缺血性脑卒中CT灌注成像与中医辨证分型的相关性初探

Study on the correlation between CT perfusion imaging and TCM syndrome differentiation of ischemic stroke

目的:分析缺血性脑卒中中医辨证分型与头颈部CT灌注成像参数的相关性,以期为缺血性脑卒中的中医辨证分型提供客观影像基础。方法:对60例缺血性脑卒中患者的头颈部CT灌注图像及临床资料进行回顾性分析,包括脑血流量(CBF)、脑血容量(CBV)、达峰时间(TTP)、平均通过时间(MTT),分析缺血的部位、范围及程度;通过望闻问切对患者进行中医辨证分型,并对灌注参数与中医证型进行相关性分析。结果:缺血性脑卒中以气虚血瘀型和风痰阻络型最常见;灌注降低主要位于基底节区、放射冠区;气虚血瘀型、风痰阻络型、肝阳暴亢型、阴虚风动型及痰热腑实型的缺血区域大小分别为(32.3±4.8)、(38.5±4.5)、(28.3±3.7)、(18.3±3.2)、(42.8±6.3)cm^2,痰热腑实型范围较广(P<0.05),常累及额叶。60例MTT及TTP均有不同程度延长,CBF下降范围常小于MTT延长范围,48例可见CBF下降,其中34例合并CBV降低,且风痰阻络型CBV下降更明显(P<0.05);2例风痰阻络型CBV稍增高。结论:中医辨证分型在一定程度上反映了脑组织的血流灌注状态,CT灌注成像可作为缺血性脑卒中中医辨证分型的客观影像手段。

Objective:To analyze the correlation between TCM syndrome differentiation of ischemic stroke and CT perfusion parameters,so as to provide objective image basis for TCM syndrome of ischemic stroke.Methods:The CT perfusion images and clinical data of 60 patients with ischemic stroke were analyzed retrospectively,including cerebral blood flow(CBF),cerebral blood volume(CBV),time to peak(TTP),mean transit time(MTT),and the location,scope and degree of ischemia were analyzed.The patients were treated with TCM syndrome differentiation,including qi deficiency and blood stasis syndrome,wind-phlegm obstruction syndrome,hyperactivity of liver yang syndrome,yin deficiency and wind mobile syndrome,and phlegm heat and fu-viscera excess syndrome.The correlation between the perfusion parameters and TCM syndrome differentiation were analyzed.Results:The most common types of ischemic stroke were qi deficiency and blood stasis syndrome and wind-phlegm obstruction syndrome.Ischemia was mainly located in basal ganglia and radial crown area.The size of ischemic areas of qi deficiency and blood stasis syndrome,wind-phlegm obstruction syndrome,hyperactivity of liver yang syndrome,yin deficiency and wind mobile syndrome,and phlegm heat and fu-viscera excess syndrome were(32.3±4.8),(38.5±4.5),(28.3±3.7),(18.3±3.2)and(42.8±6.3)cm2,with a wide range of phlegm heat and fu-viscera excess syndrome,often involving brain frontal lobe.In 60 patients,MTT and TTP were prolonged in different degrees,and CBF decreased in 48 patients,34 of them were combined with CBV decreased,especially in wind-phlegm obstruction syndrome(P<0.05),CBF decreased less than the extended range of MTT.CBV slightly increased in 2 cases,which was seen in wind-phlegm obstruction syndrome.Conclusions:TCM syndrome differentiation reflects the state of cerebral blood perfusion to a certain extent.CT perfusion imaging can be used as an objective imaging method for TCM syndrome differentiation of ischemic stroke.