缺血性卒中合并不同等级睡眠呼吸暂停低通气综合征患者的中医证候分布特点

Characteristics of Traditional Chinese Medicine Syndromes in Ischemic Stroke Patients with Different Grades of Sleep Apnea Hypopnea Syndrome

【目的】对脑卒中合并不同等级睡眠呼吸暂停低通气综合征(SAHS)患者的中医证候特点进行研究,探讨中医"中风"与"鼾症"的内在联系。【方法】收集确诊为缺血性卒中患者48例,在病房内进行至少7 h的夜间多导睡眠监测(PSG),收集睡眠期间各项指标数据后进行综合分析得到呼吸暂停低通气指数(AHI),根据AHI进行SAHS轻重程度的分组,分别是:缺血性卒中不合并SAHS组,缺血性卒中合并轻度SAHS组,缺血性卒中合并中度SAHS组,缺血性卒中合并重度SAHS组。最后对4组患者进行规范四诊,按照1994年《中风病辨证诊断标准》风、火、痰、瘀血、气虚及阴虚阳亢6种基本证候要素进行分别评分,从而得到缺血性卒中合并SAHS患者的中医证候分布特点。【结果】(1)48例患者中,多数(75.0%)具有痰证证候要素,其余依次为风证(47.9%)、气虚证(29.2%)、瘀血证(20.8%)、火证(14.6%)、阴虚阳亢证(6.3%)。(2)4组间在痰证的分布上差异有统计学意义(P=0.005),进一步行组内痰证分布比较,发现卒中合并轻度SAHS组与不合并SAHS组、合并中度SAHS组在痰证分布上差异有统计学意义(P=0.003或P=0.047)。【结论】缺血性卒中合并SAHS的中医证候分布以痰证居多,脑卒中合并轻度SAHS患者均具有痰证,与脑卒中不合并SAHS组、脑卒中合并中度SAHS组在痰证分布上具有统计学差异;风痰合并是出现最多的兼证证型,主要分布在合并重度SAHS的卒中患者。因此,痰证或为脑卒中合并SAHS发生的病理基础,合并风证可能与SAHS病情加重有关。

Objective To investigate the distribution of traditional Chinese medicine(TCM)syndromes in ischemic stroke(IS) patients with different grades of sleep apnea hypopnea syndrome(SAHS),and to explore the correlation of stroke with snoring disease in the field of TCM. Methods Forty-eight cerebral ischemic stroke patients who had the monitoring of night polysomnography(PSG)in the inpatient ward for at least 7 hours were enrolled into the study. The parameters of night sleep were collected for the calculation of apnea hypopnea index(AHI)and then SAHS was classified into various degrees according to AHI. The patients were divided into four groups,i.e.,IS without SAHS group,IS with mild SAHS group, IS with moderate SAHS group,and IS with severe SAHS group. The standardized four diagnostic methods in TCM were used for the scoring of 6 fundamental syndromes of wind, fire,phlegm,blood stasis,Qi deficiency,and yang hyperactivity due to yin deficiency according to Diagnostic Criteria for Syndrome Differentiation of Stroke issued in 1994. Finally,the characteristics of TCM syndromes in IS patients complicated with SAHS were explored. Results(1)Of the 48 cases, most of the patients(75.0%)had phlegm syndrome, and then came wind syndrome(47.9%), Qi deficiency syndrome(29.2%), blood stasis syndrome(20.8%),fire syndrome(14.6%),and yang hyperactivity due to yin deficiency syndrome(6.3%).(2) The difference of phlegm syndrome incidence among the four groups was statistically significant(P =0.005). The intragroup comparison showed that the difference of phlegm syndrome incidence in IS with mild SAHS group as compared to IS without SAHS group and to IS with moderate SAHS group was also statistically significant(P = 0.003 or P = 0.047). Conclusion IS patients complicated with SAHS are dominated by the phlegm syndrome,even IS patients with mild SAHS also have the phlegm syndrome,and the incidence of phlegm syndrome in IS patients with mild SAHS differs from that in IS patients without SAHS and in IS patients with moderate SAHS. Wind blended with phlegm is the mostly common complicated syndrome type, and mainly occurs in IS patients with severe SAHS. It is indicated that phlegm syndrome may be the basic pathogenic factor for IS with SAHS,and the combination of wind syndrome worsens the illness.