脑小血管病相关认知功能障碍中医证型分布研究

目的探讨脑小血管病(CSVD)相关认知功能障碍患者中医证候分布情况。方法采用横断面调查,纳入2016年10月—2019年12月中山市中医院就诊的脑小血管病患者272例,以简易智力状态检查量表(MMSE)结果分为无认知障碍组、轻中度认知障碍组、重度认知障碍组,按影像学总体负荷评分分为负荷1~2分组和负荷3~4分组。采集人口学信息,采用血管性痴呆中医辨证量表归纳证型分布,并结合患者影像学总体负荷评分比较组间分布差别。结果272例CSVD患者中医证型出现频次最高证候要素为瘀、痰(均超过50%),其次是腑浊(32.72%),肾精亏虚、气血亏虚见于1/3的患者。进一步分析,痰浊阻窍、瘀血阻络、腑滞浊留、气血亏虚4个证型在无认知障碍、轻度认知障碍、重度认知障碍组间分布存在差异,重度认知障碍组瘀、痰、浊证型占比较轻度认知障碍组更高(P均<0.05)。以影像学负荷评分分组,负荷1~2分组以痰浊阻窍证和瘀血阻络证最为常见,负荷3~4分组则以瘀血阻络和气血亏虚为主要证型,2组瘀血阻络、气血亏虚证型分布构成比比较差异有统计学意义(P均<0.05),从脑结构影像方面反映出血瘀是脑络病变的重要病理因素,本虚标实是脑络病变的重要病机特点。结论CSVD中医证型分布具有虚实夹杂、多证兼合的特点,瘀、痰、浊可能是认知损害的重要病理因素,血瘀脑络是主要证型。

Study on the distribution of TCM syndrome of cerebral small vascular disease related cognitive impairment

Objective It is to explore the distribution of TCM syndromes in patients with cerebral small vessel disease(CSVD)related cognitive dysfunction.Methods A cross-sectional survey was used to enroll 272 patients with CSVD who were admitted to Zhongshan Hospital of Traditional Chinese Medicine from October 2016 to December 2019.They were divided into non-cognitive impairment group,mild to medium cognitive impairment group and severe cognitive impairment group according to the results of the Mini Mental State Examination(MMSE),and were divided into load 1-2 group and load 3-4 group according to the overall imaging load score.Their demographic information was collected,the distribution of syndrome types was summarized by the TCM Syndrome Differentiation Scale for Vascular Dementia,and the distribution differences were compared between the groups based on the overall load score of the patient's imaging.Results The highest frequency of TCM syndromes were blood stasis and phlegm(both more than 50%)in 272 cases of CSVD patients,followed by organ turbid(32.72%),deficiency of kidney essence and deficiency of Qi and blood were found in 1/3 of patients.Further analysis showed that there were differences in the distribution of the four syndrome types of phlegm turbidity blocking orifices,blood stasis blocking the collaterals,turbid stasis and turbidity retained,and Qi-blood deficiency among non-cognitive impairment group,mild to medium cognitive impairment group and severe cognitive impairment group,the types of stasis,phlegm,and turbidity in the cognitive impairment group accounted for more than those in the mild cognitive impairment group(all P<0.05).According to imaging load score,the most common syndromes were syndrome of phlegm turbidity blocking orifice and blood stasis obstructing collaterals in load 1-2 groups,and the syndrome of blood stasis blocking collaterals and Qi-blood deficiency as the main syndrome types in load 3-4 groups.There was a statistically significant difference in the composition ratio of blood stasis obstructing the collaterals and Qi-blood deficiency syndromes(P<0.05).The imaging of brain structure reflected that blood stasis was the important pathological factor and root deficiency and tip excess was the important pathogenesis characteristics of collateral disease.Conclusion The distribution of TCM syndrome types of CSVD is characterized by a mixture of deficiency and excess and multiple syndromes.Stasis,phlegm,and turbidity may be important pathological factors for cognitive impairment,and blood stasis in brain collaterals are the main syndrome types.