合并脑微出血的急性缺血性中风中医证候研究

目的：观察急性脑梗死合并脑微出血（cerebral microbleeding,CMB）患者的中医证候分布,研究脑微出血亚临床状态与中风病血瘀证的相关性,探索脑卒中二级预防的方法。方法：共收集急性缺血性中风患者183例,记录患者症状及舌脉象,依据《中风病辨证诊断标准》进行证候评分,对入组患者行头颅MRI的GRE-T2＊WI扫描,分成合并及不合并CMB组,对两组患者中医证候对比分析。结果 ：183例急性中风患者中医证候以实证为主,最多见的证型为痰证、火热证及血瘀证（35.5%、31.1%及30.1%）。合并CMB的缺血性中风患者证候主要表现为一证独见或二证相兼（54.0%及41%）。中风合并CMB与无CMB组相比,血瘀症在两组间存在统计学差异（P=0.003）,其它证候两组之间无差异。合并CMB组出现痰证及血瘀证的频率最高（40.4%及39.4%）,而无CMB组出现痰证及风证频率最高（29.8%及28.6%）。合并CMB的中风患者与性别的关系,男性血瘀证的比例高,女性气虚证的比例较高。结论：合并CMB的缺血性中风患者,中医证候分布以单一证候或二证相兼多见,以实证为主,痰证与血瘀证出现频率最高;合并CMB的缺血性中风患者,CMB与血瘀证存在相关性。CMB患者中,男性血瘀证的比例高,女性气虚证的比例高,建议对于合并CMB的缺血中风患者进行活血化瘀的二级预防治疗,减少中风的复发。

TCM Syndromes of CMB Positive Cases among Acute Ischemic Stroke

Objective:To explore TCM syndromes of CMB positive patients among acute ischemic infarction,and to study the correlation between the silent CMB and blood stasis syndrome of ischemic stroke,and to investigate effective secondary preventive methods for ischemic stroke.Methods:One hundred and eighty-three cases with acute ischemic infarction were registered to record the symptoms and pulse and tongue condition,and then the diagniosis of TCM syndromes were made according to the differentiated diagnosis of syndromes rating criteria.All patients were scanned gradient echo-T2* weighted imaging and divided into two groups according to the presence of CMB.The TCM syndromes were compared between two groups.Results:The TCM syndromes of 183 cases were most dampness syndrome.The incidence of phlegm syndrome,fire-heat syndrome and blood stasis syndrome were respectively 35.5%,31.1% and 30.1%.The combination of syndromes were one single syndrome(54.0%)or two combined syndromes(41.0%).There was a significant difference of blood stasis syndrome between with or without CMB of ischemic stroke groups(P=0.003),while there was no significant difference of other syndromes.The incidence of phlegm syndrome and blood stasis syndrome were the highest among CMB positive group(40.4% and 39.4%),while incidence of phlegm syndrome and wind syndrome were the highest among CMB negative group(40.4% and 39.4%).Related sex to CMB,blood stasis syndrome were higher among male while Qi deficiency syndrome was higher among female.Conclusions:The TCM syndromes of CMB positive cases among acute ischemic stroke show one single syndrome or two combined syndromes with most being dampness syndromes and incidence of phlegm syndrome and blood stasis syndrome being the highest.CMB correlates with blood stasis syndrome among CMB positive patients.Blood stasis syndrome goes higher among male while Qi deficiency syndrome goes higher among female.It is suggested that blood-activating and stasis-resolving secdonary preventive administration is considered as an effective method to reduce the recurrence of stroke with CMB positive ischemic infarction.