome Differentiation of Collateral Disease Theory

作　　者：姜海伟 笱玉兰[2] 张忠文[2] 陈国华 葛林通 JIANG Haiwei;GOU Yulan;ZHANG Zhongwen;CHEN Guohua;GE Lintong(Hubei University of Traditional Chinese Medicine,Wuhan 430065,Hubei,China)

机构地区：[1]湖北中医药大学,武汉430065 [2]武汉市中西医结合医院 [3]湖北省第三人民医院

出　　处：《中西医结合心脑血管病杂志》2020年第3期407-410,共4页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

摘　　要：目的探讨急性缺血性脑卒中病人中医络病学辨证分型与西医TOAST分型及血管病变部位、侧支代偿分级的分布特征、对应关系,了解络病学辨证的可操作性。方法对256例急性缺血性脑卒中病人及其中146例大动脉病变者进行络病学辨证分型、TOAST分型、影像学分析大血管病变部位及侧支代偿分级,分析分布特征、络病学辨证分型与各观察指标分布的差异性和一致性。结果256例急性缺血性脑卒中病人络病学分型与TOAST分型分布方面,脑络瘀阻证以小动脉闭塞性卒中或腔隙性卒中(SAO)为主,占90.17%(46/51);热毒滞络证以大动脉粥样硬化性卒中(LAA)为主,占40.00%(26/65)、心源性脑栓塞(CE)占40.00%(26/56);脑络瘀塞证包含CE 45.45%(20/44)、LAA 27.27%(12/44)为主。脑络失荣证包括LAA 64.00%(48/75)及SAO34.67%(26/75)。脑络瘀阻证与SAO分布具有一定的一致性(Kappa=0.49)。146例大动脉病变病人,各证型在TOAST分型方面总体分布差异有统计学意义(P<0.01),LAA与脑络失荣证分布具有一定一致性(Kappa=0.41)。在病变血管方面,各证型与病变血管部位总体分布差异无统计学意义(P>0.05),一致性差(Kappa<0.40)。侧支代偿分级方面,脑络瘀塞证以一级代偿12例(36.36%)和二级代偿12例(36.36%)为主;而热毒滞络证无代偿或代偿极差者为27例(52.94%);热毒滞络证与无代偿或代偿极差者分布具有一定的对应关系(Kappa=0.44)。脑络失荣证则各级代偿均有,分布差异无统计学意义(P>0.05)。结论缺血性卒中络病学辨证分型与部分TOAST分型具有一定的对应关系,同一TOAST分型中包含不同的中医络病学病机,其差异性与血管病变部位无关,热毒滞络证与侧支代偿差异具有一定的关系。Objective To explore relationship of the Trial of Org10172 in Acute Stroke Treatment(TOAST)subtype and collateral compensation of acute ischemic stroke(AIS)and the syndrome differentiation.Methods A total of 256 patients,of which 146 patients with large artery lesions were classifiedoncollateral disease theory.TOAST classification:imaging-basedl ocation of major vascular lesions and collateral compensation grading.The differences and consistency of the syndrome differentiation based oncollateral disease theory and the distribution of the indicators were analyzed.Results The distribution of syndrome differentiation based on collateral disease theory and TOAST subtype in 256 patients with AIS showed that stasis syndrome was the syndrome differentiation in patients with small arterial occlusive(SAO)stroke or lacunar stroke,accounting for 90.17%.Heat and toxin syndrome was in patients with large-artery atherosclerosis(LAA)and cardioembolism(CE),accounting for 40.00%and 40.00%,respectively.Stasis occlusion syndrome was in patients with CE,LAA and other determined cause(ODC),accounting for 45.45%,27.27%and 18.18%,respectively.Deficiency syndrome was in patients with LAA and SAO,accounting for 64.00%and 34.67%,respectively.Stasis syndrome had a certain consistency with the distribution of SAO(Kappa=0.49).There was significant differencein the overall distribution of syndrome types among TOAST classification in 146 patients with large artery lesions(P<0.01).The distribution of LAA and deficiency syndrome was consistent(Kappa=0.41).There was no significant difference in the overall distribution of syndrome types and location of vascular lesions(P>0.05),and the consistency was poor(Kappa<0.40).The collateral compensation in patients with stasis occlusion syndrome was primary compensation(36.36%)and secondary compensation(36.36%).The collateral compensation in patients with heat and toxicity syndrome was poor compensation,accounted for 52.94%.Heat and toxicity syndrome hada certain consistency with the number of patients wi

关 键 词：缺血性卒中 络病学 辨证分型 TOAST分型 侧支代偿 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R255.2[医药卫生—临床医学]