基于“风痰瘀虚”的高血压脑小血管病病性证素的临床表现与影像学特征研究  

Clinical Manifestations and Imaging Characteristics of Syndrome Elements of Hypertensive Cerebral Small Vascular Disease Based on the Chinese Medicine Theory of Wind,Phlegm,Blood Stasis and Deficiency

作　　者：周月 方锐[1] 刘迅 林宏远 谢乐 王玮 童骄 罗运花[2] 伍大华[2] 张堃[3] 葛金文[1,5] Zhou Yue;Fang Rui;Liu Xun;Lin Hongyuan;Xie Le;Wang Wei;Tong Jiao;Luo Yunhua;Wu Dahua;Zhang Kun;Ge Jinwen(College of Integrated Chinese and Western Medicine,Hunan University of Chinese Medicine,Changsha 410208,China;Hunan Academy of Traditional Chinese Medicine Affiliated Hospital,Changsha 410006,China;The First Hospital of Hunan University of Chinese Medicine,Changsha 410007,China;The First Chinese Medicine Hospital of Changde,Changde 415000,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]湖南中医药大学第一附属医院,长沙410021 [4]常德市第一中医医院,常德415000 [5]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4374-4381,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;湖南中医药大学中西医结合一流学科开放基金(2020ZXYJH27):基于“风痰瘀虚”研究HT-CSVD的中医证型与影像学表现特征的相关性,负责人:周月。

摘　　要：目的观察高血压脑小血管病(HT-CSVD)病性证素的临床表现与影像学特征,为深入探讨其病因病机及诊断客观化提供参考依据。方法针对2020年7月至2021年7月在湖南中医药大学第一附属医院、湖南省中医药研究院附属医院、常德市第一中医院筛检的230例HT-CSVD患者,收集其人口学资料、既往病史、症状与体征、MRI检查及中医四诊等信息,建立数据库;根据患者证候特征进行风、痰、瘀、虚的病性证素判定,并分析其临床表现与影像学特征。结果HT-CSVD的病性证素分布构成比依次为虚>痰>风>瘀,症状以记忆障碍和睡眠障碍为主;其中瘀和虚性多表现为睡眠障碍,而痰、瘀、虚性多表现为记忆障碍。中医证候评分显示,风性者症状以头晕目眩为主;痰性者症状以痰多吐涎为主,评分显著高于其他3组(P<0.01)。瘀性者症状以刺痛、痛有定处为主,评分显著高于其他3组(P<0.01)。虚性者症状以气短乏力为主,评分显著高于其他3组(P<0.01)。影像学结果显示,超过25%的虚性HT-CSVD表现为腔隙性脑梗死(LI)。4组均有超过20%的HT-CSVD表现为微出血(CMB)。虚性者脑萎缩的占比均高于其他3组。血管周围间隙扩大(dVRS)等级结果分析显示,瘀性者基底节区非0级的占比最高。虚性者白质区非0级的占比最高,其次是瘀性和痰性;且3者等级超过2级的比例均高于10%。风与虚性、风与瘀性、痰与虚性之间的脑室旁高信号评分有差异;风与其他3组病性之间的深部白质高信号评分有差异。结论由于病例数较少,本初步研究结果可为HT-CSVD中医四诊客观化、微观化研究提供临床证据。Objective To observe clinical manifestations and imaging characteristics of syndrome elements of hypertensive cerebral small vascular disease hypertensive cerebral small vessel disease(HT-CSVD),and to provide possible basis for further discussion of its etiology and pathogenesis as well as objectification and standardization of HTCSVD.Methods 230 HT-CSVD subjects were chosen from the First Hospital of Hunan University of Chinese Medicine,Hunan Academy of Traditional Chinese Medicine Affiliated Hospital,the First Chinese Medicine Hospital of Changde from July 2020 to July 2021.Demographic data,previous medical history,symptoms and signs,MRI examination and four traditional Chinese medicine(TCM)diagnoses were collected to establish a database.According to the syndrome differentiation,the pathogenicity of wind,phlegm,blood stasis and deficiency was determined,and their clinical manifestations and the characteristics of imaging manifestations were analyzed.Results The nature of disease distribution in HT-CSVD subjects was deficient>phlegm>wind>blood stasis,and the syndrome score of TCM showed that the main symptoms were memory disturbance and sleep disturbance.Among them,blood stasis and deficiency were the main causes of sleep disorders,while phlegm,blood stasis and deficiency were the main causes of memory disorders.Symptom score of TCM showed that the main symptom of wind subjects was dizziness.The score of phlegm subjects in salivation was significantly higher than that of other three groups(P<0.01).The main symptom of blood stasis subjects was prickling and constant pain,and the score of it was significantly higher than that of other three groups(P<0.01).The score of the shortness of breath in deficient subjects was significantly higher than that of other three groups(P<0.01).Imaging results showed that more than 25%of subjects with deficiency had lacunar infarction(LI).The proportion of cerebral-microbleed(CMB)in all groups was more than 20%.The proportion of cerebral atrophy in patients with deficient was high

关 键 词：高血压脑小血管病 病性 影像学特征 临床表现 

分 类 号：R2-03[医药卫生—中医学]