高血压脑小血管病的中医病机思辨与治疗及其疗效评价指标述评  

A Review of TCM Pathogenesis,Treatment and Curative Effect Evaluation of Hypertensive Cerebral Small Vessel Disease

作　　者：方锐[1] 周月 彭煕文 王珊珊[1] 谢乐 梅志刚 葛金文[1,3] Fang Rui;Zhou Yue;Peng Xiwen;Wang Shanshan;Xie Le;Mei Zhigang;Ge Jinwen(School of Integrated Chinese and Western Medicine,Hunan University of Chinese Medicine,Changsha 410208,China;The Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine,Changsha 410000,China;Shaoyang University,Shaoyang 422000,China)

机构地区：[1]湖南中医药大学中西医结合学院,长沙410208 [2]湖南省中医药研究院附属医院,长沙410006 [3]邵阳学院,邵阳422000

出　　处：《世界科学技术-中医药现代化》2021年第12期4356-4363,共8页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：国家科学技术部国家重点研发计划(2018YFC1704904):脑泰方防治高血压脑小血管病变的循证优化研究,负责人:葛金文;湖南省科学技术厅省重点研发计划(2022SK2016):高血压脑小血管病中西医结合诊疗的循证优化研究,负责人:葛金文;湖南省教育厅科学研究项目(优秀青年项目)(20B436):高血压脑小血管病的中西医联合筛查模型与诊疗专家共识研究,负责人:方锐。

摘　　要：目的探讨高血压脑小血管病(Hypertensive cerebral small vessel disease,HT-CSVD)的中医病因病机,梳理HT-CSVD中医药治疗现况及其疗效评价指标。方法基于“风痰瘀虚”立论,从中医基础理论视角系统阐述HT-CSVD的发病机理;并对中医药治疗HT-CSVD文献进行方法学质量评价与牛津证据等级分类总结,归纳其疗效评价指标。结果HT-CSVD的病机为虚则气血津液不足和髓海失养,实则风、痰、瘀犯清窍,邪袭虚处,壅滞清窍而“神”乱;病位在脑窍,与心、肾、肝、脾的虚损相关;“虚”“瘀”“痰”“风”是其重要的病理枢机。当前,HT-CSVD的中医药治疗主要包括益气、活血、补肾、化痰等中药复方或注射液,针刺(取穴主穴为人迎、合谷、太冲等)及其他非药物干预3方面。其疗效评价指标以功能评分量表、影像学特征指标、机制相关生物标记物与中医证候相关有效率与评分等为主。结论本研究对HT-CSVD中医病因病机的解析,以及中医药治疗HT-CSVD的较高证据等级方案与其疗效评价指标的梳理,可望为后续HTCSVD中医药防治专家共识的制订提供参考。Objective To explore the etiology and pathogenesis of hypertensive cerebral small vessel disease(HT-CSVD),and to review the status of TCM treatment and evaluation indicators of HT-CSVD.Methods Based on the theory of"wind phlegm stasis deficiency",the pathogenesis of HT-CSVD was systematically expounded from the perspective of basic theories for traditional Chinese medicine(TCM).The methodological quality evaluation and Oxford evidence classification of clinical literature on TCM treatment of HT-CSVD were carried out,and the efficacy evaluation indicators were summarized.Results The pathogenesis of HT-CSVD was deficiency syndrome of qi,blood and fluid,as well as loss of nutrition of medullary sea.TCM excessive syndrome of wind,phlegm and blood stasis caused the harm of the clear orifices,and evil forces attacked the deficiency of body,which causes confusion of"spirit".The location of HTCSVD was in the brain,and it was related with the deficiency of heart,kidney,liver,and spleen."Deficiency","stasis","phlegm"and"wind"were the important pathological factors of HT-CSVD.At present,TCM treatment of HT-CSVD mainly included three aspects:(1)TCM compound or injection for supplementing qi,promoting blood circulation,tonifying kidney,eliminating phlegm;(2)acupuncture(The main acupoints were Renying(ST9),Hegu(LI4),Taichong(LR3),etc.);(3)other non-drug.The mainly efficacy evaluation indicators were functional score scale,imaging characteristics,mechanism related biomarkers and TCM syndrome related efficiency and score.Conclusion The paper analyzes the TCM etiology and pathogenesis of HT-CSVD,meanwhile it also reviews the higher level evidence of TCM treatment and efficacy evaluation indicators for HT-CSVD,both of which may provide evidence-based medical proof for the formulation of the consensus of TCM prevention and treatment of HT-CSVD in the future.

关 键 词：高血压脑小血管病 病因病机 治疗方案 疗效评价 

分 类 号：R259[医药卫生—中西医结合]