颈动脉粥样硬化与缺血性卒中的关系及中医证候要素演变分析

A Follow-up Study on the Correlation between Carotid Atherosclerosis and Stroke with Changes of TCM syndrome elements

目的:探析颈动脉粥样硬化斑块或狭窄与脑卒中的关系及中医证候要素分布和变化,为脑卒中防治提供依据。方法:2012年对北京市丰台区王佐镇脑卒中高危人群进行调查,2015年对相同人群进行第二次调查,共收集有效资料542例,按有无缺血性卒中分为2组,比较颈动脉硬化斑块有无、特征、部位、中医证候要素差异,分析3年随访中新增卒中患者的颈动脉病变、危险因素及中医证候要素变化。结果:颈动脉斑块组既往脑卒中患者比例高于无斑块组,以颈动脉窦部为斑块好发部位、低回声或混合回声斑块为多,2组患者单一中医证候要素无显著差异,气虚+痰、痰+火在2组中分布差异有统计学意义;双侧颈动脉狭窄较单侧狭窄及无狭窄组既往卒中患者比例高;3年中新发卒中10例,中医证候要素均发生变化且多与火证相关。结论:颈动脉斑块及双侧狭窄与脑卒中发生相关,证候要素以气虚+痰、痰+火为其特征;在脑卒中病情变化中火、血瘀、痰等证候要素发生变化。

Objective：To explore the correlation between carotid atherosclerosis and stroke with the changes of TCM syndrome ele- ments in the process in order to provide the evidence for prevention and treatment of cerebrovascular diseases. Methods：A total number of 542 patients with high risk of stroke were selected from Wangzuo Town in 2012, and were followed up for 3 years. They were divided into CAS group and non-CAS group and TCM symptoms, history of stroke, position and features of carotid atherosclero- sis were analyzed. Changes of carotid atherosclerosis, risk factors and TCM symptoms were described in newly incident cases during the follow up period. Results ： The proportion of patients who had stroke history in CAS group was higher than that in the non-CAS group and hypo or mixed echo plaque in carotid sinus were more common. There was no significant difference in single TCM syn- drome elements between the two groups, but qi-deficiency plus phlegm and phlegm-fire showed significant difference in two groups. Patients with bilateral stenosis of carotid artery were much more than patients with lateral stenosis or without stenosis. Ten new ca- ses occurred during the 3 years follow up and changes in TCM syndrome elements all had certain correlation with fire syndromes. Conclusion ： Carotid atherosclerosis and bilateral stenosis of carotid artery were positively correlated with the occurrence of stroke, with the elements of qi-deficiency plus phlegm or phlegm-fire. Changes in fire, phlegm, and blood stasis appeared in the progression of stroke.