急性缺血性中风MR-DWI影像表现与中医证型关系的初步研究
摘要
目的
通过回顾性分析急性缺血性中风(acute ischemic apoplexy，AIA)病例的头颅磁共振弥散加权成像(diffusion weighted imaging，DWI)影像表现与中医临床证型资料，探讨急性缺血性中风MR-DWI影像表现与中医辨证分型的关系，目的为急性缺血性中风的中医临床辨证提供客观参考指标，使其中医辨证客观化、微观化。
方法
选择85例(男57例，女28例)急性缺血性中风患者的MR-DWI影像图像资料，采集梗塞灶部位、大小、ADC值等影像信息。并按照统一的中医辨证标准进行辨证分型，分为肝阳暴亢、风痰阻络、痰热腑实、气虚血瘀、阴虚风动等五种证型。建立数据库并应用统计软件SPSS13.0进行统计学分析，探讨急性缺血型中风MR-DWI影像表现与中医证型之间的关系。
结果
急性缺血病灶位于基底节与脑叶最多见，两者在所有病变部位中约占63.53％，其次为丘脑、脑干，小脑最少，其中基底节区病灶以气虚血瘀型多见，与其他各中医证型组比较，差异具有统计学意义(P＜0.05)；缺血性梗塞灶以局灶性脑梗塞最多，占40／85，其次是大片脑梗塞，占32／85，不同大小梗塞灶组的中医证型差异具有统计学意义(P＜0.05)，其中大片脑梗塞以风痰阻络型多见，局灶性脑梗塞以痰热腑实、阴虚风动证型多见，腔隙性脑梗塞以肝阳暴亢型多见。本研究病例中合并出血者较少，仅占11／85，合并出血与无合并出血的急性缺血性中风患者中医证型差异具有统计学意义(P＜0.05)，合并出血时，以肝阳暴亢、风痰阻络型多见，无合并出血时以气虚血瘀型多见。缺血性梗塞灶中心区ADC值在各中医证型组之间差异具有统计学意义(P＜0.05)，肝阳暴亢证型组最低，与其他四证型比较具有显著性差异(P＜0.05)，而梗塞灶边缘ADC值各中医证型组之间比较无显著性差异(P＞0.05)；
结论
1．急性缺血性中风不同病灶部位与中医证型具有一定的联系；可将脑叶、基底节区缺血性梗塞灶作为气虚血瘀型辨证的客观参考指标，将丘脑区病灶作为阴虚风动型辨证的客观参考指标，将脑干病灶作为痰热腑实型辨证的客观参考指标，将小脑病灶作为风痰阻络型辨证的客观参考指标。
2．急性缺血性中风有无合并出血与中医证型具有一定的联系；可将合并出血作为肝阳暴亢、风痰阻络型辨证的客观参考指标。
3．急性缺血性中风梗塞灶病灶大小与中医证型具有一定的联系；可将大片脑梗塞作为风痰阻络型辨证的客观参考指标，将局灶性脑梗塞作为痰热腑实、阴虚风动型辨证的客观参考指标，将腔隙性脑梗塞作为肝阳暴亢型辨证的客观参考指标。
4．急性缺血性中风缺血病灶中心ADC值与中医证型具有一定的联系；可将缺血性梗塞病灶中心ADC显著下降作为肝阳暴亢型辨证的客观参考指标。
5．MR弥散加权成像可为研究急性缺血性中风影像表现与不同中医证型间的关系提供有益的补充。
Objective
It' s to investigate the relationship between the MR diffusion weighted imaging (MR-DWI) scanning appearance and Traditional Chinese Medicine (TCM) differentiation syndromes of the patients of acute ischemic apoplexy (AIA),through analyzing materials of brain MR-DWI scanning and ADC value in different TCM syndromes of AIA patients. At the same time, we also hope to provide convenient, suitable and approvable objective targets for the Chinese clinical medicine.
Methods
We had retrospectively reviewed the MR-DWI scanning imaging and clinical records of standard 85 examples (male 57 examples, female 28 examples ).The AIA patients involved in the clinical study were divided into the TCM groupsof Ganyangbaokang, Fengtanzuluo, Tanrefushi, Qixuxueyu, Yinxufengdong. During the study ,we had measured the ADC value, infarction volume and filled out DWI signs table, and made statistics analysis by the statistical software SPSS 13.0.
