缺血性中风中医证候演变与中风复发关系研究
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摘要
目的探讨包括中医证候演变特点在内的多种复发因素对于缺血性中风的影响。方法前瞻性收集339例急性期缺血性中风病患者资料,随访1年,运用Cox回归分析多种可能因素对于缺血性中风复发的影响。结果缺血性中风患者1年复发率为11.7%(39/333),大动脉粥样硬化性脑梗死复发风险是小动脉闭塞性脑梗死的2.573倍,恢复期阴虚阳亢证显现的患者复发风险是未显现患者的3.991倍,男性复发风险是女性的2.74倍,急性期使用中药汤剂患者复发风险是未使用患者的34.3%。结论大动脉粥样硬化性脑梗死、男性患者、缺血性中风恢复期阴虚阳亢证的显现是中风复发的独立危险因素,急性期中药汤药治疗是复发的保护性因素。
Objective It is to explore the effects of multiple recurrence factors including the Changes of TCM syndrome elements evolution on ischemic stroke. Methods A prospective collection of 339 patients with acute ischemic stroke was followed up for 1 year. Cox regression was used to analyze the effects of various possible factors on the recurrence of ischemic stroke. Results The 1-year recurrence rate of ischemic stroke patients was 11.7%(39/333). The risk of recurrence of large atherosclerotic cerebral infarction was 2.573 times that of small arterial occlusive cerebral infarction. The risk was 3.991 times that of unexplained patients, and the risk of male recurrence was 2.74 times that of females. In the acute phase, the risk of recurrence in patients with traditional Chinese medicine decoction was 34.3% of patients who did not use it. Conclusion Large atherosclerotic cerebral infarction, male patients, ischemic stroke recovery during the appearance of YinxuYangkang pattern is an independent risk factor for stroke recurrence, taking Chinese medicine decoction timely during the acute stage is a protective factor for recurrence.
Objective It is to explore the effects of multiple recurrence factors including the Changes of TCM syndrome elements evolution on ischemic stroke. Methods A prospective collection of 339 patients with acute ischemic stroke was followed up for 1 year. Cox regression was used to analyze the effects of various possible factors on the recurrence of ischemic stroke. Results The 1-year recurrence rate of ischemic stroke patients was 11.7%(39/333). The risk of recurrence of large atherosclerotic cerebral infarction was 2.573 times that of small arterial occlusive cerebral infarction. The risk was 3.991 times that of unexplained patients, and the risk of male recurrence was 2.74 times that of females. In the acute phase, the risk of recurrence in patients with traditional Chinese medicine decoction was 34.3% of patients who did not use it. Conclusion Large atherosclerotic cerebral infarction, male patients, ischemic stroke recovery during the appearance of YinxuYangkang pattern is an independent risk factor for stroke recurrence, taking Chinese medicine decoction timely during the acute stage is a protective factor for recurrence.
