基于颈动脉粥样硬化的急性脑梗死与血瘀证相关性的回顾性研究

Study on Relationship between Carotid Atherosclerosis and Blood Stasis Syndrome

探讨血瘀证与颈动脉血流动力学、颈动脉粥样硬化斑块及其活性物质的相关性。对来源于中国人民解放军第306医院的136例脑梗死组患者及73例对照组人群进行中医证候要素评分及颈动脉彩色多普勒超声检查,并用ELISA法检测脑梗死患者血清基质金属蛋白酶-9(MMPs-9),基质金属蛋白酶抑制因子-1(TIMP-1),成纤维细胞生长因子(b-FGF)及超敏C反应蛋白(Hs-CRP)的含量。血瘀证与动脉粥样硬化呈正相关;血瘀证与颈动脉内径、斑块的形态及数目呈正相关,且其斑块具有不稳定性。在发生脑梗死时,斑块数目增加、不稳性增高;血瘀证存在颈动脉内径增大、IMT增厚、部分颈动脉狭窄及血流速度改变,在发生脑梗死时颈动脉内径明显增大,IMT增厚及颈动脉狭窄的程度加重,狭窄支数增多;脑梗死血瘀证与血清MMP-9呈正相关。动脉粥样硬化病变是血瘀证的重要病理基础。

To observe the relationship between the blood stasis syndrome （BSS） defined by Chinese medicine with carotid hemodynamics, carotid atherosclerotic plaques （CAP） and atherosclerotic relative active substances. Two hundred and nine patients were selected from 306th Hospital of The Chinese People＇ s Liberation Army. All subjects comprised 136 patients with acute cerebral infarction （CI） and 73 volunteers without acute cerebral infarction. All patients were examined with color dopplor ultrasound for hemodynamics, IMT and CAP of carotid artery. Morever, ELISA method was used to test the levels of matrix metalloproteinase-9 （MMPS-9） , tissue inhibitor of matrix metalloproteinase-1 （TIMP-1）, b-fibroblast growth factor （ b-FGF）, high sensitive C- reactive protein （Hs-CRP） and blood-lipid in blood-serum in CI patients. The patients with BSS had AS. There was correlation between carotid diameter, the number of CAP and ulcerative CAP with BSS. Morever, the CAP in patients with BSS have unstablity. The number and unstablity of CAP increased in patients with BSS have CI. The carotid diameter of patients with BSS increased, and also the patients with BSS had CAS and abnormal carotid hemodynamies. The carotid diameter, the degree of CAS and number of CAS increased in paitents with BSS have CI. There was correlation between matrix metallopeptidase-9 （MMP-9） with BSS. Contrarily, there was no correlation between TIMP-1, b-FGF, Hs-CRP, blood-lipid with BSS. Conclusion： The important pathological basis of blood stasis syndrome （BSS） defined by Chinese medicine is Atherosclerosis.