症状性脑动脉狭窄的中医证素分析
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摘要
目的探讨症状性脑动脉狭窄中医证素的特点。方法选取2015年12月至2018年6月湖北省中医院脑病科门诊及住院140例确诊为脑动脉狭窄患者,录入动脉狭窄程度、既往病史、临床表现、证素等信息,依据临床表现将患者分为症状性脑动脉狭窄组118例、无症状脑动脉狭窄组22例,观察分析症状性及无症状的脑动脉狭窄患者的中医证素特点;将症状性脑动脉狭窄患者依据脑动脉狭窄程度分为轻度组、中度组、重度组,分析各组中医证素特点。结果风证是症状性脑动脉狭窄最常见的中医证素类型(P<0.05),二者呈现正相关关系,风证在轻度和中度脑动脉狭窄所占比例最大,风证的常见临床表现包括:舌体颤抖、脉弦、头晕目眩、病情数变。结论脑动脉狭窄与中医证素风证最为相关,与痰、血瘀亦有较密切联系,把握和应用脑动脉狭窄患者的证素规律,对于有脑卒中危险因素的患者早期进行积极干预,可以防止中风发作。
Objective To investigate the characteristics of pattern factors of traditional Chinese medicine(TCM) of symptomatic cerebral artery stenosis(SCAS). Methods The patients diagnosed with cerebral artery stenosis(CAS, n=140) were chosen from Out-patient and In-patient Department in Chinese Medicine Hospital of Hubei Province from Dec. 2015 to June 2018. The information of CAS severity, past medical history, clinical symptoms and TCM pattern factors were collected. The patients were divided, according to clinical symptoms, into SCAS group(n=118) and non-SCAS group(n=22). The characteristics of TCM pattern factors were observed and analyzed in 2 groups. SCAS group was divided, according to CAS severity, into mild CAS group, moderate CAS group and severe CAS group. The characteristics of TCM pattern factors were analyzed in all groups. Results Wind pattern was the most common type of TCM pattern factor of SCAS(P<0.05), and they were positively correlated to each other. The percentage of wind pattern was the highest in mild CAS group and moderate CAS group. The common symptoms of wind pattern included tongue trembling, wiry pulse, dizziness and rapid changes of illness. Conclusion CAS was closely correlated to wind pattern(one of TCM pattern factors), and also related to phlegm and blood stasis. To understand and grasp the laws of TCM pattern factors of CAS can intervene early the patients with stroke risk factors and prevent them from stroke attack.
Objective To investigate the characteristics of pattern factors of traditional Chinese medicine(TCM) of symptomatic cerebral artery stenosis(SCAS). Methods The patients diagnosed with cerebral artery stenosis(CAS, n=140) were chosen from Out-patient and In-patient Department in Chinese Medicine Hospital of Hubei Province from Dec. 2015 to June 2018. The information of CAS severity, past medical history, clinical symptoms and TCM pattern factors were collected. The patients were divided, according to clinical symptoms, into SCAS group(n=118) and non-SCAS group(n=22). The characteristics of TCM pattern factors were observed and analyzed in 2 groups. SCAS group was divided, according to CAS severity, into mild CAS group, moderate CAS group and severe CAS group. The characteristics of TCM pattern factors were analyzed in all groups. Results Wind pattern was the most common type of TCM pattern factor of SCAS(P<0.05), and they were positively correlated to each other. The percentage of wind pattern was the highest in mild CAS group and moderate CAS group. The common symptoms of wind pattern included tongue trembling, wiry pulse, dizziness and rapid changes of illness. Conclusion CAS was closely correlated to wind pattern(one of TCM pattern factors), and also related to phlegm and blood stasis. To understand and grasp the laws of TCM pattern factors of CAS can intervene early the patients with stroke risk factors and prevent them from stroke attack.
引文
[1] 王陇德.脑卒中筛查与防治工程:关注动脉硬化的高危因素—探求尽快降低我国脑卒中发病、死亡和伤残之策[J].中国医学前沿杂志(电子版),2011,3(3):1-3.Wang LD. Stroke screening and prevention engineering: paying attention to the high risk factors of arteriosclerosis, exploring the strategies of decreasing the incidence, death and disability of stroke in China as soon as possible[J]. Chin J Front Med Sci(Elect Ver), 2011, 3(3): 1-3.
