血管性痴呆中医辨病辨证与患者CT影像改变的相关性

背景脑血管病的CT影像表现与中医辨病辨证的相关性研究属于中西医结合影像学的范畴,是现代医学影像与传统中医相交叉的边缘性学科.目的探讨 CT影像表现与中医辨病辨证的相关性,评价 CT在血管性痴呆(vascular dementia, VD)中医辨病辨证中作用. 设计以诊断为依据的横断面研究.地点和对象研究对象为解放军 252医院神经科诊断为 VD的患者 30例,男18例,女 12例.入选患者均在实施治疗方案之前进行中医辨证分型和 CT表现对照.主要观察指标 VD患者中医辨证分型的 4种类型肾精虚衰型、心脾两虚型、痰浊阻窍型和淤血阻络型相应的头颅CT表现. 结果中医辨证以淤血阻窍型多见, CT表现以多发性梗塞灶者多见.CT表现在中医辨证(脑萎缩淤血阻窍型 2例,痰浊阻窍型 4例,肾精虚衰型2例,心脾两虚型 2例)之间差异无显著性意义(χ 2=10.353,P=0.323).辨病与中医辨证之间差异无显著性意义(χ2=9.931,P=0.356).脑萎缩与室旁对称性片状低密度及蛛网膜下腔高密度相比,差异无显著性意义(χ2=3.354, P=0.067),而多发性梗死灶与后两种表现相比,差异有显著性意义(χ2=5.445, P=0.020). 结论 VD各证型中 CT主要表现为多发性脑梗死.各种 CT表现在中医各证型之间的出现频率差异不显著,但在辨病过程中CT具有重要作用.

Relationship of CT to traditional Chinese medical differentiation of syndromes and diseases in vascular dementia

BACKGROUND:It belongs to one of contents of integrated traditional and western medicine in imaging to study the relationship of CT to traditional Chinese medical differentiation of syndromes and disease for vascular dementia(VD),which is a marginal subject of intersection between modern medical imaging and traditional Chinese medicine(TCM).At present, however,the study about it is still rare. OBJECTIVE:To study the relationship of CT to TCM differentiation of syndromes and diseases in order to evaluate the role of CT in TCM differentiation of syndromes and disease in VD. DESIGN:Traverse-sectional study based on diagnosis. SETTING and PARTICIPANTS:Thirty VD patients were recruited randomly from the Department of Neurology of PLA 252 Hospital between January 2001 and September 2002,including male 18 and female 12 with the mean age of(68.1± 7.8) years. INTERVENTIONS:All the VD patients' TCM differentiations of syndromes and diseases and CT features were compared before clinical treatment. MAIN OUTCOME MEASURES: The CT features of the 4 types of TCM differentiations of syndromes of VD were observed,namely,Nephrasthenia and essence feficiency(NED),cardiosplenic asthenia(CA),phlegm stasis stagnating orifice(PSSO) and blood stasis stagnating orifice(BSSO). RESULTS: BSSO was the most common in the 4 types of TCM differentiations.Multiple infarcts were the most common feature in CT findings in VD.There was no statistical difference of CT findings appeared in each of the TCM differentiations(χ 2=10.353, P=0.323) as well as between TCM differentiations of syndromes and diseases(χ 2=9.931, P=0.356) . There was no statistical difference between the encephalatrophy and the two CT findings of symmetric periventricular patchy hypoattenuation and subarachnoid hyperattenuation(χ 2=3.354, P=0.067) , but statistical difference between the multiple infarction and the two latter was found(χ 2=5.445, P=0.020) . CONCLUSION: The main CT feature of VD is multiple infarctions in all the TCM differentiations.There was no statistical difference of CT findings appeared among the TCM differentiations.CT played an important part in disease differentiation.