基于因子分析探讨急性缺血性脑卒中后认知障碍患者331例证候要素分布特点  

The Characteristics of the Syndrome Elements Distribution of 331 Cases with Cognitive Impairment After Acute Ischemic Stroke Based on the Factor Analysis

作　　者：申伟 金香兰 黎明全 赵建军 张虎 王振垚 杨健[5] 熊昕[5] 余尚贞 石青 傅晨 陈宝鑫 赵珈艺 魏竞竞 王敏 王莹 张允岭 SHEN Wei;JIN Xianglan;LI Mingquan;ZHAO Jianjun;ZHANG Hu;WANG Zhenyao;YANG Jian;XIONG Xin;YU Shangzhen;SHI Qing;FU Chen;CHEN Baoxin;ZHAO Jiayi;WEI Jingjing;WANG Min;WANG Ying;ZHANG Yunling(Graduate School of Beijing University of Chinese Medicine,Beijing,100029;Dongfang Hospital,Beijing University of Chinese Medicine;Affiliated Hospital of Changchun University of Traditional Chinese Medicine;Shunyi Hospital of Beijing Hospital of Traditional Chinese Medicine;Chongqing Hospital of Traditional Chinese Medicine;Wuyi Hospital of Traditional Chinese Medi-cine of Jiangmen City;Wangjing Hospital,China Academy of Chinese Medical Sciences;Xiyuan Hospital,China Academy of Chinese Medical Sciences)

机构地区：[1]北京中医药大学研究生院,北京市朝阳区100029 [2]北京中医药大学东方医院 [3]长春中医药大学附属医院 [4]北京中医医院顺义医院 [5]重庆市中医院 [6]广东省江门市五邑中医院 [7]中国中医科学院望京医院 [8]中国中医科学院西苑医院

出　　处：《中医杂志》2020年第11期978-983,共6页Journal of Traditional Chinese Medicine

基　　金：国家中医药管理局中医药行业科研专项(201407001-8);国家中医药管理局中医药传承与创新“百千万”人才工程(岐黄学者)-国家中医药领军人才支持计划项目(国中医药人教发[2018]12号)。

摘　　要：目的探讨急性缺血性脑卒中后认知障碍的中医证候要素,为临床早期干预提供辨证论治依据。方法纳入多中心协作收集的急性缺血性脑卒中后认知障碍患者331例,采用"中医症状、舌脉象观察表"进行四诊信息采集,内容含40项临床症状、20项舌象及10种脉象。对受试者的70项四诊信息采用因子分析方法进行证候要素提取,并统计证候要素分布特点。结果 40项临床症状中出现频率位于前5位的为乏力(44.71%)、言语謇涩(41.99%)、失眠(41.39%)、夜尿频多(35.95%)、神疲(35.35%)。舌色以舌暗出现频率最高,占53.47%;苔色以苔白最为常见,占66.77%;苔质以苔薄最多,占48.94%。脉弦出现频率最高,占65.86%,其次为脉滑、脉沉。经因子分析后共得出6个证候要素,其中气虚比例最高(43.20%),其次为痰(23.56%)、血瘀(16.31%)、火(8.46%)、阴虚(5.44%)、阳虚(3.02%),病位以肾、脾、肝多为常见。结论急性缺血性脑卒中后认知障碍中医证候要素以气虚为主,肾脾亏虚、痰瘀互结可能是脑卒中急性期出现认知障碍的重要病理因素。Objective To explore the elements of traditional Chinese medicine(TCM) syndromes of cognitive impairment after acute ischemic stroke, and to provide the basis for syndrome differentiation and treatment for early clinical intervention. Methods A total of 331 patients with cognitive impairment after acute ischemic stroke were collected by multi-center collaboration. The information of the four diagnosis methods was collected by using the Chinese Medicine Symptoms, Tongue and Pulse Observation Table, which included 40 clinical symptoms, 20 tongue manifestations and 10 kinds of pulse. Factor analysis method was used to extract the syndrome elements from the 70 items of diagnosis information of the subjects, and the distribution characteristics of syndrome elements were counted. Results Among the 40 clinical symptoms, the top 5 of frequency of occurrence were fatigue(44.71%), verbal astringency(41.99%), insomnia(41.39%), frequent nocturia at night(35.95%), and spiritual fatigue(35.35%). Among tongue manifestations, dark tongue is the largest frequency of tongue color, accounting for 53.47%;white tongue coating is most common tongue color accounting for 66.77%;the most common tongue quality is thin tongue coating, accounting for 48.94%. Stringy pulse is the most common pulse manifestation, accounting for 65.86%, followed by slippery pulse and deep pulse. After factor analysis, a total of 6 syndrome elements were obtained, of which the proportion of qi deficiency was the highest(43.20%), followed by phlegm(23.56%), blood stasis(16.31%), fire(8.46%), yin deficiency(5.44%), and yang deficiency(3.02%), the disease is more common in the kidney, the spleen and the liver. Conclusion The main TCM syndromes of cognitive impairment after acute ischemic stroke are qi deficiency. Deficiency of the kidney and the spleen and intermin-gled phlegm and blood stasis may be the important pathological factors of cognitive impairment in the acute stage of stroke.

关 键 词：急性缺血性脑卒中 认知障碍 证候要素 因子分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]