急性缺血性中风伴颅内动脉狭窄患者证候特点

目的分析急性缺血性中风伴颅内动脉粥样硬化性狭窄(ICAS)患者中医证候特点。方法收集行MRA检查的165名急性缺血性中风(中经络)患者,辨证分为风火上扰、风痰阻络、痰热腑实、阴虚风动、气虚血瘀5型。分析ICAS与中医证候间的关系、ICAS患者病变特点、风火上扰型患者病变特点,比较男女患者病变不同点。结果 ICAS患者和未见狭窄患者中医证型分布有差异(P=0.0184),ICAS组患者平均年龄高于无狭窄组(P=0.022);风火上扰型患者在ICAS患者所占比例高于在未见狭窄患者中所占比例(P=0.0103),男性比例显著高于其它证型(P=0.0031),平均LDLC水平低于其它证型(P=0.049),吸烟人数所占比例显著高于其它证型(P=0.0009);男性的平均LDLC水平显著低于女性(P=0.0028),糖尿病患病人数比例显著低于女性(P=0.0000),吸烟人数比例显著高于女性(P=0.0000),缺血性中风复发率高于女性(P=0.0126)。结论风火上扰在中风和ICAS发展过程中起重要作用,男性、吸烟的中风患者易产生风火上扰证型,此型患者颅内动脉狭窄率更高。

Syndrome characteristics of patients with acute ischemic stroke complicated with intracranial atherosclerotic stenosis

Objective To explore the characteristic of the traditional Chinese medicine（TCM） syndrome distribution in patients with acute ischemic stroke（Stroke in meridian） complicated with intracranial atherosclerotic stenosis（ICAS）.Methods Totally 165 patients with acute ischemic stroke,inspected with magnetic resonance angiography（MRA）,were divided into five groups as syndrome of wind-fire stirring up（SWFS）,syndrome of wind-phlegm and meridian stagnant（SWPMS）,syndrome of phlegm-heat and fu-organ excess（SPHFE）,syndrome of wind stirring due to yin-deficiency（SWSYS） and syndrome of qideficiency and blood-stasis（SQDBS）.The relationship between ICAS and TCM syndrome,pathology feature of patients with ICAS and patients of SWFS,the pathological difference between male and female were analyzed.Results TCM syndrome distribution showed statistical difference between patients with ICAS and without ICAS（P= 0.0184）,and patients with ICAS were older than patients without ICAS（P=0.022）.Higher percentage of SWFS in ICAS（P=0.0103）,male or smokers in patients of SWFS（P=0.0031 or 0.0009） were observed,and low density lipoprotein cholesterol（LDLC） level in patients of SWFS was lower than other syndromes（P=0.049）.LDLC level（P=0.0028） and the percentage of patients with diabetes mellitus（P=0.0000）in male were significantly lower than in female,and that of smokers（P=0.0000） and the stroke recurrence rate were higher than female.Conclusion SWFS played a key role during the development of stroke and ICAS.Male and smokers with stroke trended to suffer SWFS which had a higher ICAS ratio.