Results
Eighty-five cases were admitted. Among all the TCM groups, ADC value in the middle of acute infarction was different prominently(P＜0. 05).And middle ADC value in the group of Ganyangbaokang syndrome was lowest than the other four TCM differentiation syndromes of AIA. Regarding to ADC on the edge of sickness stoves of AIA in all the TCM syndrome groups, we havn' t find prominent difference (P＞0. 05) . Only 11 examples who had the sign of hemorrhage , accounting for about 12.94%.And the sign of hemorrhage in Ganyangbaokang、Tanrefushi syndrome was more common than the other TCM differentiation syndromes, and the difference was prominent (P＜0. 05). Furthmore, we found that TCM syndrome were different greatly between the TCM groups who had the sign of hemorrhage and those who hadn't, And the difference was prominent (p＜0. 05). The sickness stoves of AIA lied in brain leaf and basis festival were more common than those lied in the other positions in brain, accounting for about 63.53% , Secondly cerebral ganglion and lastly cerebellum. Moreover ,the sickness stoves in the basis festival belong to the group of Qixuxueyu were more than the other TCM groups. Lastly ,the TCM syndrome in all the syndrome groups with different infarction volume was also different prominently (P＜0. 05).
Conclusions
1. There lies certain relationship between TCM differentiation syndromes and sickness stove spot in AIA cases, We may take the sickness spot of brain leaf and basis festival as a referential, objective target to Qixuxueyu syndrome, cerebral ganglion as Yinxufengdong TCM syndrome , brain stem as Tanrefushi TCM syndrome, and cerebellum as Fengtanzuluo TCM syndrome.
2. There lies certain relationship between TCM differentiation syndromes and the sign of hemorrhage in DWI image, We may take this sign as a referential objective target to Ganyangbaokang and Fengtanzuluo syndrome in AIA.
3. There lies certain relationship between TCM differentiation syndromes and acute infarction volume in AIA.
4. There lies certain relationship between TCM differentiation syndromesand middle ADC value in the sickness stove spot of AIA, We may consider the sign of ADC value reducing greatly a referential objective target of Ganyangbaokang syndrome in AIA.
5. MR-DWI may provide helpful supplement to the study on relationship between the image appearance and the differentiation of TCM syndrome in AIA.
通过回顾性分析急性缺血性中风(acute ischemic apoplexy，AIA)病例的头颅磁共振弥散加权成像(diffusion weighted imaging，DWI)影像表现与中医临床证型资料，探讨急性缺血性中风MR-DWI影像表现与中医辨证分型的关系，目的为急性缺血性中风的中医临床辨证提供客观参考指标，使其中医辨证客观化、微观化。
方法
选择85例(男57例，女28例)急性缺血性中风患者的MR-DWI影像图像资料，采集梗塞灶部位、大小、ADC值等影像信息。并按照统一的中医辨证标准进行辨证分型，分为肝阳暴亢、风痰阻络、痰热腑实、气虚血瘀、阴虚风动等五种证型。建立数据库并应用统计软件SPSS13.0进行统计学分析，探讨急性缺血型中风MR-DWI影像表现与中医证型之间的关系。
结果
急性缺血病灶位于基底节与脑叶最多见，两者在所有病变部位中约占63.53％，其次为丘脑、脑干，小脑最少，其中基底节区病灶以气虚血瘀型多见，与其他各中医证型组比较，差异具有统计学意义(P＜0.05)；缺血性梗塞灶以局灶性脑梗塞最多，占40／85，其次是大片脑梗塞，占32／85，不同大小梗塞灶组的中医证型差异具有统计学意义(P＜0.05)，其中大片脑梗塞以风痰阻络型多见，局灶性脑梗塞以痰热腑实、阴虚风动证型多见，腔隙性脑梗塞以肝阳暴亢型多见。本研究病例中合并出血者较少，仅占11／85，合并出血与无合并出血的急性缺血性中风患者中医证型差异具有统计学意义(P＜0.05)，合并出血时，以肝阳暴亢、风痰阻络型多见，无合并出血时以气虚血瘀型多见。缺血性梗塞灶中心区ADC值在各中医证型组之间差异具有统计学意义(P＜0.05)，肝阳暴亢证型组最低，与其他四证型比较具有显著性差异(P＜0.05)，而梗塞灶边缘ADC值各中医证型组之间比较无显著性差异(P＞0.05)；
