高血压合并脑微出血认知障碍特点及中医证型分析  

Characteristics of cognitive impairment and analysis of TCM syndrome differentiation in hypertensive patients with cerebral microbleed

作　　者：武秋娣 晏晓慧 吴旦 李文磊 WU Qiu-di;YAN Xiao-hui;WU Dan;LI Wen-lei(Department of Neurology,Jiangsu Province Hospital of Chinese Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210000,China)

机构地区：[1]南京中医药大学附属医院江苏省中医院神经内科,江苏南京210000

出　　处：《中国临床研究》2023年第3期334-338,共5页Chinese Journal of Clinical Research

基　　金：国家自然科学基金面上项目(81973794);江苏省中医药局课题(JD201803);江苏省高层次卫生人才“六个一工程”拔尖人才项目(LGY201806)。

摘　　要：目的 分析高血压合并脑微出血患者中医证型和影像学特点,及其与认知功能障碍的相关性。方法 利用磁敏感加权成像技术(SWI)对2019年1月至2021年12月在江苏省中医院就诊的225例高血压患者进行脑微出血评估,将患者分为脑微出血组108例和非脑微出血组117例,对2组患者进行中医证型和脑微出血病灶特点分析,应用简易智力状态量表(MMSE)和蒙特利尔认知量表(MoCA)对认知功能进行评定,比较两组患者认知障碍的发生情况,分析认知障碍患者中医证型特点。结果 225例高血压患者中108例(48.0%)存在脑微出血,位置主要位于深部及幕下。脑微出血患者中肝火亢盛型最多见,其次是阴虚阳亢型。脑微出血组认知功能障碍发生率(58.3%)明显高于非脑微出血组(21.4%),合并认知功能障碍患者肝火亢盛型最多见。结论 肝火亢盛和阴虚阳亢是高血压脑微出血患者的主要证型,高血压脑微出血患者认知障碍的发生率明显升高,肝火亢盛证型是合并认知障碍患者的主要证型。Objective To analyze the TCM syndrome differentiation and imaging characteristics of hypertensive patients with cerebral microbleeds(CMB),as well as their correlation with cognitive dysfunction.Methods A total of 225 hypertensive patients who were treated in Jiangsu Province Hospital of Chinese Medicine from January 2019 to December 2021 were assessed for CMB by sensitivity weighted imaging(SWI),and they were divided into CMB group(n=108)and non-CMB group(n=117).The two groups of patients were analyzed by TCM syndrome differentiation,CMB lesions characteristics,and the cognitive function was assessed by the simple mental state scale(MMSE)and the Montreal cognitive scale(MoCA).The occurrence of cognitive impairment between the two groups was compared,and the characteristics of TCM syndrome types of patients with cognitive impairment were analyzed.Results In 225 hypertensive patients,108 cases(48.0%)had CMB,which was mainly located in the deep and infratentorial.The type of liver-fire flaring-up was the most common syndrome type in patients with CMB,followed by the type of hyperactivity of yang due to yin deficiency.The incidence of cognitive dysfunction in CMB group(58.3%)was significantly higher than that in non-CMB group(21.4%),and type of liver-fire flaring-up was the most common syndrome type in patients with cognitive impairment.Conclusion Liver-fire flaring-up and hyperactivity of yang due to yin deficiency are the main syndrome types of hypertensive CMB.The incidence of cognitive impairment in patients with hypertensive CMB is significantly higher,and the type of liver-fire flaring-up is the main syndrome type of patients with cognitive impairment.

关 键 词：高血压 脑微出血 认知障碍 磁敏感加权成像 中医证型 肝火亢盛 阴虚阳亢 

分 类 号：R544.1[医药卫生—心血管疾病] R743.34[医药卫生—内科学]