脑梗死患者证型分布与颅脑CT灌注参数和短期预后的关系  

The relationship between the distribution of syndrome types and cerebral CT perfusion parameters and short-term prognosis in patients with cerebral infarction

作　　者：韩芸 乔缘 王晨 张倩倩[1] 韩宝华[2] HAN Yun;QIAN Yuan;WANG Chen(Department of Emergency ICU,The First Affiliated Hospital of Hebei North University,Zhangjiakou Hebei 075000,China;Department of Emergency,The First Affiliated Hospital of Hebei North University,Zhangjiakou Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院急诊ICU,河北张家口075000 [2]河北北方学院附属第一医院急诊科,河北张家口075000

出　　处：《四川中医》2023年第11期93-97,共5页Journal of Sichuan of Traditional Chinese Medicine

基　　金：河北省卫生健康委科研基金项目(编号:20220030)。

摘　　要：目的:分析急性脑梗死患者中医证候分布与颅脑CT灌注成像(CTP)参数和短期预后的关系。方法:选取2021年2月至2022年1月收治的126例急性脑梗死患者。所有患者均接受头颅CT检查。分析126例患者的中医证型分布特点;比较不同中医证型患者病变部位、病灶大小及CTP参数;对所有患者进行为期6个月的跟踪随访,采用改良Rankin量表(mRS)将患者分为预后良好及预后不良组,比较两组中医证型分布情况及CTP参数。结果:126例患者中气虚血瘀证33例,风痰瘀阻证51例,风火上扰证42例,三种证候分型患者的脑梗死病变部位及病灶大小比较差异明显(P<0.05),其中风痰瘀阻证患者病变部位主要集中在前循环皮质(23.53%)及基底节(45.10%),以中小面积脑梗死(70.59%)为主,而气虚血瘀证及风火上扰证患者的病变部位主要集中在后循环(48.48%、57.14%),病灶大小主要表现为腔隙性脑梗死(84.85%、76.19%)。三种证候分型患者的CTP参数比较差异有统计学意义(P<0.05),风痰瘀阻证的rCBF、rCBV值低于气虚血瘀证及风火上扰证(P<0.05),rMTT值较其他两组延长(P<0.05);气虚血瘀证患者的rCBF值低于风火上扰证,rMTT值高于风火上扰证(P<0.05)。随访6个月时,126例患者预后良好95例,预后不良31例,气虚血瘀证及风痰瘀阻证预后不良例数明显高于风火上扰证(P<0.05)。预后良好组患者的rCBV值较预后不良组明显升高,rMTT值缩短(P<0.05),而两组rCBF值比较无明显差异(P>0.05)。结论:急性脑梗死患者的CTP参数及短期预后情况与中医证候分型密切相关。与气虚血瘀证及风火上扰证患者相比,风痰瘀阻证的rCBF、rCBV值降低及rMTT值延长更明显,且风火上扰证患者的预后情况最佳。Objective:To analyze the relationship between TCM syndrome type distribution and cranial CT perfusion(CTP)parameters and short-term prognosis in patients with acute cerebral infarction.Methods:126 patients with acute cerebral infarction who were treated from February 2021 to January 2022 were selected.All patients underwent head CT examination.The distribution characteristics of TCM syndrome types of 126 patients were analyzed,and the lesion location,lesion size and CTP parameters were compared among patients with different TCM syndrome types.All patients were followed up for 6 months,and modified Rankin scale(mRS)was used to divide patients into good prognosis group and poor prognosis group,and the distribution of TCM syndrome types and CTP parameters were compared.Results:Among the 126 patients in this study,there were 33 cases of qi deficiency and blood stasis syndrome,51 cases of wind-phlegm and blood stasis syndrome and 42 cases of wind-fire disturbance syndrome.The lesion position and lesion size of cerebral infarction were significantly different among the three syndrome types(P<0.05).The lesions of patients with wind phlegm and blood stasis syndrome were mainly concentrated in the anterior circulation cortex(23.53%)and basal ganglia(45.10%),with mainly small and medium-sized cerebral infarction(70.59%),and the lesions of patients with qi deficiency and blood stasis syndrome and wind-fire disturbance syndrome were mainly concentrated in the posterior circulation(48.48%,57.14%),and the lesion size was mainly shown as lacunar cerebral infarction(84.85%,76.19%).There were statistically significant differences in CTP parameters among the three syndrome types(P<0.05).The rCBF and rCBV of patients with wind-phlegm and blood stasis syndrome were lower than those of patients with qi deficiency and blood stasis syndrome and wind-fire disturbance syndrome(P<0.05),and the rMTT was longer than that of patients with the other two syndrome types(P<0.05).The rCBF of patients with qi deficiency and blood stasis syndrome w

关 键 词：急性脑梗死 中医辩证分型 CT灌注参数 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]