不同中医证型颈动脉硬化患者颈动脉彩色超声特点比较及中医辨证治疗效果

Features of carotid ultrasonography in patients with carotid artery sclerosis of different TCM syndromes & the effect of TCM syndrome differentiation treatment

目的探究不同中医证型颈动脉硬化(CAS)患者颈动脉彩色超声特点及中医辨证治疗效果。方法选取我院心血管内科收治的CAS患者320例,按照中医证候进行辨证分型,采用多普勒超声分析不同中医证型CAS患者颈动脉彩色超声特点;并根据其治疗方式对CAS患者分为西医组和中西医联合组,均连续治疗12周,比较两组治疗前后颈动脉内-中膜厚度(IMT)、斑块Crouse积分、斑块数目。结果320例患者中肾阴亏虚型34例(10.36%)、肝肾阴虚型31例(9.69%)、气虚痰浊型110例(34.38%)、肾虚血瘀型70例(21.88%)、肾虚痰浊型49例(15.31%)、肾虚气滞型26例(8.13%)。肾虚血瘀型患者斑块数目低于气虚痰浊型和肾虚气滞型(P<0.05),肾虚血瘀型CAS中度狭窄率高于肾阴亏虚型、肾虚气滞型,气虚痰浊型CAS重度狭窄率高于肾虚痰浊型(P<0.05)。采用西药治疗者151例(47.19%),采用中西药联合治疗者169例(52.81%)。治疗后,两组斑块Crouse积分、斑块数目低于治疗前,中西药联合组低于西药组(P<0.05)。西药组和中西药联合组治疗期间,均未发生明显不良反应。结论颈动脉彩色超声可以为中医辨证分型提供参考,且中医辨证分型治疗可显著降低CAS患者斑块Crouse积分、斑块数目。

Objective To explore the reatures of carotid ultrasonography in patients with different TCM syndromes of carotid artery sclerosis(CAS)and the effect of TCM syndrome differentiation treatment.Methods A total of 320 CAS patients admitted to the Department of Cardiology in our hospital were selected,according to the dialectical classification of TCM syndromes,doppler ultrasound was used to analyze the features of the carotid ultrasonography in CAS patients of different TCM syndromes;and according to their treatment methods,CAS patients were divided into Western medicine group andintegrative medicine group,12 weeks of treatmeat,Carotid IMT,plaque Crouse score,and number of plaques were compared between the two groups before and after treatment.Results Among the 320 patients,34 patients had kidney yin deficiency(10.36%),31 patients had liver and kidney yin deficiency(9.69%),110 patients had qi deficiency and phlegm turbidity(34.38%),and 70 patients had kidney deficiency and blood stasis(21.88%).49 cases(15.31%)of kidney deficiency and turbid phlegm,26 cases(8.13%)of kidney deficiency and qi stagnation.The number of plaques in patients with kidney deficiency and blood stasis was lower than that of qi deficiency and phlegm turbidity and kidney deficiency and qi stagnation(P<0.05).The rate of moderate CAS stenosis in kidney deficiency and blood stasis was higher than those in kidney yin deficiency,kidney deficiency and qi stagnation,and severe stenosis of Qi deficiency;151 cases(47.19%)were treated with western medicine,and 169 cases(52.81%)were treated with integrative medicine.The plaque crouse score and the number of plaques decreased in the two groups after treatment,and the degree of decrease in integrative medicine group was more obvious than that in the western medicine group(P<0.05).During the treatment period of the two groups,no obvious adverse reactions occurred.Conclusion Carotid artery color Doppler ultrasound can provide a reference for TCM dialectical typing,and TCM dialectical typing treatment can significantly reduce the crouse score and the number of plaques in CAS patients.