结论
1．急性缺血性中风不同病灶部位与中医证型具有一定的联系；可将脑叶、基底节区缺血性梗塞灶作为气虚血瘀型辨证的客观参考指标，将丘脑区病灶作为阴虚风动型辨证的客观参考指标，将脑干病灶作为痰热腑实型辨证的客观参考指标，将小脑病灶作为风痰阻络型辨证的客观参考指标。
2．急性缺血性中风有无合并出血与中医证型具有一定的联系；可将合并出血作为肝阳暴亢、风痰阻络型辨证的客观参考指标。
3．急性缺血性中风梗塞灶病灶大小与中医证型具有一定的联系；可将大片脑梗塞作为风痰阻络型辨证的客观参考指标，将局灶性脑梗塞作为痰热腑实、阴虚风动型辨证的客观参考指标，将腔隙性脑梗塞作为肝阳暴亢型辨证的客观参考指标。
4．急性缺血性中风缺血病灶中心ADC值与中医证型具有一定的联系；可将缺血性梗塞病灶中心ADC显著下降作为肝阳暴亢型辨证的客观参考指标。
5．MR弥散加权成像可为研究急性缺血性中风影像表现与不同中医证型间的关系提供有益的补充。
Objective
It' s to investigate the relationship between the MR diffusion weighted imaging (MR-DWI) scanning appearance and Traditional Chinese Medicine (TCM) differentiation syndromes of the patients of acute ischemic apoplexy (AIA),through analyzing materials of brain MR-DWI scanning and ADC value in different TCM syndromes of AIA patients. At the same time, we also hope to provide convenient, suitable and approvable objective targets for the Chinese clinical medicine.
Methods
We had retrospectively reviewed the MR-DWI scanning imaging and clinical records of standard 85 examples (male 57 examples, female 28 examples ).The AIA patients involved in the clinical study were divided into the TCM groupsof Ganyangbaokang, Fengtanzuluo, Tanrefushi, Qixuxueyu, Yinxufengdong. During the study ,we had measured the ADC value, infarction volume and filled out DWI signs table, and made statistics analysis by the statistical software SPSS 13.0.
Results
Eighty-five cases were admitted. Among all the TCM groups, ADC value in the middle of acute infarction was different prominently(P＜0. 05).And middle ADC value in the group of Ganyangbaokang syndrome was lowest than the other four TCM differentiation syndromes of AIA. Regarding to ADC on the edge of sickness stoves of AIA in all the TCM syndrome groups, we havn' t find prominent difference (P＞0. 05) . Only 11 examples who had the sign of hemorrhage , accounting for about 12.94%.And the sign of hemorrhage in Ganyangbaokang、Tanrefushi syndrome was more common than the other TCM differentiation syndromes, and the difference was prominent (P＜0. 05). Furthmore, we found that TCM syndrome were different greatly between the TCM groups who had the sign of hemorrhage and those who hadn't, And the difference was prominent (p＜0. 05). The sickness stoves of AIA lied in brain leaf and basis festival were more common than those lied in the other positions in brain, accounting for about 63.53% , Secondly cerebral ganglion and lastly cerebellum. Moreover ,the sickness stoves in the basis festival belong to the group of Qixuxueyu were more than the other TCM groups. Lastly ,the TCM syndrome in all the syndrome groups with different infarction volume was also different prominently (P＜0. 05).
Conclusions
1. There lies certain relationship between TCM differentiation syndromes and sickness stove spot in AIA cases, We may take the sickness spot of brain leaf and basis festival as a referential, objective target to Qixuxueyu syndrome, cerebral ganglion as Yinxufengdong TCM syndrome , brain stem as Tanrefushi TCM syndrome, and cerebellum as Fengtanzuluo TCM syndrome.
