肢体淋巴水肿中医证型与超声显像的关系

目的：探讨肢体淋巴水肿中医辨证分型和超声显像改变的关系,为中医辨证提供依据。 方法：对107例下肢淋巴水肿患者进行中医辨证分型,所有病例均行彩色超声检查,检测皮肤全层、皮下组织和深筋膜增厚度,按照超声图像将皮下组织回声和皮下组织形态分为5个不同的等级,然后比较不同中医证型各观察指标的差异,分析中医证型与超声显像改变的相关性。 结果：下肢淋巴水肿各个证型均有其独特的声像图特征。与寒湿阻络型相比,湿热下注和痰凝血瘀型患者皮肤、皮下组织和深筋膜明显增厚（P〈0.05,P〈0.01）;痰凝血瘀型患者皮肤和皮下组织增厚度与湿热下注型比较,差异亦有统计学意义（P〈0.01）。皮下组织回声以湿热下注型最低,而痰凝血瘀型最高（P〈0.05）;不同证型皮下组织的形态比较,差异亦有统计学意义（P〈0.05）,以痰凝血瘀型结构紊乱最为明显。 结论：淋巴水肿的超声显像改变与中医证型有一定相关性,影像学资料也可以作为中医辨证客观化的新指标,对于淋巴水肿的诊治具有一定意义。

Relationship between ultrasound imaging and traditional Chinese medicine syndrome in limb lymphedema

Objective： To study the correlation between traditional Chinese medicine （TCM） syndrome type and the ultrasound imaging changes in patients with limb lymphedema, and to provide evidence for TCM syndrome differentiation.
Metheds： Syndrome typing was done and ultrasonography was performed in 107 patients with limb lymphedema. The thickenings of derma, hypodermis and deep-fascia were measured. The ultrasound echo intensity and the morphology of the hypodermis were classified into five degrees according to the ultrasonogram. The ultrasound indexes in the limb lymphedema patients with different syndromes were compared, and the relationship between TOM syndromes and the ultrasound indexes was analyzed.
Results： There were specific ultrasound image features in different TCM syndromes of limb lymphedema. The thickenings of derma, hypodermis and deep-fascia in the limb lymphedema patients with downward migration of damp-heat or phlegm stagnation and blood stasis were more significant than those in the patients with collateral obstruction due to cold-dampness （P〈0.05, P〈0. 01）. The thickenings of derma and hypodermis in the patients with phlegm stagnation and blood stasis were obviously more severe than those in the patients with downward migration of damp-heat （P〈0. 01）. The maximum and minimum ultrasound echo intensities of hypodermis were in phlegm stagnation and blood stasis and downward migration of damp-heat respectively （P〈0.05）, and there was a significant difference in the hypodermal morphology among the three syndrome types （P〈 0. 05）. The most obvious structure disturbance was observed in the patients with phlegm stagnation and blood stasis syndrome.
Conclusion： TCM syndrome type of limb lymphedema is related to ultrasound image changes. The imaging data can be regarded as new objective indexes for TCM syndrome differentiation, and it has an important value for diagnosis and treatment of limb lymphedema.