引文
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[9]孙琛琛.血脂异常肝肾阴虚、气滞血瘀、阴虚阳亢三证的代谢组学研究[D].北京:北京中医药大学,2017
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[11]Lee M,Wu YL,Ovbiagele B.Trends in Incident and Recurrent Rates of First-Ever Ischemic Stroke in Taiwan between 2000 and 2011[J].J Stroke,2016,18(1):60-65
[12]胡薇薇,杨巧莲,刘文生,等.老年高危非致残性缺血性脑血管病患者复发的临床特点分析[J].中华老年心脑血管病杂志,2017,19(8):843-845
[13]唐珊,李俐,赵娅蓉.不同性别缺血性脑卒中病人复发风险调查[J].护理研究,2017,31(23):2940-2941
[14]张攀攀,李刚,宋江华,等.星形胶质细胞与雌激素神经保护作用关系的研究进展[J].神经损伤与功能重建,2018,13(3):146-148
[15]Amarenco P,Lavallée PC,Labreuche J,et al.One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke[J].N Engl J Med,2016,374(16):1533-1542
[16]Lovett JK,Coull AJ,Rothwell PM.Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies[J].Neurol,2004,62(4):569-573
[17]李佳佳,马征.TOAST分型与急性脑梗死患者近期预后的关系[J].实用临床医药杂志,2018,22(1):58-60
[18]张迪权.补阳还五汤对缺血性脑中风急性期大鼠脑组织NO/NO、TXA2/PGI2的影响[D].沈阳:辽宁中医药大学,2015
[19]夏鑫华,刘梅.基于代谢组学的补阳还五汤干预缺血性脑卒中的作用机制研究[J].中华中医药学刊,2014,32(7):1659-1662
[20]黎正求.星蒌通腑汤治疗急性缺血性中风痰热腑实证患者的临床疗效[J].中国药物经济学,2016,11(6):80-82
[21]张军,黄燕,王永炎,等.中西医结合急性中风一二级预防的进展与热点[J].中华中医药学刊,2009,27(2):278-283
[2]Di Legge S,Koch G,Diomedi M,et al.Stroke Prevention:Managing Modifiable Risk Factors[J].Stroke Res Treat,2012,2012:391538
[3]《中国急性脑缺血性脑卒中诊治指南2014》发布[J].临床荟萃,2015,30(6):686
[4]卫生部疾病控制司,中华医学会神经病学分会.中国脑血管病防治指南(节选)[J].中国现代神经疾病杂志,2006,6(4):330-334
[5]国家食品药品监督管理总局.中药新药治疗中风临床研究技术指导原则[S].2015
[6]中风病辨证诊断标准(试行)[J].北京中医药大学学报,1994,17(3):64-66
[7]朱文锋,何清湖.现代中医临床诊断学[M].北京:人民卫生出版社,2003:362-367
[8]张静,赵建军,杨伟,等.基于中医证候特征的缺血性中风复发风险的横断面分析[J].中国实验方剂学杂志,2018,24(12):194-198
[9]孙琛琛.血脂异常肝肾阴虚、气滞血瘀、阴虚阳亢三证的代谢组学研究[D].北京:北京中医药大学,2017
[10]胡怀强,周永红,王新陆.论肝肾阴虚是中风病病机之根[J].中华中医药学刊,2009,27(12):2520-2522
[11]Lee M,Wu YL,Ovbiagele B.Trends in Incident and Recurrent Rates of First-Ever Ischemic Stroke in Taiwan between 2000 and 2011[J].J Stroke,2016,18(1):60-65
[12]胡薇薇,杨巧莲,刘文生,等.老年高危非致残性缺血性脑血管病患者复发的临床特点分析[J].中华老年心脑血管病杂志,2017,19(8):843-845
[13]唐珊,李俐,赵娅蓉.不同性别缺血性脑卒中病人复发风险调查[J].护理研究,2017,31(23):2940-2941
[14]张攀攀,李刚,宋江华,等.星形胶质细胞与雌激素神经保护作用关系的研究进展[J].神经损伤与功能重建,2018,13(3):146-148
[15]Amarenco P,Lavallée PC,Labreuche J,et al.One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke[J].N Engl J Med,2016,374(16):1533-1542
[16]Lovett JK,Coull AJ,Rothwell PM.Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies[J].Neurol,2004,62(4):569-573
[17]李佳佳,马征.TOAST分型与急性脑梗死患者近期预后的关系[J].实用临床医药杂志,2018,22(1):58-60
[18]张迪权.补阳还五汤对缺血性脑中风急性期大鼠脑组织NO/NO、TXA2/PGI2的影响[D].沈阳:辽宁中医药大学,2015
[19]夏鑫华,刘梅.基于代谢组学的补阳还五汤干预缺血性脑卒中的作用机制研究[J].中华中医药学刊,2014,32(7):1659-1662
[20]黎正求.星蒌通腑汤治疗急性缺血性中风痰热腑实证患者的临床疗效[J].中国药物经济学,2016,11(6):80-82
[21]张军,黄燕,王永炎,等.中西医结合急性中风一二级预防的进展与热点[J].中华中医药学刊,2009,27(2):278-283