基于DTI评价急性缺血性脑卒中运动功能缺损程度与肾虚髓亏证的相关性研究  

Study on the Correlation Between the Degree of Motor Dysfunction and the Syndrome of Kidneymarrow Deficiency in Acute Ischemic Stroke Based on DTI

作　　者：朱巍明 李鑫[2] 姬琳[3] 宗寿健[3] 王振松[3] 孟智宏[1] 刘伟 Zhu Weiming;Li Xin;Ji Lin;Zong Shoujian;Wang Zhensong;Meng Zhihong;Liu Wei(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300381,China;Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250001,China;Scientific bureau of Shandong University of Traditional Chinese Medicine,Jinan 250355,China)

机构地区：[1]天津中医药大学第一附属医院/国家中医针灸临床医学研究中心,天津300381 [2]山东中医药大学附属医院,济南250014 [3]山东中医药大学第二附属医院,济南250001 [4]山东中医药大学科研处,济南250355

出　　处：《世界科学技术-中医药现代化》2022年第5期2137-2150,共14页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：泰山学者工程专项经费资助(tsqn201909186):髓亏证与缺血性脑卒中神经功能缺损程度的相关性及针药结合的泛髓疗法对缺血性脑卒中的作用及机制研究,负责人:刘伟;中医药创新骨干人才培训项目专项经费;山东省中医药高层次人才培育项目专项经费。

摘　　要：目的运用核磁共振弥散张量成像技术(DTI),从皮质脊髓束损伤程度评价的角度,探讨肾虚髓亏证与急性缺血性脑卒中运动功能缺损程度相关性,丰富中风病病机及证候诊断,拓宽缺血性脑卒中的中医药防治思路,为急性缺血性脑卒中肾虚髓亏证患者运动功能损伤程度提供临床依据,强调肾虚髓亏证在急性缺血性脑卒中运动功能损伤中的重要意义。方法纳入符合诊断标准的90例病例,根据证候分别归入肾虚髓亏组和非肾虚髓亏组,每组各45例。每组患者均给予常规西药治疗。对两组患者入院后行弥散张量成像检测,同时分别于治疗前及治疗后14天,记录两组患者NIHSS评分、改良Barthel指数量表及简化Fugl-Meyer运动功能评分量表评分,比较两组病例发病时的轻重程度及治疗前后两组病例组间的恢复差异。结果研究显示,治疗前肾虚髓亏组在NIHSS评分方面高于非肾虚髓亏组(P<0.05);治疗前肾虚髓亏组在改良Barthel指数量表及简化Fugl-Meyer运动功能评分方面低于非肾虚髓亏组(P<0.05)。治疗前后NIHSS评分、改良Barthel指数评分及简化Fugl-Meyer运动功能评分改善情况,非肾虚髓亏组要优于肾虚髓亏组(P<0.05)。治疗前两组患者在健侧内囊后肢及大脑脚外侧处FA值及ADC值无明显差异;肾虚髓亏组在患侧内囊后肢及大脑脚外侧处FA值及ADC值均低于非肾虚髓亏组(P<0.05)。相关性分析得出,两组患者患侧内囊后肢FA值与患者治疗前NIHSS评分呈负相关;两组患者患侧内囊后肢FA值与患者改良Barthel指数评分及简化Fugl-Meyer运动功能评分呈正相关;肾虚髓亏组患者患侧内囊后肢FA值与肾虚髓亏证中医证候评分呈负相关。结论肾虚髓亏是急性缺血性脑卒中运动功能障碍的重要病机。研究结果显示,两组皮质脊髓束损伤程度与神经功能及运动功能损伤存在相关性,且肾虚髓亏组在皮质脊髓束的损伤程度方面与其Objective To explore the correlation between the kidney-marrow deficiency syndrome and motor function deficit degree of acute ischemic stroke, enrich the pathogenesis and syndrome diagnosis of stroke, and broaden the idea of traditional Chinese medicine prevention and treatment of ischemic stroke, using magnetic resonance diffusion tensor imaging(DTI) technology, from the perspective of evaluation of corticospinal tract injury, so as to provide a clinical basis for the degree of motor function injury in patients with the kidney-marrow deficiency syndrome in acute ischemic stroke,emphasizing the importance of the kidney-marrow deficiency syndrome in the motor function injury in acute ischemic stroke.Methods Ninety patients meeting the diagnostic criteria were included and classified into the kidney-marrow deficiency group and non-kidney-marrow deficiency group, with 45 cases in each group. Patients in both groups were given conventional western medicine treatment. Diffusion tensor imaging was performed for the two groups after admission, and NIHSS scores, modified Barthel index scale and simplified Fugl-Meyer motor function scale were recorded before and 14 days after treatment, respectively, to compare the severity of the onset of the two groups of patients and the difference in recovery between the two groups before and after treatment.Results The results showed that NIHSS scores in the kidney-marrow deficiency syndrome group were higher than those in the non-kidney-marrow deficiency group(P<0.05). Before treatment, the modified Barthel index scale and simplified Fugl-Meyer motor function score in the kidney-marrow deficiency syndrome group were lower than those in the non-kidney-marrow deficiency group(P<0.05). The improvement of NIHSS score, modified Barthel index score and simplified Fugl-Meyer motor function score before and after treatment was better in the non-kidney-marrow deficiency group than in the kidneymarrow deficiency syndrome group(P<0.05). It was found that there was no obvious difference in FA v

关 键 词：急性缺血性脑卒中 肾虚髓亏 弥散张量成像 运动功能 

分 类 号：R2-03[医药卫生—中医学]