“上虚则眩”理论的椎-基底动脉形态病理学机制研究

Study on Morphological Pathological Mechanism of Vertebral Basilar Artery of Deficiency of the Upper Causing Dizziness Theory

目的:为探讨"上虚则眩"理论的椎-基底动脉形态病理学机制,拟证实与椎-基底动脉形态病理学改变的相关性。方法:符合"上虚"(椎动脉供血不足)型眩晕患者60例,男34例,女26例;年龄28～85岁,平均年龄50.73岁;病程2周～10年以上。先作TCD检测证实属椎动脉系供血不足性眩晕,再作3D-CTA检查椎-基底动脉形态病理学变化,分析"上虚则眩"的椎-基底动脉形态病理学机制。结果:60例120支椎-基底动脉中,经TCD检测有椎动脉血流速改变86支,占71.7%;基底动脉血流速改变82支,占68.3%;小脑后下动脉血流速改变60支,占50.0%。3D—CTA检查有V1段有形态病理学改变的71支,占59.2%;V2段有形态病理学改变的37支,占30.8%;V3段有形态病理学改变的28支,占23.3%;V4段有形态病理学改变的102支,占85.0%。结论:椎—基底动脉形态学病理改变→血流速改变→椎动脉系供血不足→小脑缺血是引起眩晕的病理"轴"。椎—基底动脉形态学病理改变是椎动脉系供血不足性眩晕的病理机制,与中医"上虚则眩"理论基本一致。

Objective: In order to discuss the morphological pathological mechanism of the vertebral basilar artery of the Deficiency of the Upper Causing Dizziness,and try to prove the correlation between the morphological pathological changes of vertebral basilar artery and the Deficiency of the Upper Causing Dizziness Theory.Method:In 60 cases of vertigo patients who were identified as Deficiency of the Upper(Insufficient blood supply of vertebral artery),34 cases were male and 26 female;aged from 28~85,average 50.73 years old;the course of disease was from 2 weeks to more than 10 years.First of all,we will use Transcranial Doppler(TCD) to confirm that the vertigo is caused by insufficient blood supply of vertebral artery.Secondly,we will use a three dimensional computed topographic angiography(3D-CTA) to test the morphological pathological changes of the vertebral basilar artery,researching the morphological pathological mechanism of the vertebral basilar artery of the Deficiency of the Upper Causing Dizziness.Results: Among 120 vertebral basilar arteries of 60 cases,there are 60(71.1%) vertebral arteries,82(50.0%) basilar arteries and 60(50%) posterior inferior cerebellar arteries have changes of the blood flow.There are 71(59.2%) vertebral basilar arteries have vascular morphological changes of segment V1,37(30.8%) vertebral basilar arteries have vascular morphological changes of segment V2,and 102(85.0%) vertebral basilar arteries have vascular morphological changes of segment V4.Conclusion: the morphological pathological mechanism changes of the vertebral basilar artery→changes of the blood flow→insufficient blood supply of the vertebral artery→insufficient blood supply of the cerebella is the mechanism of the vertigo.And it was basically consistent to the traditional Chinese medicine theory of Deficiency of the Upper Causing Dizziness.