脑型Wilson病患者中医证候与病变脑区相关研究

Correlation Study on TCM Syndrome and Brain Region in Patients with Neurological Wilson’s Disease

目的探讨脑型Wilson病(WD)中医证候分布与颅脑磁共振成像(MRI)病损脑区的相关性。方法对184例脑型WD患者进行四诊合参辨证及颅脑MRI检测,运用Logistic回归分析中医证候与MRI病损脑区的相关性。结果颅脑MRI病损脑区出现频率以壳核(93.5%)、皮质脑萎缩(44.0%)、丘脑(33.7%)、尾状核头部(32.1%)4个部位常见;中医症状以大便秘结(79.2%)、口苦口腻(75.0%)、肢体僵硬(70.8%)、急躁易怒(70.8%)、神疲乏力(66.7%)5个症状常见;中医证型以肝胆湿热(32.1%)、痰湿阻络(17.9%)、肝肾阴虚(13.1%)、肝郁脾虚(9.8%)、脾肾阳虚(9.8%)5个证型常见。Logistic逐步线性回归分析显示肝胆湿热证与皮质脑萎缩有关[OR(95%CI):1.158(0.263-5.097)];气血两虚证与脑干、丘脑、脑叶软化有关[OR(95%CI):1.125(1.002-1.263)、1.133(1.002-1.281)、1.333(1.005-1.769)];痰火扰心证与丘脑、脑叶软化有关[OR(95%CI):1.214(1.039-1.419);13.000(1.323-127.727)];痰瘀互结证与脑干、丘脑有关[OR(95%CI):3.625(0.383-34.331)、1.133(1.002-1.281)];脾肾阳虚证与尾状核头部和壳核有关[OR(95%CI):1.200(0.428-3.363)、4.444(1.131-17.464)]。每个病损脑区有其相应外在中医证型表现特征(P<0.05,P<0.01)。结论脑型WD中医外显证候表现与不同病损脑区相关,不同中医证候具有相应的MRI影像学特点,可以作为临床中医辨证分型客观化指标的参考依据。

Objective To observe the correlation between the distribution of Chinese medical syndromes of neurological Wilson’s disease(WD)and brain regions damaged by brain MRI.Methods Totally 184 neurological WD patients were diagnosed by Chinese medical diagnosis and syndrome differentiation and brain MRI imaging.Logistic regression analysis was used to study the correlation between Chinese medical syndromes and MRI lesion brain areas.Results Brain MRI lesions were commonly seen in four parts of the brain areas:putamen(93.5%),cortical brain atrophy(44.0%),thalamus(33.7%),and head of caudate nucleus(32.1%).The symptoms of Chinese medicine were five common symptoms:constipation(79.2%),bitter mouth(75.0%),stiff limbs(70.8%),irritability(70.8%),and fatigue(66.7%).Five common Chinese medical syndromes were Gan-Dan dampness-heat(32.1%),phlegm-dampness blocking collaterals(17.9%),Gan-Shen yin deficiency(13.1%),Gan stagnation and Pi deficiency(9.8%),Pi-Shen yang deficiency(9.8%).Logistic stepwise linear regression analysis showed that Gan-Dan dampness-heat syndrome was correlated to cortical brain atrophy[OR(95%CI):1.158(0.263-5.097)].Qi-blood deficiency syndrome was correlated to brainstem,thalamus,and brain lobe softening[OR(95%CI)]:1.125(1.002-1.263);1.133(1.002-1.281);1.333(1.005-1.769)].Phlegm-fire disturbing Xin syndrome was correlated to softening of the thalamus and brain lobe softening[OR(95%CI):1.214(1.039-1.419);13.000(1.323-127.727)].Intermingled phlegm-stasis blood syndrome was correlated to brainstem and thalamus[OR(95%CI):3.625(0.383-34.331);1.133(1.002-1.281)].PiShen yang deficiency syndrome was correlated to head of the nucleus and putamen[OR(95%CI):1.200(0.428-3.363);4.444(1.131-17.464)].Each different brain area had corresponding external Chinese medical syndrome characteristics(P<0.05,P<0.01).Conclusions The manifestations of external Chinese medical syndromes of neurological WD were correlated to different brain regions with different lesions.Different Chinese medical syndromes had corresponding MRI imaging characteristics,which could be used as a reference basis for objective indices of clinical Chinese medical syndrome differentiation.