[2] 国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行)[J]. 北京中医药大学学报,1996,19(1):55-56.Encephalopathy Emergency Cooperative Group, State Administration of Traditional Chinese Medicine. Diagnostic and therapeutic evaluation criteria for stroke disease (Trial)[J]. Journal of Beijing University of Traditional Chinese Medicine, 1996, 19(1): 55-56.
[3] 李明春,刘振华.缺血性脑卒中患者脑动脉狭窄的好发部位及危险因素的研究[J].中国当代医药,2012,19(11):152-154.Li MC, Liu ZH. Distribution and risk factors of cerebral artery stenosis in patients with ischemic stroke[J]. China Modern Medicine, 2012, 19(11): 152-154.
[4] 王桂红,王拥军,姜卫剑,等.缺血性脑血管病患者脑动脉狭窄的分布及特征[J].中华老年心脑血管病杂志,2003,5(5):315-317.Wang GH, Wang YJ, Jiang WJ, et al. Distribution of cerebral artery stenosis in patients with ischemic cerebrovascular disease[J]. Chin J Geriatr Cariovasc Cerebrovasc Di, 2003, 5(5): 315-317.
[5] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.Cerebrovascular Disease Group, Neurology Branch of Chinese Medical Association. Guidelines for diagnosis and treatment of acute ischemic stroke in China (2014)[J]. Chin J Neurol, 2015, 48(4): 246-257.
[6] 张维文,王晓莉,崔永健,等.无症状脑梗死的临床特征及危险因素分析[J].解放军医药杂志,2016,28(8):81-84.Zhang WW, Wang XL, Cui YJ, et al. Analysis of clinical features and risk factors of silent cerebral infarcts[J]. Med & Pharm J Chin PLA, 2016, 28(8): 81-84.
[7] 濮月华,秦海强,王伊龙,等. 美国国立卒中协会短暂性脑缺血发作治疗指南[J].中国卒中杂志,2007,2(12):995-1002.Pu YH, Qin HQ, Wang YL, et al. Treatment guideline for transient ischemic attack of National Stroke Association USA[J]. Chin J Stroke, 2007, 2(12): 995-1002.
[8] 国家中医药管理局脑病急症协作组.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.Encephalopathy Emergency Cooperative Group, State Administration of Traditional Chinese Medicine. Diagnostic criteria for pattern differentiation of stroke (Trial)[J]. Journal of Beijing University of Traditional Chinese Medicine, 1994, 17(3): 64-66.
[9] 高颖,马斌,刘强,等.《缺血性中风证候要素诊断量表》临床验证[J].中医杂志,2012,53(1):23-25.Gao Y, Ma B, Liu Q, et al. Clinical verifications of Diagnostic Scale of Ischemic Stroke Pattern Elements[J]. Journal of Traditional Chinese Medicine, 2012, 53(1): 23-25.
[10] 王永炎, 张启明, 张志斌. 证候要素及其靶位的提取[J].山东中医药大学学报,2006,30(1):6.Wang YY, Zhang QM, Zhang ZB. The induction of syndrome factor and affecting target[J]. Journal of Shandong University of TCM, 2006, 30(1): 6.
[11] 朱文锋. 创立以证素为核心的辨证新体系[J].湖南中医学院学报,2004,24(6):38.Zhu WF. Establishing a new system of pattern differentiation with pattern factors as core[J]. Journal of TCM Uni. of Hunan, 2004, 24(6): 38.
[12] 李支援,吕风亚,张英. 大脑中动脉狭窄程度与不同急性脑梗死模式的相关性研究[J].国际神经病学神经外科学杂志,2015,42(3):233-237.Li ZY, Lyu FY, Zhang Y. An analysis of relationship between degree of middle cerebral artery stenosis and different patterns of acute cerebral infarction[J]. Journal of International Neurology and Neurosurgery, 2015, 42(3): 233-237.