2. There lies certain relationship between TCM differentiation syndromes and the sign of hemorrhage in DWI image, We may take this sign as a referential objective target to Ganyangbaokang and Fengtanzuluo syndrome in AIA.
3. There lies certain relationship between TCM differentiation syndromes and acute infarction volume in AIA.
4. There lies certain relationship between TCM differentiation syndromesand middle ADC value in the sickness stove spot of AIA, We may consider the sign of ADC value reducing greatly a referential objective target of Ganyangbaokang syndrome in AIA.
5. MR-DWI may provide helpful supplement to the study on relationship between the image appearance and the differentiation of TCM syndrome in AIA.
引文
[1] 王永炎．近10年中风病临床研究述证[J]．北京中医学院学报，1987；10(3)：1．
[2] 刘岑，王永炎．化痰通腑法治疗意识障碍理论溯源[J]．北京中医药大学学报，2000；23(4)：10．
[3] 陶根鱼，杜晓泉．益气活血法在缺血性中风病中的地位[J]．陕西中医学院学报，1998；21(2)：1-2．
[4] 田德录．中医内科学[M]．北京中医药大学七年制中医学专业补充教材．1994：164．
[5] 熊家平，周承志，甘红．急性缺血性脑梗塞中医认识及用药思路[J]．浙江中医学院学报，2001；25(1)：19．
[6] 王永炎．关于提高脑血管疾病疗效难点的思考[J]．中国中西医结合杂志，1997；17(2)：195-196．
[7] 余恒才，陈伟儿．解毒通梗液直肠滴注合蝮蛇抗栓酶及脑活素治疗急性脑梗死34例疗效观察[J]．中国中西医结合急救杂志，2000；7(5)：286-289．
[8] 温跃才．加味黄连解毒汤治疗脑梗塞100例[J]．吉林中医药，1998；(1)：26．
[9] 张树泉，李世杰，苗香圃．补肾活血化痰是脑梗塞的基本治法[J]．山东中医杂志，1997；16(12)：534．
[10] 李平．张学文教授论颅脑水瘀证治疗[J]．中国中医急症，1993；2(5)：209—210．
[11] 黄融琪．中风急性期脑水肿救治体会[J]．福建中医药，1994；25(3)：27．
[12] 王玉民．中风病神昏的病机探讨[J]．中医杂志，1999；40(9)．
[13] 陈理书，陈丽芬，蒋方建，等．中风痰瘀气血关系探讨[J]．北京中医药大学学报，1998；21(6)：57-58．
[14] 国家中医药管理局．中医病证诊断疗效标准[M]．1994．6．28：24-25．
[15] Hahn EL. Spin echoes. Phys Rev, 1950, 80: 580-593.
[16] Stejskal EO. Tanner JE. Spin diffusion measurements: spin-echoin the presence of a tim e dependent field gradient. J Chem Phys, 1965, 42: 288-292.
[17] Lebihan D, Breton E, Lalleraand D, et al. MR imaging of intravoxel motions: applications to diffusion and perfusion in neurological discorders. Radiology, 1986, 161: 401-407.
[18] HasegawaY, FisherM, Latour LL, etal. MRI diffusion mapping of reversible and irreversible ischemic injury in focal brain ischemia. Neurology, 1994, 44: 1484-1490.
[19] Desmond PM, Lovell AC, Rawlinson AA, et al. The value of apparent diffusion coefficient maps in early cerebral ischemia. AJNR, 2001, 22: 1260-1267.
[20] Tong DC, Adam A, Mosely ME, et al. Relationship between apparent coefficient and subsequent hemorrhagic transformation following acute ischemic stroke. Stroke, 2000, 31: 2378-2384.
[21] Mullens ME, Schaefer PW, Sorensen AG, et al. CT and conventional diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department. Radiology, 2002, 224: 353-360.
[22] Lee JL, Kidwell CS, Alger J, et al. Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography. Stroke, 2000, 31: 1081-1089.
