高血压中医分型与脑微出血的关系

Relationship between Traditional Chinese Medical Syndrome Classification of Hypertension and Cerebral Microbleeds

目的对高血压脑微出血患者临床特征进行辨证分析,探讨不同证型临床特点。方法本研究将符合标准的高血压病患者,按其临床表现进行辨证,收集临床资料。根据头MRI检查,分为脑微出血组及非脑微出血组。结果共纳入208例高血压患者,其中脑微出血组100例。脑微出血组肝火亢盛及其兼证共38例(38%),阴阳两虚及其兼证34例(34%),此2种证型占比最多。脑微出血患者兼证以瘀证为主(P=0.02)。按脑微出血部位分亚组,脑叶微出血患者年龄较大(P=0.01),主要表现为阴阳两虚(P=0.04)。各临床证型与脑微出血严重程度比较,差异无统计学意义。结论瘀证可能为高血压脑微出血的主要致病因素。脑叶微出血的患者主要以高龄为主,以阴阳两虚为主证。

Objective To research the syndrome and clinical classification of patients with hypertension and cerebral microbleeds,and to discuss the clinical distribution characteristics of different syndromes. Methods The patients who met the inclusion involved in this study.All the cases were divided into different syndrome types according to the clinical characteristics by TCM experts. All the patients underwent magnetic susceptibility weighted imaging,and were classified into a cerebral microbleeds or no cerebral microbleeds group. The brain MRI characteristics between two groups were compared. Results Two hundreds and eight hypertension patients were included. One hundred patients had cerebral microbleeds. One hundred and eight patients had no cerebral microbleeds. In the microbleeds group,the most common syndromes were liver fire flaming upward and dual deficiency of yin and yang. There were 38 patients in syndrome of liver fire flaming upward,and 34 patients in syndrome of dual deficiency of yin and yang. The mainly clinical mixed syndromes was blood stasis( P = 0. 02).In subgroup analysis,the patients with microbleeds in cerebral lobe were older( P = 0. 01),and mainly were syndrome of dual deficiency of yin and yang( P = 0. 04). There was no significant difference between clinical syndromes and the severity of cerebral microbleeds.Conclusion Blood stasis is the important pathogenic factors of hypertension cerebral microbleeds. cerebral lobe microbleeds mainly occur in the elderly and the major syndrome is dual deficiency of yin and yang.