[13] 马斌,高颖.中风病恢复期证候要素的研究[J].江苏中医药,2007,39(1):27-29.Ma B, Gao Y. Study on pattrn elements of convalescent stroke[J]. Jiangsu Journal of Traditional Chinese Medicine, 2007, 39(1): 27-29.
[14] 袁国强,李叶双,吴以岭,等.短暂性脑缺血发作患者中医证候分布规律研究[J].中华中医药杂志,2008,23(6):484-486.Yuan GQ, Li YS, Wu YL, et al. Research of distribution regularity on TCM syndrome of transient ischemic attack patients[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2008, 23(6): 484-486.
[15] 邱敏,孙科,陶劲,等. “中风”病之“内风”病机溯源[J].中国中医基础医学杂志,2016,22(2):163-164.Qiu M, Sun K, Tao J, et al. “Internal wind” pathology origin discussion in stroke[J]. Journal of Basic Chinese Medicine, 2016, 22(2): 163-164.
[16] 朱晨.中风内风学说研究[J].中外医学研究,2015,13(6):158-159.Zhu C. Research on internal wind theory of stroke[J]. Chinese and Foreign Medical Research, 2015, 13(6): 158-159.
[17] 柴可夫,王亚丽.从痰瘀论治胰岛素抵抗[J].中华中医药杂志,2005,20(9):542-543.Chai KF, Wang YL. Treatment of insulin resistance based on phlegm and stasis[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2005, 20(9): 542-543.
[18] 安佰海,吉中强,唐明.从热、毒、痰、瘀互结论治中风病先兆证[J].中医杂志,2012,53(9):744-746.An BH, Ji ZQ, Tang M. Treatment of threatened apoplexy based on binding of heat, toxin, phlegm and blood stasis[J]. Journal of Traditional Chinese Medicine, 2012, 53(9): 744-746.
[19] 张锦,张允岭,郭蓉娟,等.从“毒损脑络”到“毒损络脉”的理论探讨[J].北京中医药,2013,32(7):483-486.Zhang J, Zhang YL, Guo RJ, et al. From toxin damaging brain collaterals to toxin damaging collaterals[J]. Beijing Journal of Traditional Chinese Medicine, 2013, 32(7): 483-486.
[2] 国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行)[J]. 北京中医药大学学报,1996,19(1):55-56.Encephalopathy Emergency Cooperative Group, State Administration of Traditional Chinese Medicine. Diagnostic and therapeutic evaluation criteria for stroke disease (Trial)[J]. Journal of Beijing University of Traditional Chinese Medicine, 1996, 19(1): 55-56.
[3] 李明春,刘振华.缺血性脑卒中患者脑动脉狭窄的好发部位及危险因素的研究[J].中国当代医药,2012,19(11):152-154.Li MC, Liu ZH. Distribution and risk factors of cerebral artery stenosis in patients with ischemic stroke[J]. China Modern Medicine, 2012, 19(11): 152-154.
[4] 王桂红,王拥军,姜卫剑,等.缺血性脑血管病患者脑动脉狭窄的分布及特征[J].中华老年心脑血管病杂志,2003,5(5):315-317.Wang GH, Wang YJ, Jiang WJ, et al. Distribution of cerebral artery stenosis in patients with ischemic cerebrovascular disease[J]. Chin J Geriatr Cariovasc Cerebrovasc Di, 2003, 5(5): 315-317.
[5] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.Cerebrovascular Disease Group, Neurology Branch of Chinese Medical Association. Guidelines for diagnosis and treatment of acute ischemic stroke in China (2014)[J]. Chin J Neurol, 2015, 48(4): 246-257.
[6] 张维文,王晓莉,崔永健,等.无症状脑梗死的临床特征及危险因素分析[J].解放军医药杂志,2016,28(8):81-84.Zhang WW, Wang XL, Cui YJ, et al. Analysis of clinical features and risk factors of silent cerebral infarcts[J]. Med & Pharm J Chin PLA, 2016, 28(8): 81-84.
[7] 濮月华,秦海强,王伊龙,等. 美国国立卒中协会短暂性脑缺血发作治疗指南[J].中国卒中杂志,2007,2(12):995-1002.Pu YH, Qin HQ, Wang YL, et al. Treatment guideline for transient ischemic attack of National Stroke Association USA[J]. Chin J Stroke, 2007, 2(12): 995-1002.