[23] 倪建明，沈天真，陈星荣．脑组织ADC值定量研究的影响因素分析[J]．中国医学计算机成像杂志，2005；11(1)：1-5．
[24] 张权，孙骏谟，田志雄，等．超早期脑梗塞及再灌注动物模型的磁共振弥散加权成像研究[J]．临床放射学杂志，2001；20(6)：466-470．
[25] Desmond PM, Lovell AC, Rawlinson AA, et al. The Value of Apparent Diffusion Coefficient Maps in Early Cerebral Ischemia[J]. AJNR. 2001, 22(7): 1260-1267.
[26] Liu KF, Li F, Tatlisumak T, et al. Regional Variations in the Apparent Diffusion Coefficient and the Intracellular Distribution of Water in Rat Brain During Aculte Focal Ischemia[J]. Stroke, 2001, 32(8): 1897-1905.
[27] 殷信道，冯晓源，符荣，等．大鼠超急性脑梗死弥散灌注磁共振成像的实验研究[J]．临床放射学杂志，2002；21(4)：320-323．
[28] 江魁明，李志钊，彭唏，等．扩散加权成像在急性脑缺血性中风诊断中的价值[J]．临床放射学杂志，2002；21(6)：415-418．
[29] 牟慧琴．张仲景辨病结合与现代医学疾病认识[J]．河南中医，2006；26(1)：20-21．
[30] 张东友．影像医学如何为中医“证”求证[J]．中国中西医结合影像学杂志，2006；4(6)：401-403．
[31] 张东友．中西医结合影像学[M]．武汉：湖北科学技术出版社，2000；69—70；138—146．
[32] 中华神经科学会．各类脑血管疾病诊断要点[J]．中华神经科杂志，1996；29(6)：379-381．
[33] 恽敏．中医影像诊断学[M]．南京：南京出版社，1994，第一版：78．
[34] 苏庆杰，陈志斌．急性缺血性脑卒中的病理基础与临床辩证治疗．海南医学院学 报，2003；9(3)：185-187．
[35] 张东友，王进，周益群．脑功能区病变与中风病证型相关性研究[J]．现代诊断与治疗，2000；11(1)：8—11．
[36] 姜平，丁沧清．腔隙性脑梗塞中医证型与CT观察[J]．辽宁中医杂志，1997；24(3)：105—106．
[37] 陈建新，翟昭华，陈永林．脑梗塞的中医辩证分型与CT表现的相关性研究[J]．川北医学院学报，2005；20(2)：188—189．
[38] 侯键，余朝骏，李明富，等．中风病急性期病灶CT定量规律研究[J]．中国中西医结合影像学杂志，2006；4(3)：165—169．
[39] Mullens ME, Schaefer PW, Sorensen AG, et al. CT and conventional diffusion —weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department[J]. Radiology, 2002, 22(4): 353-360.
[40] 蔡葵，陈娟，罗汉华．磁共振的弥散成像对急性中风的诊断价值[J]．中国医学影像技术，2000；14(7)：532—534．
[41] Rohl L, Ostergaard L, Simonsen CZ, et al. Viability Thresholds of Ischemic Penumbra of Hyperacute Stroke Defined by Perfusion—Weighted MRI and Apparent Diffusion Coeffcient[J]. Stroke, 2001, 32(5): 1140—1146.
