炎症指标与病灶位置对再发性缺血性脑卒中中医辨证分型的影响研究

Study on the Influence of Inflammatory Marks and Lesion Location on TCM Syndrome Differentiation and Classification of Recurrent Ischemic Stroke

目的:探讨再发性缺血性脑卒中(RIS)患者的中医辨证分型与炎症指标、头颅磁共振成像(MRI)检查结果的关系。方法:收集上海建工医院2021年5月至2023年5月收治的120例RIS患者进行中医辨证分型和MRI检查,采集患者的临床指标、炎症指标和人口学资料等信息,比较不同中医证型患者的炎症指标、头颅MRI病灶分布部位的差异,分析不同患者在性别、年龄、体质量指数(BMI)、烟酒史、糖尿病、高血压、高脂血症和炎症指标水平等方面的差异,探讨这些因素与中医证候类型的关系。结果:风痰瘀阻证型患者病灶多分布于基底节和丘脑(P<0.05);肝阳上亢证型则多见于脑干(P<0.05);阴虚风动证型病灶在脑叶和基底节较明显(P<0.05);痰热腑实证型病灶以丘脑为主(P<0.05);而气虚血瘀证型患者脑叶病灶占比最多(P<0.05)。此外,风痰瘀阻、肝阳上亢和痰热腑实证型患者炎症指标血清淀粉样蛋白A(SAA)、白细胞介素–6(IL–6)和C反应蛋白(CRP)水平显著上升,其中痰热腑实证型最为明显,而阴虚风动和气虚血瘀证型炎症指标水平较低。logistic回归分析显示,性别、BMI、吸烟史和高脂血症病史是中医证型的影响因素,炎症指标也均是中医证型的影响因素。结论:RIS患者头颅MRI、炎症指标与中医辨证分型存在一定联系,头颅MRI影像学检查可以作为中医证型的辨证参考,炎症指标可以作为辨证分型实证类型的客观辅助指标。

Objective To explore the relationship between TCM syndrome differentiation and classification of patients with recurrent ischemic stroke(RIS),inflammatory marks and cerebral magnetic resonance imaging(MRI).Methods A total of 120 RIS patients admitted to Shanghai Jiangong Hospital from May 2021 to May 2023 were collected for TCM syndrome differentiation and MRI examination.Clinical indicators,inflammatory indicators and demographic data of patients were collected,the differences of inflammatory indicators and brain MRI lesion distribution in patients with different TCM syndrome types were compared,and the differences in gender,age,body mass index(BMI),tobacco and alcohol history,diabetes,hypertension,hyperlipidemia and inflammatory indicators among different patients were analyzed.To explore the relationship between these factors and TCM syndrome types.Results Patients with wind-phlegm-stasis syndrome mainly distributed in basal ganglia and thalamus(P<0.05).The syndrome type of liver-yang hyperactivity was more common in brain stem(P<0.05).The lesions of Yin deficiency wind movement syndrome were more obvious in the cerebral lobe and basal ganglia(P<0.05).The main lesions of phlegm-heat fu-organ were thalamus(P<0.05).The proportion of cerebral lobular lesions in patients with Qi deficiency and blood stasis syndrome was the highest(P<0.05).In addition,serum amyloid A(SAA),interleukin-6(IL-6)and C-reactive protein(CRP)were significantly increased in patients with wind-phlegm-stasis,liver-yang hyperactivity and phlegm-heat fu-fu syndrome,among which the phlegm-heat fu-fu syndrome was the most obvious,while the levels of inflammatory indicators were lower in patients with Yin deficiency wind movement and Qi deficiency blood stasis syndrome.logistic regression analysis showed that gender,BMI,smoking history and history of hyperlipidemia were the influencing factors of TCM syndrome type,and inflammatory indicators were also the influencing factors of TCM syndrome type.Conclusion There is a certain relationship between head MRI and inflammation indicators of RIS patients and TCM syndrome differentiation.Head MRI imaging examination can be used as a reference for TCM syndrome differentiation,and inflammation indicators can be used as objective auxiliary indicators for the empirical type of syndrome differentiation.