[8] 国家中医药管理局脑病急症协作组.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.Encephalopathy Emergency Cooperative Group, State Administration of Traditional Chinese Medicine. Diagnostic criteria for pattern differentiation of stroke (Trial)[J]. Journal of Beijing University of Traditional Chinese Medicine, 1994, 17(3): 64-66.
[9] 高颖,马斌,刘强,等.《缺血性中风证候要素诊断量表》临床验证[J].中医杂志,2012,53(1):23-25.Gao Y, Ma B, Liu Q, et al. Clinical verifications of Diagnostic Scale of Ischemic Stroke Pattern Elements[J]. Journal of Traditional Chinese Medicine, 2012, 53(1): 23-25.
[10] 王永炎, 张启明, 张志斌. 证候要素及其靶位的提取[J].山东中医药大学学报,2006,30(1):6.Wang YY, Zhang QM, Zhang ZB. The induction of syndrome factor and affecting target[J]. Journal of Shandong University of TCM, 2006, 30(1): 6.
[11] 朱文锋. 创立以证素为核心的辨证新体系[J].湖南中医学院学报,2004,24(6):38.Zhu WF. Establishing a new system of pattern differentiation with pattern factors as core[J]. Journal of TCM Uni. of Hunan, 2004, 24(6): 38.
[12] 李支援,吕风亚,张英. 大脑中动脉狭窄程度与不同急性脑梗死模式的相关性研究[J].国际神经病学神经外科学杂志,2015,42(3):233-237.Li ZY, Lyu FY, Zhang Y. An analysis of relationship between degree of middle cerebral artery stenosis and different patterns of acute cerebral infarction[J]. Journal of International Neurology and Neurosurgery, 2015, 42(3): 233-237.
[13] 马斌,高颖.中风病恢复期证候要素的研究[J].江苏中医药,2007,39(1):27-29.Ma B, Gao Y. Study on pattrn elements of convalescent stroke[J]. Jiangsu Journal of Traditional Chinese Medicine, 2007, 39(1): 27-29.
[14] 袁国强,李叶双,吴以岭,等.短暂性脑缺血发作患者中医证候分布规律研究[J].中华中医药杂志,2008,23(6):484-486.Yuan GQ, Li YS, Wu YL, et al. Research of distribution regularity on TCM syndrome of transient ischemic attack patients[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2008, 23(6): 484-486.
[15] 邱敏,孙科,陶劲,等. “中风”病之“内风”病机溯源[J].中国中医基础医学杂志,2016,22(2):163-164.Qiu M, Sun K, Tao J, et al. “Internal wind” pathology origin discussion in stroke[J]. Journal of Basic Chinese Medicine, 2016, 22(2): 163-164.
[16] 朱晨.中风内风学说研究[J].中外医学研究,2015,13(6):158-159.Zhu C. Research on internal wind theory of stroke[J]. Chinese and Foreign Medical Research, 2015, 13(6): 158-159.
[17] 柴可夫,王亚丽.从痰瘀论治胰岛素抵抗[J].中华中医药杂志,2005,20(9):542-543.Chai KF, Wang YL. Treatment of insulin resistance based on phlegm and stasis[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2005, 20(9): 542-543.
[18] 安佰海,吉中强,唐明.从热、毒、痰、瘀互结论治中风病先兆证[J].中医杂志,2012,53(9):744-746.An BH, Ji ZQ, Tang M. Treatment of threatened apoplexy based on binding of heat, toxin, phlegm and blood stasis[J]. Journal of Traditional Chinese Medicine, 2012, 53(9): 744-746.
[19] 张锦,张允岭,郭蓉娟,等.从“毒损脑络”到“毒损络脉”的理论探讨[J].北京中医药,2013,32(7):483-486.Zhang J, Zhang YL, Guo RJ, et al. From toxin damaging brain collaterals to toxin damaging collaterals[J]. Beijing Journal of Traditional Chinese Medicine, 2013, 32(7): 483-486.