急性脑梗死患者中医证型与磁共振弥散加权成像表现的相关性研究

目的分析急性脑梗死患者中医证型与磁共振弥散加权成像(MR-DWI)表现的相关性,为急性脑梗死的中医辨证分型提供客观依据。方法303例患者予以中医辨证分型及头颅MR-DWI检查,观察患者梗死病灶部位、大小及表现弥散系数(ADC)值。结果按照中医辨证分型分为风痰阻络证125例,风火上扰证49例,气虚血瘀证64例,阴虚风动证38例,痰热腑实证27例。不同梗死病灶部位与中医证型之间比较差异有统计学意义(P<0.001);梗死病灶在基底节区以风痰阻络证多见,梗死病灶在脑干部位以阴虚风动证、气虚血瘀证多见,梗死病灶在脑叶部位以痰热腑实证多见,梗死病灶在小脑部位以风火上扰证多见(P<0.05)。不同梗死病灶类型与中医证型之间比较差异有统计学意义(P<0.001);腔隙性脑梗死中风痰阻络证、风火上扰证、阴虚风动证居多,局灶性脑梗死中气虚血瘀证多见,大面积脑梗死中痰热腑实证多见(P<0.05)。不同中医证型梗死病灶ADC值之间,以及各组对侧正常脑组织ADC值之间均无显著差异(P>0.05),但不同中医证型患者梗死病灶ADC值明显低于对侧脑组织(P<0.001)。结论不同中医证型的急性脑梗死患者之间MR-DWI成像表现中梗死病灶部位及大小有显著差异,MR-DWI可作为诊断急性脑梗死的有效方式,可以为急性脑梗死患者中医辨证分型提供客观参考依据。

Correlation between TCM Syndrome Types and Magnetic Resonance-Diffusion Weighted Imaging in Patients with Acute Cerebral Infarction

Objective:To study the correlation between TCM syndrome types and Magnetic Resonance-Diffusion Weighted Imaging(MR-DWI)in patients with acute cerebral infarction,in order to provide objective basis for TCM dialectical classification of acute cerebral infarction.Methods:A total of 303 patients with acute cerebral infarction were selected to receive TCM syndrome differentiation and head MR-DWI examination.The location,size and apparent diffusion coefficient(ADC)value of infarction lesions were observed.Results:According to the dialectical classification of TCM,there were 125 cases of wind phlegm obstructing collaterals syndrome,49 cases of wind fire disturbance syndrome,64 cases of qi deficiency and blood stasis syndrome,38 cases of yin deficiency and wind movement syndrome,and 27 cases of phlegm heat and sthenic-fu syndrome.There were significant differences between different infarct locations and TCM syndrome types(P<0.001).In basal ganglia,wind phlegm obstructing collaterals syndrome was more common;in brainstem,yin deficiency and wind movement syndrome and qi deficiency and blood stasis syndrome were more common;in cerebral lobe,phlegm heat and sthenic-fu syndrome was more common;in cerebellum,wind fire disturbance syndrome was more common(P<0.05).There were significant differences between different types of infarction focus and TCM syndrome types(P<0.001).In lacunar cerebral infarction,wind phlegm obstructing collaterals syndrome,wind fire disturbance syndrome,yin deficiency and wind movement syndrome were the most common.In focal cerebral infarction,qi deficiency and blood stasis syndrome was the most common,and in large area cerebral infarction,phlegm heat and sthenic-fu syndrome was the most common(P<0.05).There was no significant difference between ADC values of infarct lesions of different TCM syndrome types and that of contralateral normal brain tissue in each group(P>0.05),but ADC values of infarct lesions of patients with different TCM syndrome types were significantly lower than those of contralateral brain tissue(P<0.001).Conclusion:There were significant differences in the location and size of infarction lesions in MR-DWI imaging between patients with different TCM syndrome types of acute cerebral infarction.MRDWI can be used as an effective way to diagnose acute cerebral infarction,and can provide an objective reference for TCM dialectical classification of patients with acute cerebral infarction.