颈动脉硬化斑块内新生血管与高血压中医证型的关系

Correlation between Neovascularization in Carotid Atherosclerotic Plaque and TCM Syndrome Types of Hypertension

目的基于超声超微血管成像技术(SMI)探讨颈动脉硬化斑块内新生血管与中医证型的关系。方法选取2018年3月—2020年9月在黑龙江中医药大学附属第一医院治疗的高血压合并颈动脉硬化斑块病人404例,参照《中药新药临床研究指导原则》将入组的404例病人分为肝火亢盛型、阴虚阳亢型、痰湿壅盛型和阴阳两虚型,采用具有超微血流成像技术的东芝彩色超声诊断仪Aplio400,对病人进行颈部血管超声检查,观察并记录病人颈总动脉及颈总动脉球部内中膜厚度(IMT)值、斑块声像学特点、Crouse斑块积分等。结果高血压合并颈动脉硬化斑块痰湿壅盛型病人Crouse斑块积分高于其他证型,肝火亢盛型病人颈总动脉IMT、颈总动脉球部IMT小于阴阳两虚型及痰湿壅盛型,差异均有统计学意义(P<0.05)。高血压不同的中医证型颈动脉粥样斑块形成情况不同,痰湿壅盛型病人斑块形成最多,并以低回声及混合回声为主。痰湿壅盛型病人斑块SMI分级高于其他证型,差异均有统计学意义(P<0.05)。结论痰湿壅盛型病人较其他证型更容易形成斑块,Crouse斑块积分更高,不稳定斑块生成概率增加;痰湿壅盛型SMI分级均高于其他证型,斑块稳定性差。

Objective To explore the correlation between neovascularization in carotid atherosclerotic plaques and traditional Chinese medicine(TCM)syndrome types by superb micro-vascular imaging(SMI).Methods A total of 404 patients with hypertension complicated with carotid atherosclerotic plaques were selected from March 2018 to September 2020 in First Affiliated Hospital,Heilongjiang University of Chinese Medicine.The patients were divided into 4 types:hyperactivity of liver fire,Yin deficiency and Yang excess,stagnation of phlegm dampness,and deficiency of both yin and Yang.The patients were examined by ultrasound with Toshiba color ultrasound diagnostic instrument Aplio400 with SMI.The intima-media thickness(IMT)of common carotid artery and carotid bulb,the sonographic characteristics of plaque,and Crouse plaque integral were recorded.Results Crouse plaque score of hypertension patients with stagnation of phlegm dampness syndrome was higher than those of other syndrome(P<0.05).The IMT of common carotid artery and carotid bulb in hypertension patients with hyperactivity of liver fire syndrome were lower than those in patients with deficiency of both yin and Yang syndrome and stagnation of phlegm dampness syndrome(P<0.05).The formation of carotid atherosclerotic plaque was different in hypertension with different TCM syndromes.The plaque formation rate of stagnation of phlegm dampness syndrome patients was the highest,with low echo and mixed echo.The SMI grade of hypertension with stagnation of phlegm dampness syndrome was higher than that of hypertension with other syndrome(P<0.05).Conclusion Hypertension patients with stagnation of phlegm dampness were more likely to form plaques than those of hypertension with other syndromes.These patients may be with higher Crouse plaque score and probability of unstable plaque formation.The SMI grade of patients with stagnation of phlegm dampness was higher than those hypertension with other syndromes,and the plaque stability was poor.