基于典型相关分析的缺血性中风患者中医证型与颈动脉斑块相关性的多中心、前瞻性研究  

Correlation between Traditional Chinese Medicine Syndromes and Carotid Plaque in Patients with Ischemic Stroke based on Canonical Correlation Analysis:A Multicenter Prospective Study

作　　者：席俊羽 张利丹 魏瑞丽[1] 谢雁鸣[1] 蔡业峰[2] 沈晓明 赵德喜 谢颖桢 赵性泉[6] 孟繁兴 于海青[8] XI Junyu;ZHANG Lidan;WEI Ruili;XIE Yanming;CAI Yefeng;SHEN Xiaoming;ZHAO Dexi;XIE Yingzhen;ZHAOXingquan;MENGFanxing;YU Haiqing(Institute of Basic Research in Clinical Medicine,China Academy of Medical Sciences,Beijing,100700;Guangdong Provincial Hospital of Traditional Chinese Medicine;The First Affiliated Hospital of Henan University of Chinese Medicine;The Affiliated Hospital of Changchun University of Chinese Medicine;Dongzhimen Hospital,Beijing University of Chinese Medicine;Beijing Tiantan Hospital,Capital Medical University;Dongfang Hospital,Beijing University of Chinese Medicine;Taiyuan Hospital of Traditional Chinese Medicine)

机构地区：[1]中国中医科学院中医临床基础医学研究所,100700 [2]广东省中医院 [3]河南中医药大学第一附属医院 [4]长春中医药大学附属医院 [5]北京中医药大学东直门医院 [6]首都医科大学附属北京天坛医院 [7]北京中医药大学东方医院 [8]太原市中医医院

出　　处：《中医杂志》2023年第10期1028-1035,共8页Journal of Traditional Chinese Medicine

基　　金：中医药行业科研专项(201507003-8);国家中医药管理局2021年岐黄学者支持项目(国中医药人教函[2022]6号)。

摘　　要：目的 探讨缺血性中风患者颈动脉斑块与中医证型的相关性。方法 利用注册登记式研究,纳入全国7家分中心脑病科收治的明确诊断为缺血性中风的患者,收集并记录患者的基线人口学信息、中医证型诊断、颈动脉斑块情况(包括颅内血管狭窄程度、颈动脉斑块厚度、颈动脉血管狭窄程度、颈动脉斑块性质与内膜增厚)等。对颈动脉斑块情况与中医证型特征进行典型相关分析:以缺血性中风患者各中医证型为X组变量,对应的综合变量为U;以颈动脉斑块情况为Y组变量,对应的综合变量为V,利用这两个综合变量之间的相关关系来反映两组指标之间的整体相关性,探索缺血性中风患者颈动脉斑块与不同证型的相关关系。结果 共纳入2558例缺血性中风患者,其中首发1741例,复中817例。颅内血管与颈动脉血管均是无狭窄患者最多(1703例,66.58%;2080例,81.31%);斑块性质表现最多的为非均质不稳定性斑块(1221例,47.73%);存在内膜增厚的患者(1725例,67.44%)多于无内膜增厚者(833例,32.56%);颈动脉斑块厚度为(2.14±1.48)mm。证型方面以气虚血瘀证(1505例,58.87%)占比最多,痰热腑实证(27例,1.05%)占比最少。典型相关分析结果显示,风痰火亢证与颈动脉斑块厚度呈正相关(r=0.040,P<0.05),风痰瘀阻证与颈动脉斑块厚度(r=0.050,P<0.05)、颈动脉血管狭窄程度(r=0.049,P<0.05)呈正相关,痰湿蒙神证与颈动脉血管狭窄程度呈正相关(r=0.049,P<0.05),气虚血瘀证与颅内血管狭窄程度呈正相关(r=0.099,P<0.05)。结论 缺血性中风患者的常见证候类型为风痰瘀阻证与气虚血瘀证,风痰火亢证、风痰瘀阻证、痰湿蒙神证和气虚血瘀证与缺血性中风患者的颅、颈部血管病理结构的形成相关。Objective To explore the correlation between carotid plaque and traditional Chinese medicine(TCM)syndrome in patients with ischemic stroke.Methods The patients with ischemic stroke admitted to the encephalopathy departments of seven sub-centers across the country were included in the registration study,and the baseline demographic information,TCM syndromes and carotid plaque characteristics including the degree of intracranial vascular stenosis,plaque thickness,carotid artery stenosis,plaque nature and intimal thickening were collected and recorded.The canonical correlation analysis was performed between the characteristics of carotid plaque and TCM syndrome,taking each TCM syndrome as group X variable and corresponding comprehensive variable as U,while taking carotid plaque characteristics as group Y variable and corresponding comprehensive variable as V.The correlation between the two comprehensive variables was used to reflect the overall correlation between the two groups of indicators,and indicate the correlation between carotid plaque and different TCM syndromes.Results A total of 2558 patients with ischemic stroke were included,involving 1741 cases of first episode and 817 cases of recurrence.In terms of the degree of intracranial vascular stenosis and carotid vessels stenosis,the patients without stenosis were the most(1703 cases,66.58%;2080 cases,81.31%).Heterogeneous unstable plaques were mostly seen(1221 cases,47.73%).There were 1725 patients with intimal thickening(67.44%),and 833 patients without intimal thickening(32.56%).The plaque thickness was 2.14±1.48mm.Qi deficiency and blood stasis syndrome accounted for the most(1505 cases,58.87%),while phlegm heat and bowel excess syndrome accounted for the least(27 cases,1.05%).Canonical correlation analysis showed that wind-phlegm heat exuberance syndrome was positively correlated with plaque thickness(r=0.040,P<0.05),while wind-phlegm obstruction syndrome was positively correlated with the thickness of plaque(r=0.050,P<0.05)and the degree of carotid art

关 键 词：缺血性中风 颈动脉斑块 颈动脉狭窄 中医证型 典型相关分析 

分 类 号：R277.7[医药卫生—中医学]