急性缺血性中风发病24 h内头颅CT相关特征与早期神经功能恶化、90 d预后、中医证候要素的相关性研究  

tudy on the correlation between cranial CT features of acute ischemic stroke onset within 24 h and early neurological deterioration,90 d prognosis,and traditional Chinese medicine syndrome elements

作　　者：康利高阁 高颖[3] 唐欢 沈红波 刘蕾 刘丽亚 高岩 孔令博 KANG Ligaoge;GAO Ying;TANG Huan;SHEN Hongbo;LIU Lei;LIU Liya;GAO Yan;KONG Lingbo(Beijing University of Chinese Medicine,Beijing 100029,China;Fangshan Hospital,Beijing University of Chinese Medicine,Beijing 102488,China;Institute of Encephalopathy,Beijing University of Chinese Medicine,Beijing 100700,China;Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学房山医院 [3]北京中医药大学脑病研究院 [4]北京中医药大学东直门医院

出　　处：《北京中医药大学学报》2025年第3期424-437,共14页Journal of Beijing University of Traditional Chinese Medicine

基　　金：北京市中医药科技发展资金项目(No.BJZYQN-2023-30);首都卫生发展科研专项项目(No.2018-1-4191)。

摘　　要：目的探究普通头颅计算机断层扫描(CT)对急性缺血性中风(AIS)患者急性期的早期神经功能恶化(END)、远期预后和中医证候要素的评估潜力。方法本研究纳入2019年11月—2021年5月北京中医药大学房山医院急诊科发病24 h以内的AIS患者101例。以是否出现END,发病90 d预后(非致残结局或功能独立结局),以及证候要素(内火、痰湿、血瘀、气虚、阴虚)是否成立作为因变量和分组依据,分析发病24 h内AIS患者首次普通头颅CT的相关特征与END、发病90 d预后及首发证候要素的相关性。结果本研究纳入男性61例、女性40例;年龄(64.43±10.56)岁;普通头颅CT检查距发病3.50(1.50,9.75)h;轻型AIS 70例(69.3%),中型AIS 30例(29.7%),重型AIS 1例(1.0%);静脉溶栓患者15例(14.9%)。101例患者中,发病24 h内可见6个证候要素,其中,内风101例(100.0%),内火58例(57.4%),痰湿60例(59.4%),血瘀67例(66.3%),气虚39例(38.6%),阴虚23例(22.8%)。受累肢体对侧脑区存在病灶的人群END发生率(32.9%)高于受累肢体对侧脑区不存在病灶的人群(10.7%),且与END的发生呈强正相关(OR=4.082,P=0.026)。基底神经节区(33.3%)及颈动脉系统供血区(32.8%)有病灶的人群END发生率分别高于基底神经节区(15.8%)及颈动脉系统供血区(14.7%)无病灶的人群,并均与END的发生呈中等的正相关(OR=2.667,P=0.047;OR=2.836,P=0.044)。出现脑白质变性(30.8%)和受累肢体对侧脑区存在病灶(52.1%)的人群较无脑白质变性(63.6%)和受累肢体对侧脑区未发现病灶(78.6%)的人群非致残结局比例低,且均与非致残结局的出现呈强负相关(OR=0.254,P=0.034;OR=0.296,P=0.015)。有脑白质变性(30.8%)和受累肢体对侧脑区存在病灶(64.4%)的人群较无脑白质变性(77.3%)和受累肢体对侧脑区未发现病灶(89.3%)的人群功能独立结局比例低,且均与功能独立结局的出现呈强负相关(OR=0.131,P=0.001;OR=0.217,P=0.014)。基底神经节区有病灶的人群内火�Objective To investigate the potential of conventional cranial computed tomography(CT)in assessing the early neurological deterioration(END),long-term prognosis,and traditional Chinese medicine(TCM)syndrome elements during the acute phase in patients with acute ischemic stroke(AIS).Methods This study included 101 patients with AIS onset within 24 h in the Emergency Department of Fangshan Hospital,Beijing University of Chinese Medicine,from November 2019 to May 2021.To investigate the correlation between the relevant characteristics of the first conventional cranial CT in patients with AIS onset within 24 h and END,90 d prognosis,and initial syndrome elements,the presence or absence of END,the 90 d prognosis(non-disabling outcome or functionally independent outcome),and the establishment of syndrome elements(internal fire,phlegm-dampness,blood stasis,qi deficiency,yin deficiency)were used as dependent variables and grouping criteria.Results This study included 61 males and 40 females,with an age of(64.43±10.56)years.The time from onset to conventional cranial CT examination was 3.50(1.50,9.75)h.Among the patients,there were 70 cases(69.3%)of mild AIS,30 cases(29.7%)of moderate AIS,and one case(1.0%)of severe AIS.Fifteen patients(14.9%)received intravenous thrombolysis.Among the 101 patients,six syndrome elements were observed within 24 h of onset:internal wind in 101 cases(100.0%),internal fire in 58 cases(57.4%),phlegm-dampness in 60 cases(59.4%),blood stasis in 67 cases(66.3%),qi deficiency in 39 cases(38.6%),and yin deficiency in 23 cases(22.8%).The incidence of END was higher in patients with lesions in the contralateral cerebral hemisphere to the affected limb(32.9%)than in those without such lesions(10.7%),showing a strong positive correlation with END occurrence(OR=4.082,P=0.026).The incidence of END was higher in patients with lesions in the basal ganglia region(33.3%)and the carotid system blood supply area(32.8%)than in those without lesions in the basal ganglia region(15.8%)and the carotid system terri

关 键 词：急性缺血性中风 计算机断层扫描 证候要素 早期神经功能恶化 远期预后 

分 类 号：R255.2[医药卫生—中医内科学]