中风发病前出现“毒损脑络”病情变化人群临床特点研究

A Study on the Clinical Features of Patients with Illness Progression of Toxin Damaging Brain Collaterals Before the Onset of Stroke

【目的】通过总结中风发病前出现病情变化人群“毒损脑络”的临床特征,增进对发病前病情变化的识别及治疗,以预防中风的发生。【方法】对337例急性缺血性脑卒中(急性脑梗死)患者进行回顾性调查,采用调查表采集包括发病前病情变化在内的临床信息及发病72 h内的血常规、生化指标等资料。依据调查信息并结合专家意见,判断患者是否属于“毒损脑络”病情变化。通过病例对照研究,分析出现病情变化人群的临床特点,通过聚类分析总结其证候特征。【结果】(1)337例患者中,排除数据不全病例23例,经专家经验判断,符合病情变化97例,未出现病情变化158例,可能属于病情变化59例,最终将出现病情变化的97例和未出现病情变化的158例,共255例纳入本次研究。(2)与中风前未出现病情变化的人群相比,发病前病情变化者更多出现在高血压(P<0.05)、嗜食肥甘厚味(P<0.01)、少食蔬菜(P<0.1)的人群中,且发病前诱因多见(P<0.05)。同时具有发病时较高的中性粒细胞百分比(NE%)及中性粒细胞/淋巴细胞比值(NLR),较低的淋巴细胞百分比(LY%)、总蛋白(TP)、总胆红素(TB)、直接胆红素(DBIL)的特点。(3)发病前病情变化以神识情绪、头面五官清窍受扰失养,出现头晕昏沉、疲乏倦怠、嗜睡思睡、口干口苦、急躁易怒/烦躁不安/心神不宁等为主要表现(P<0.01),呈现痰瘀阻络、风火上扰、清阳不升、清窍失养、肝阳上亢、痰火上扰等证候,符合毒性火热、秽浊蒙神扰窍的“毒损脑络”临床特点。(4)理化指标与中医症状关系方面,TP、DBIL分别与反映清窍失养受扰的病征相关,TB与反映痰火内扰的病征相关。【结论】高血压病、嗜食肥甘厚味者需要重视神识情绪、头面五官清窍受扰失养的变化,及时诊治,可有助于预防中风的发生。

Objective To identify and to intervene the pre-onset illness progression by summarizing the clinical features of pre-onset stroke patients with the manifestations of toxin damaging brain collaterals,so as to prevent the occurrence of stroke. Methods A retrospective survey of 337 patients with acute ischemic stroke(acute cerebral infarction) was carried out, using a questionnaire to collect the clinical information of pre-onset illness progression and routine blood and biochemical parameters within 72 hours after onset. According to the responding information and the opinions of the expert, the illness progression of toxin damaging brain collaterals was identified. And then the case-control study was adopted to analyze the clinical features of patients with clinical manifestations of toxin damaging brain collaterals,and the syndrome characteristics were summarized by cluster analysis. Results(1)Among the 337 patients, 23 cases with incomplete data were excluded, and then by following to the experts’ experience, 97 cases were identified to have illness progression, 158 cases were identified to have no illness progression and 59 cases might have illness progression. Eventually, a total of255 cases were finally included in this study, including the 97 cases with illness progression and 158 cases without illness progression.(2)Compared with the patients without illness progression before the onset of stroke,pre-onset illness progression was usually seen in the patients with hypertension(P<0.05), having dietary preference of fatty,sweet and heavy food(P<0.01),and less in-take of vegetables(P<0.01),and was mostly induced by pre-onset triggers(P<0.05). The patients with pre-onset illness progression also had higher neutrophil percentage(NE%)and neutrophil/lymphocyte ratio(NLR), and lower lymphocyte percentage(LY%), total protein(TP),total bilirubin(TB)and direct bilirubin(DBIL)during the onset.(3)The main manifestations of the patients with pre-onset illness progression were dizziness and drowsiness,fatigue and lassitude,drowsiness and sleepiness,dry mouth and bitterness in the mouth,impatience and irritability or restlessness or disturbance of the mind(P<0.01),characterized by the disorders of mental and emotions,and the disturbance and malnutrition of the clear orifices of the head and face. The manifestations of the patients with pre-onset illness progression can be classified into the syndromes of phlegm and blood stasis blocking collaterals,upward stirring of wind-fire,clear yang failing to ascend, clear orifices failing in nourishment, upper hyperactivity of liver yang and upward disturbance of phlegm-fire,which are consistent with the clinical characteristics of toxic fire and heat and filthy turbidity clouding the mind and disturbing the orifices induced by toxin damaging brain collaterals.(4)In terms of the relationship of physicochemical indicators with TCM symptoms,TP and DBIL were associated with symptoms due to the disturbance and malnutrition of the clear orifices,and TB was associated with symptoms due to internal disturbance of phlegm and fire. Conclusion The patients with hypertension and having dietary preference of fatty,sweet and heavy food should pay attention to the manifestations of the disorders of mental and emotions and the disturbance and malnutrition of the clear orifices of the head and face,and the early identification and intervention of the pre-onset illness progression will benefit for preventing stroke.