[42] 韩振廷．中风病辨证论治[M]．北京：中医古籍出版社，2006，第一版：12．
[43] 梁伟雄，黄培新，刘茂才，等．中风病急性期中医证候分布规律的研究[J]．广州中医药大学学报，1997；14(2)：71—74．
[44] 粱伟雄，温泽淮，赖世隆，等．中风病中医证候特征与脑病理改变的相关关系研究[J]．新中医，1999；31(7)：41—42．
[45] 韩艾．化瘀通脉注射液对脑梗塞患者血流变学和凝血酶的影响[J]．中医杂志，2000；41(6)：353-354．
[46] 张汉梁，黄坚红，黄应杰．中风病不同病程中医证候特征与脑病理改变关系的研究[J]，中医研究，2000；13(6)：17—19．
[47] 韩艾．化瘀通脉注射液对脑梗塞患者血流变学和凝血酶的影响[J]．中医杂志，2000；41(6)：353—354．
[48] 申涛，郭赛珊，梁晓春，等．中药仙贞片对气阴两虚兼肾虚血瘀Ⅱ型糖尿病患者红细胞变形性的影响[J]．中国中西医结合杂志，1998；18(7)：405—407．
[49] 胡浩宇，王大明，李捷．中风病中医辨证分型与MR的关系[J]．浙江中西医结合杂志，2001；11(12)：759．
[2] 刘岑，王永炎．化痰通腑法治疗意识障碍理论溯源[J]．北京中医药大学学报，2000；23(4)：10．
[3] 陶根鱼，杜晓泉．益气活血法在缺血性中风病中的地位[J]．陕西中医学院学报，1998；21(2)：1-2．
[4] 田德录．中医内科学[M]．北京中医药大学七年制中医学专业补充教材．1994：164．
[5] 熊家平，周承志，甘红．急性缺血性脑梗塞中医认识及用药思路[J]．浙江中医学院学报，2001；25(1)：19．
[6] 王永炎．关于提高脑血管疾病疗效难点的思考[J]．中国中西医结合杂志，1997；17(2)：195-196．
[7] 余恒才，陈伟儿．解毒通梗液直肠滴注合蝮蛇抗栓酶及脑活素治疗急性脑梗死34例疗效观察[J]．中国中西医结合急救杂志，2000；7(5)：286-289．
[8] 温跃才．加味黄连解毒汤治疗脑梗塞100例[J]．吉林中医药，1998；(1)：26．
[9] 张树泉，李世杰，苗香圃．补肾活血化痰是脑梗塞的基本治法[J]．山东中医杂志，1997；16(12)：534．
[10] 李平．张学文教授论颅脑水瘀证治疗[J]．中国中医急症，1993；2(5)：209—210．
[11] 黄融琪．中风急性期脑水肿救治体会[J]．福建中医药，1994；25(3)：27．
[12] 王玉民．中风病神昏的病机探讨[J]．中医杂志，1999；40(9)．
[13] 陈理书，陈丽芬，蒋方建，等．中风痰瘀气血关系探讨[J]．北京中医药大学学报，1998；21(6)：57-58．
[14] 国家中医药管理局．中医病证诊断疗效标准[M]．1994．6．28：24-25．
[15] Hahn EL. Spin echoes. Phys Rev, 1950, 80: 580-593.
[16] Stejskal EO. Tanner JE. Spin diffusion measurements: spin-echoin the presence of a tim e dependent field gradient. J Chem Phys, 1965, 42: 288-292.
[17] Lebihan D, Breton E, Lalleraand D, et al. MR imaging of intravoxel motions: applications to diffusion and perfusion in neurological discorders. Radiology, 1986, 161: 401-407.
[18] HasegawaY, FisherM, Latour LL, etal. MRI diffusion mapping of reversible and irreversible ischemic injury in focal brain ischemia. Neurology, 1994, 44: 1484-1490.
[19] Desmond PM, Lovell AC, Rawlinson AA, et al. The value of apparent diffusion coefficient maps in early cerebral ischemia. AJNR, 2001, 22: 1260-1267.
[20] Tong DC, Adam A, Mosely ME, et al. Relationship between apparent coefficient and subsequent hemorrhagic transformation following acute ischemic stroke. Stroke, 2000, 31: 2378-2384.
[21] Mullens ME, Schaefer PW, Sorensen AG, et al. CT and conventional diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department. Radiology, 2002, 224: 353-360.
[22] Lee JL, Kidwell CS, Alger J, et al. Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography. Stroke, 2000, 31: 1081-1089.
[23] 倪建明，沈天真，陈星荣．脑组织ADC值定量研究的影响因素分析[J]．中国医学计算机成像杂志，2005；11(1)：1-5．
[24] 张权，孙骏谟，田志雄，等．超早期脑梗塞及再灌注动物模型的磁共振弥散加权成像研究[J]．临床放射学杂志，2001；20(6)：466-470．
[25] Desmond PM, Lovell AC, Rawlinson AA, et al. The Value of Apparent Diffusion Coefficient Maps in Early Cerebral Ischemia[J]. AJNR. 2001, 22(7): 1260-1267.
