急性脑梗死患者中医证型与MRI影像学表现及外周血指标相关性研究

Correlation between Chinese Medicine Syndromes and MRI Imaging Manifestations and Peripheral Blood Indexes in Patients with Acute Cerebral Infarction

目的探究急性脑梗死患者中医证型与MRI影像学表现及外周血指标的相关性。方法回顾分析南京中医药大学附属盐城中医院142例急性脑梗死患者的资料,根据中医辨证分型,将患者分为气虚血瘀证组83例、风痰阻络证组37例与阴虚风动证组22例。收集三组患者的临床资料,包括基本信息、MRI影像学表现、外周血指标。分析比较三组临床资料的差异及中医证型与临床各指标的相关性。采用Logistic回归分析临床各指标对中医证型的影响因素。结果三组患者年龄、外周血单核细胞、血清D-二聚体、糖化血红蛋白、甘油三脂、高密度脂蛋白、尿酸存在差异(P<0.05)。阴虚风动证与气虚血瘀证相比,单病灶占比存在差异(P<0.01)。气虚血瘀证患者多为腔隙性梗死(74.70%),相比风痰阻络证及阴虚风动证患者梗死面积分布更均匀(P<0.01)。中医证型与D-二聚体呈负相关(r=-0.327,P<0.001),与病灶数呈正相关(r=0.291,P<0.001)。多因素分析提示单核细胞、D-二聚体、糖化血红蛋白、高密度脂蛋白、尿酸为中医证型分布的影响因素。结论急性脑梗死的中医证型与外周血指标有一定相关性,其中单核细胞、血清D-二聚体、糖化血红蛋白、高密度脂蛋白和尿酸数值的异常可作为急性脑梗死的中医辨证分型的关键指标。

Objective To explore the correlation between Chinese medicine(CM)syndromes and MRI imaging manifestations and peripheral blood indicators in patients with acute cerebral infarction.Methods A retrospective analysis was conducted on the data of 142 patients with acute cerebral infarction in Yancheng Traditional Chinese Medicine Hospital affiliated to Nanjing University of Chinese Medicine.According to CM syndrome differentiation,the patients were assigned to qi deficiency and blood stasis syndrome(QDBSS)group(83 cases),wind and phlegm obstructing channel syndrome(WPOCS)group(37 cases)and yin deficiency induced wind stirring syndrome(YDWSS)group(22 cases).Clinical data of the three groups were collected,including basic information,MRI findings and peripheral blood indicators.The difference of clinical data and the correlation between CM syndrome types and clinical indexes were analyzed and compared.Logistic regression was used to analyze the influencing factors of clinical indicators on CM syndrome types.Results There were significant differences in age,peripheral blood monocytes,serum D-dimer,glycosylated hemoglobin,triglyceride,high-density lipoprotein and uric acid among the three groups(P<0.05).There was a statistically significant difference in the proportion of single lesions between YDWSS and QDBSS groups(P<0.01).The patients with QDBSS were mostly lacunar infarction(74.70%),and the distribution of infarct area was more uniform compared to the patients with WPOCS and YDWSS(P<0.01).CM syndrome types were negatively correlated with D-dimer(r=-0.327,P<0.001),and positively correlated with the number of lesions(r=0.291,P<0.001).Multivariate analysis showed that monocytes,D-dimer,glycosylated hemoglobin,high-density lipoprotein and uric acid were the influencing factors of CM syndrome type distribution.Conclusions The CM syndrome types of acute cerebral infarction have certain correlations with peripheral blood indicators.Among them,abnormalities in monocytes,serum D-dimer,glycosylated hemoglobin,high-density lipoprotein,and uric acid levels can serve as key indicators for the differentiation of CM syndrome types in acute cerebral infarction.