老年患者耳鸣中医证型及中药疗效与脑梗死部位的关系

Relations among syndrome types of traditional Chinese medicine, curative effects of Chinese herbs and cerebral infarct sites in elderly patients with tinnitus

目的探究老年耳鸣患者的中医证型及中药疗效与脑梗死发病部位的关系。方法回顾性分析2015年6月至2016年6月期间中日友好医院耳鸣伴脑梗死的112例60岁以上老年患者的病历资料，按中医辨证分为7个证型，同时按脑梗死部位进行分类，研究中医证型及中药治疗效果与脑梗死部位的关系。结果耳鸣中医辨证实证组与虚证组比较，脑梗死部位多在额叶[16．7％（10／60）比9．6％（5／52）]、枕叶[18．3％（11／60）比5．8％（3／52）]、颞叶[13．3％（8／60）比1．9％（1／52）]等大脑皮质以及丘脑[6．7％（4／60）比0．0％（0／52）]；虚证组与实证组比较，脑梗死部位多位于放射冠[40．4％（21／52）比23．3％（14／60）]、基底节[34．6％（18／52）比16．7％（10／60）]、小脑[7．7％（4／52）比5．0％（3／60）]；差异有统计学意义（P〈0．05）。从中药治疗效果来看，脑梗死部位在额叶、枕叶、颞叶及丘脑者，疗效较好；脑梗死部位在基底节、放射冠、小脑者，疗效较差，差异有统计学意义（P〈0．05）。结论老年耳鸣的中医证型与脑梗死发病部位有一定关系，脑梗死部位不同，中药疗效也不一样。

Objective To investigate the relations among syndrome types of traditional Chinese medicine （TCM）, curative effects of Chinese herbs and cerebral infarct sites in elderly patients with tinnitus. Methods Totally 112 patients（ 〉 60 years old） with tinnitus and cerebral infarction from June 2015 to June 2016 in China-Japan Friendship Hospital were retrospectively analyzed. The patients were subgrouped according to TCM syndrome types of tinnitus （7 types） and sites of cerebral infarction. The relations among TCM syndrome types, the efficacy of treatment by Chinese herbs and cerebral infarct sites were analyzed. Results The constituent ratios of cerebral infarct sites at frontal lobe, occipital lobe, temporal lobe and thalamus in sthenia syndrome of tinnitns group were significantly higher than those in asthenia syndrome of tinnitus group[ 16. 7% （10/60） vs 9. 6% （5/52）, 18.3% （11/60） vs 5.8% （3/52）, 13.3% （8/60） vs 1.9% （ 1/52）, 6. 7% （4/60） vs 0. 0% （0/52） ] （P 〈0. 05）. The constituent ratios of cerebral infarct sites at corona radiate, basal ganglia and cerebellum in asthenia syndrome of tinnitus group were significantly higher than those in sthenia syndrome of tinnitus group [ 40. 4% （ 21/52 ） vs 23.3% （14/60）, 34. 6% （15/52） vs 16. 7% （10/60）, 7.7% （4/52） vs 5.0% （3/60） ] （ P 〈 0. 05 ）. Patients with frontal lobe, occipital lobe, temporal lobe and thalamus infarctions showed better response to Chinese herbs than patients with corona radiate, basal ganglia and cerebellum infarctions （P 〈 0.05 ）. Conclusion There is a certain relation between TCM syndrome types of tinnitus and sites of cerebral infarction in elderly patients, and the effectiveness of Chinese medical treatment is associated with cerebral infarct sites.