【作者】 李林森；

【导师】 田金洲； 蔡艺灵；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2008， 博士

【摘要】 目的:基于王永炎院士的“证候概念及其属性”及田金洲教授提出的“证候靶位及表征”理论,研究血瘀证与颈动脉血流动力学、颈动脉粥样硬化斑块及其活性物质的关系,探讨CAS与血瘀证的相关性。方法:对来源于中国人民解放军第306医院的136例脑梗死组患者及73例对照组人群进行中医证候要素评分及颈动脉彩色多普勒超声检查,并用ELISA法检测脑梗死患者血清MMPS-9、TIMP-1、b-FGF及Hs-CRP的含量。结果:(1)血瘀证与颈动脉血流动力学的相关性:a.在脑梗死患者中,血瘀证组的右侧颈动脉、左CCA、ICA内径均显著大于非血瘀证组(P <0.01/0.05),血瘀证与双侧颈动脉内径呈显著正相关(P <0.01)。在对照人群中,血瘀证组的双侧CCA内径均大于非血瘀证组(P <0.05),血瘀证与左CCA内径有相关性(P <0.05)。脑梗死血瘀证组的双侧颈动脉内径显著大于对照血瘀证组(P <0.01)。b.在总体人群中,血瘀证组的右CCA的IMT显著大于非血瘀证组(P <0.01)。在脑梗死患者中,血瘀证组的右ECA、左CCA及左ICA的IMT大于非血瘀证组(P <0.05),血瘀证与颈动脉粥样硬化呈正相关(P <0.05)。脑梗死血瘀证组的颈动脉硬化、IMT增厚率、左ICA的IMT大于对照血瘀证组(P <0.05)。c.在总体人群中,血瘀证组双侧ECA收缩期流速、右CCA的PI小于非血瘀证组(P <0.01/0.05),左CCA舒张期流速大于非血瘀证组(P <0.05)。脑梗死血瘀证组双侧ECA、右ICA收缩期流速,双侧CCA、右ECA的RI、双侧CCA、右ECA的PI大于对照血瘀证组(P <0.01/0.05)。总体血瘀证与双侧ECA收缩期流速、右CCA、右ECA的PI呈负相关(P <0.01/0.05),与左CCA舒张期流速呈正相关(P <0.01)。对照血瘀证与右CCA舒张期流速呈正相关(P <0.05)。(2)血瘀证与颈动脉粥样硬化斑块的相关性:a.在脑梗死患者中,血瘀证组颈动脉斑块不匀质、不规则率高于非血瘀证组(P <0.05)。脑梗死血瘀证组颈动脉斑块有无、数目、不规则及不匀质率大于对照血瘀证组(P <0.01)。总体血瘀证与颈动脉斑块形态呈正相关(P <0.05)。脑梗死血瘀证与斑块数目、性质呈正相关(P <0.05)。b.在脑梗死患者中,血瘀证的颈动脉狭窄及多支狭窄率较非血瘀证显著增高(P <0.01)。脑梗死血瘀证组的颈动脉狭窄及多支狭窄率高于对照血瘀证组(P <0.01)。脑梗死血瘀证与颈动脉狭窄、狭窄支数呈正相关(P <0.01)。(3)血瘀证与颈动脉粥样硬化活性物质的相关性:脑梗死患者血清MMP-9比较,血瘀证组较非血瘀证组显著升高(P <0.01),血瘀证与血清MMP-9呈正相关(P <0.01)。结论:1.血瘀证与动脉粥样硬化呈正相关。2.血瘀证与颈动脉内径、斑块的形态及数目呈正相关,且其斑块具有不稳定性。在发生脑梗死时,斑块数目增加、不稳性增高。3.血瘀证存在颈动脉内径增大、IMT增厚、部分颈动脉狭窄及血流速度改变,在发生脑梗死时颈动脉内径明显增大,IMT增厚及颈动脉狭窄的程度加重,狭窄支数增多。4.脑梗死血瘀证与血清MMP-9呈正相关。更多还原

【Abstract】 OBJECTIVE: According to the new theory of“the conception and attribute of the sndyrome”, this study is to observe the relationship between the Blood Stasis Syndrome(BSS) defined by Chinese medicine with carotid hemodynamics, carotid atherosclerotic plaques(CAP) and atherosclerotic relative active substances, to look for correlation between atherosclerosis(AS) with BSS.METHODS: 209 patients were selected from 306th Hospital of The Chinese People’s Liberation Army .All subjects comprised 136 patients with acute cerebral infarction(CI) and 73 volunteers without acute cerebral infarction. All patients were examined color dopplor ultrasound for hemodynamics ,IMT and CAP of carotid artery. Morever,ELISA way was used to test the levels of MMPS-9,TIMP-1,b-FGF , Hs-CRP and blood-lipid in blood-serum in CI patients.RESULTSL1)The correlation between BSS and carotid hemodynamics:Ⅰ.The carotid diameter, intima-media thickness(IMT) of BSS group is more than none- Blood Stasis Syndrome(NBSS) group(P <0.01/0.05). and also the carotid velocity, Resistance indexes(RI), Pulsatile indexes(PI) of several carotid artery in BSS group is more than NBSS group(P <0.01/0.05),but the carotid velocity of several carotid artery of BBS group is less than NBBS group (P <0.01/0.05).Ⅱ:There is correlation between carotid diameter, AS, diastolic velocities of several carotid artery with BSS(P <0.01/0.05).contraily, systolic velocity of several carotid artery, PI has a negative correlation with BSS(P <0.01/0.05).(2) The correlation between BSS and CAP:Ⅰ.The frequency of ulcerative CAP in BSS group is higher than NBSS group(P <0.05).The frequency of ulcerative and heterogeneous CAP in patients with BSS and CI are more than those patients without BSS have CI(P <0.01/0.05). There is correlation between the quantity of CAP and ulcerative CAP with BSS(P<0.05).Ⅱ.Carotid atherosclerotic stenosis(CAS) and the quantity of CAS in BSS group is more than NBSS group (P <0.01/0.05). The frequency of CAS in patients with BSS and CI are much more than those patients without BSS have CI(P <0.01). There is significant correlation between the quantity of CAS and CAS with BSS(P<0.01).(3) The correlation between BSS and atherosclerotic relative active substances:The levels of MMP-9 in blood serum in patients with CI have BSS is much more than those patients without BSS have CI(P<0.01). There is significantly correlation between MMP-9 with BSS(P<0.01).Comparing to NBSS group, the levels of TIMP-1,b-FGF and Hs-CRP in blood serum in BSS group are no significantly difference(P >0.05). There is no signifantly difference between TIMP-1,b-FGF , Hs-CRP, blood-lipid with BSS(P >0.05).CONCLUSIONL1)The patients with BSS have AS. (2)There is correlation between carotid diameter,the number of CAP and ulcerative CAP with BSS.Morever, the CAP in patients with BSS have unstablity. The number and unstablity of CAP increased in patients with BSS have CI.(3) The carotid diameter of patients with BSS have increased,and also the patients with BSS have CAS and abnormal carotid hemodynamics. The carotid diameter,the degree of CAS and number of CAS increased in paitents with BSS have CI.(4)There is correlation between MMP-9 with BSS.Contrarily,there are no correlation between TIMP-1,b-FGF , Hs-CRP, blood-lipid with BSS.更多还原