重症脑卒中的影像学改变与中风闭脱证的相关性研究

Correlation of Imaging Changes with the Excess-type Stroke and Prostrationtype Stroke in Severe Cerebral Apoplexy Patients

【目的】探讨重症脑卒中影像学改变与中医证型的相关性。【方法】采用回顾性研究方法,收集2016年1月至2021年8月在广州中医药大学第一附属医院重症医学科及颅脑科就诊,符合重症脑卒中诊断的175例患者,根据中医诊断标准分为闭证(痰热内闭证、痰热腑实证、痰浊蒙窍证)以及脱证(痰湿蒙神证、元气败脱证),分析性别、生命体征、影像学改变等与中医证型的相关性。【结果】(1)剔除资料不完整病例5例,最终纳入170例患者,其中闭证105例(61.76%),脱证65例(38.24%);具体证型分为痰热内闭49例(28.82%),痰热腑实25例(14.71%),痰浊蒙窍31例(18.24%),痰湿蒙神32例(18.82%),元气败脱33例(19.41%)。(2)经单因素分析,额叶与小脑病变在闭证与脱证之间的差异均有统计学意义(P<0.05或P<0.01);在脱证与闭证患者之中,脱证患者更易合并额叶病变,闭证患者更易合并小脑病变。性别、心率、高血压病史等因素在闭证与脱证及中医具体证型之间的差异均有统计学意义(P<0.05或P<0.01)。(3)经多因素分析,性别、高血压病、蛛网膜下腔出血及小脑病变在闭证与脱证之间的差异均有统计学意义(P<0.05)。【结论】在重症脑卒中患者中,男性、高血压、小脑为主要病变的患者更容易表现为闭证,其中小脑为主要病变患者更容易表现为闭证中的痰热腑实证、痰浊蒙窍证;脱证(尤其是元气败脱证)中女性患者及合并蛛网膜下腔出血的患者比例较闭证高。女性、无高血压病史、合并蛛网膜下腔出血是重症脑卒中出现脱证的危险因素。

Objective To investigate the correlation between imaging changes and traditional Chinese medicine(TCM)syndromes of severe cerebral apoplexy.Methods A retrospective study was conducted in 175 patients who were hospitalized in Intensive Care Unit and the Department of Craniocerebral Injury of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2016 to August 2021.All of the 175 patients met the diagnostic criteria of severe cerebral apoplexy.The patients were classified into excess-type stroke(differentiated as internal obstruction of phlegm-heat syndrome,phlegm-heat and fu-organ excess syndrome,and turbid phlegm blocking the orifice syndrome)and prostration-type stroke(differentiated as phlegm-damp blocking the clear orifices syndrome and primordial qi collapse syndrome)according to the TCM diagnostic criteria.And then the correlation of TCM syndrome types with the gender,vital signs and imaging changes was analyzed.Results(1)Five cases with incomplete data were excluded and a total of 170 patients were eventually included,of which105(61.76%)were classified into excess-type stroke and 65(38.24%)were classified into prostration-type stroke.The distribution of specific syndrome types were as follows:49 cases(28.82%)of internal obstruction of phlegmheat syndrome,25 cases(14.71%)of phlegm-heat and fu-organ excess syndrome,31 cases(18.24%)of turbid phlegm blocking the orifice syndrome,32 cases(18.82%)of phlegm-damp blocking the clear orifices syndrome,and 33 cases(19.41%)of primordial qi collapse syndrome.(2)The univariate analysis showed that the differences of lesions in the frontal lobe and cerebellum were statistically significant between excess-type stroke patients and prostration-type stroke patients(P<0.05 or P<0.01),and patients with prostration-type stroke were more likely to be complicated with frontal lobe lesions,while patients with excess-type stroke were more likely to be complicated with cerebellar lesions.The differences in gender,heart rate and history of hypertension were statistically significant between excess-type stroke and prostration-type stroke and among the specific syndrome types(P<0.05 or P<0.01).(3)The multifactorial analysis showed that the differences in the gender,history of hypertension,subarachnoid hemorrhage and cerebellar lesions were all statistically significant between excesstype stroke and prostration-type stroke(P<0.05).Conclusion In patients with severe cerebral apoplexy,the gender of male,history of hypertension,and predominant cerebellar lesions are the risk factors of suffering from excess-type stroke,and the patients with predominant cerebellar lesions are more likely to manifest as phlegmheat and fu-organ excess syndrome and turbid phlegm blocking the orifice syndrome.The proportions of female patients and patients complicated with subarachnoid hemorrhage are higher in prostration-type stroke(especially in the case of primordial qi collapse syndrome)than those in excess-type stroke.The gender of female,absence of history of hypertension,and complicated with subarachnoid hemorrhage are the risk factors for prostration-type stroke in severe erebral apoplexy patients.