[26] Liu KF, Li F, Tatlisumak T, et al. Regional Variations in the Apparent Diffusion Coefficient and the Intracellular Distribution of Water in Rat Brain During Aculte Focal Ischemia[J]. Stroke, 2001, 32(8): 1897-1905.
[27] 殷信道，冯晓源，符荣，等．大鼠超急性脑梗死弥散灌注磁共振成像的实验研究[J]．临床放射学杂志，2002；21(4)：320-323．
[28] 江魁明，李志钊，彭唏，等．扩散加权成像在急性脑缺血性中风诊断中的价值[J]．临床放射学杂志，2002；21(6)：415-418．
[29] 牟慧琴．张仲景辨病结合与现代医学疾病认识[J]．河南中医，2006；26(1)：20-21．
[30] 张东友．影像医学如何为中医“证”求证[J]．中国中西医结合影像学杂志，2006；4(6)：401-403．
[31] 张东友．中西医结合影像学[M]．武汉：湖北科学技术出版社，2000；69—70；138—146．
[32] 中华神经科学会．各类脑血管疾病诊断要点[J]．中华神经科杂志，1996；29(6)：379-381．
[33] 恽敏．中医影像诊断学[M]．南京：南京出版社，1994，第一版：78．
[34] 苏庆杰，陈志斌．急性缺血性脑卒中的病理基础与临床辩证治疗．海南医学院学 报，2003；9(3)：185-187．
[35] 张东友，王进，周益群．脑功能区病变与中风病证型相关性研究[J]．现代诊断与治疗，2000；11(1)：8—11．
[36] 姜平，丁沧清．腔隙性脑梗塞中医证型与CT观察[J]．辽宁中医杂志，1997；24(3)：105—106．
[37] 陈建新，翟昭华，陈永林．脑梗塞的中医辩证分型与CT表现的相关性研究[J]．川北医学院学报，2005；20(2)：188—189．
[38] 侯键，余朝骏，李明富，等．中风病急性期病灶CT定量规律研究[J]．中国中西医结合影像学杂志，2006；4(3)：165—169．
[39] Mullens ME, Schaefer PW, Sorensen AG, et al. CT and conventional diffusion —weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department[J]. Radiology, 2002, 22(4): 353-360.
[40] 蔡葵，陈娟，罗汉华．磁共振的弥散成像对急性中风的诊断价值[J]．中国医学影像技术，2000；14(7)：532—534．
[41] Rohl L, Ostergaard L, Simonsen CZ, et al. Viability Thresholds of Ischemic Penumbra of Hyperacute Stroke Defined by Perfusion—Weighted MRI and Apparent Diffusion Coeffcient[J]. Stroke, 2001, 32(5): 1140—1146.
[42] 韩振廷．中风病辨证论治[M]．北京：中医古籍出版社，2006，第一版：12．
[43] 梁伟雄，黄培新，刘茂才，等．中风病急性期中医证候分布规律的研究[J]．广州中医药大学学报，1997；14(2)：71—74．
[44] 粱伟雄，温泽淮，赖世隆，等．中风病中医证候特征与脑病理改变的相关关系研究[J]．新中医，1999；31(7)：41—42．
[45] 韩艾．化瘀通脉注射液对脑梗塞患者血流变学和凝血酶的影响[J]．中医杂志，2000；41(6)：353-354．
[46] 张汉梁，黄坚红，黄应杰．中风病不同病程中医证候特征与脑病理改变关系的研究[J]，中医研究，2000；13(6)：17—19．
[47] 韩艾．化瘀通脉注射液对脑梗塞患者血流变学和凝血酶的影响[J]．中医杂志，2000；41(6)：353—354．
[48] 申涛，郭赛珊，梁晓春，等．中药仙贞片对气阴两虚兼肾虚血瘀Ⅱ型糖尿病患者红细胞变形性的影响[J]．中国中西医结合杂志，1998；18(7)：405—407．
[49] 胡浩宇，王大明，李捷．中风病中医辨证分型与MR的关系[J]．浙江中西医结合杂志，2001；11(12)：759．