【作者】 桑池学；

【导师】 刘波；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2007， 硕士

【摘要】 目的通过回顾性分析急性缺血性中风(acute ischemic apoplexy，AIA)病例的头颅磁共振弥散加权成像(diffusion weighted imaging，DWI)影像表现与中医临床证型资料，探讨急性缺血性中风MR-DWI影像表现与中医辨证分型的关系，目的为急性缺血性中风的中医临床辨证提供客观参考指标，使其中医辨证客观化、微观化。方法选择85例(男57例，女28例)急性缺血性中风患者的MR-DWI影像图像资料，采集梗塞灶部位、大小、ADC值等影像信息。并按照统一的中医辨证标准进行辨证分型，分为肝阳暴亢、风痰阻络、痰热腑实、气虚血瘀、阴虚风动等五种证型。建立数据库并应用统计软件SPSS13.0进行统计学分析，探讨急性缺血型中风MR-DWI影像表现与中医证型之间的关系。结果急性缺血病灶位于基底节与脑叶最多见，两者在所有病变部位中约占63.53％，其次为丘脑、脑干，小脑最少，其中基底节区病灶以气虚血瘀型多见，与其他各中医证型组比较，差异具有统计学意义(P＜0.05)；缺血性梗塞灶以局灶性脑梗塞最多，占40／85，其次是大片脑梗塞，占32／85，不同大小梗塞灶组的中医证型差异具有统计学意义(P＜0.05)，其中大片脑梗塞以风痰阻络型多见，局灶性脑梗塞以痰热腑实、阴虚风动证型多见，腔隙性脑梗塞以肝阳暴亢型多见。本研究病例中合并出血者较少，仅占11／85，合并出血与无合并出血的急性缺血性中风患者中医证型差异具有统计学意义(P＜0.05)，合并出血时，以肝阳暴亢、风痰阻络型多见，无合并出血时以气虚血瘀型多见。缺血性梗塞灶中心区ADC值在各中医证型组之间差异具有统计学意义(P＜0.05)，肝阳暴亢证型组最低，与其他四证型比较具有显著性差异(P＜0.05)，而梗塞灶边缘ADC值各中医证型组之间比较无显著性差异(P＞0.05)；结论1．急性缺血性中风不同病灶部位与中医证型具有一定的联系；可将脑叶、基底节区缺血性梗塞灶作为气虚血瘀型辨证的客观参考指标，将丘脑区病灶作为阴虚风动型辨证的客观参考指标，将脑干病灶作为痰热腑实型辨证的客观参考指标，将小脑病灶作为风痰阻络型辨证的客观参考指标。2．急性缺血性中风有无合并出血与中医证型具有一定的联系；可将合并出血作为肝阳暴亢、风痰阻络型辨证的客观参考指标。3．急性缺血性中风梗塞灶病灶大小与中医证型具有一定的联系；可将大片脑梗塞作为风痰阻络型辨证的客观参考指标，将局灶性脑梗塞作为痰热腑实、阴虚风动型辨证的客观参考指标，将腔隙性脑梗塞作为肝阳暴亢型辨证的客观参考指标。4．急性缺血性中风缺血病灶中心ADC值与中医证型具有一定的联系；可将缺血性梗塞病灶中心ADC显著下降作为肝阳暴亢型辨证的客观参考指标。5．MR弥散加权成像可为研究急性缺血性中风影像表现与不同中医证型间的关系提供有益的补充。更多还原

【Abstract】 ObjectiveIt’ s to investigate the relationship between the MR diffusion weighted imaging (MR-DWI) scanning appearance and Traditional Chinese Medicine (TCM) differentiation syndromes of the patients of acute ischemic apoplexy (AIA),through analyzing materials of brain MR-DWI scanning and ADC value in different TCM syndromes of AIA patients. At the same time, we also hope to provide convenient, suitable and approvable objective targets for the Chinese clinical medicine.MethodsWe had retrospectively reviewed the MR-DWI scanning imaging and clinical records of standard 85 examples (male 57 examples, female 28 examples ).The AIA patients involved in the clinical study were divided into the TCM groupsof Ganyangbaokang, Fengtanzuluo, Tanrefushi, Qixuxueyu, Yinxufengdong. During the study ,we had measured the ADC value, infarction volume and filled out DWI signs table, and made statistics analysis by the statistical software SPSS 13.0.ResultsEighty-five cases were admitted. Among all the TCM groups, ADC value in the middle of acute infarction was different prominently(P＜0. 05).And middle ADC value in the group of Ganyangbaokang syndrome was lowest than the other four TCM differentiation syndromes of AIA. Regarding to ADC on the edge of sickness stoves of AIA in all the TCM syndrome groups, we havn’ t find prominent difference (P＞0. 05) . Only 11 examples who had the sign of hemorrhage , accounting for about 12.94%.And the sign of hemorrhage in Ganyangbaokang、Tanrefushi syndrome was more common than the other TCM differentiation syndromes, and the difference was prominent (P＜0. 05). Furthmore, we found that TCM syndrome were different greatly between the TCM groups who had the sign of hemorrhage and those who hadn’t, And the difference was prominent (p＜0. 05). The sickness stoves of AIA lied in brain leaf and basis festival were more common than those lied in the other positions in brain, accounting for about 63.53% , Secondly cerebral ganglion and lastly cerebellum. Moreover ,the sickness stoves in the basis festival belong to the group of Qixuxueyu were more than the other TCM groups. Lastly ,the TCM syndrome in all the syndrome groups with different infarction volume was also different prominently (P＜0. 05).Conclusions1. There lies certain relationship between TCM differentiation syndromes and sickness stove spot in AIA cases, We may take the sickness spot of brain leaf and basis festival as a referential, objective target to Qixuxueyu syndrome, cerebral ganglion as Yinxufengdong TCM syndrome , brain stem as Tanrefushi TCM syndrome, and cerebellum as Fengtanzuluo TCM syndrome.2. There lies certain relationship between TCM differentiation syndromes and the sign of hemorrhage in DWI image, We may take this sign as a referential objective target to Ganyangbaokang and Fengtanzuluo syndrome in AIA.3. There lies certain relationship between TCM differentiation syndromes and acute infarction volume in AIA.4. There lies certain relationship between TCM differentiation syndromesand middle ADC value in the sickness stove spot of AIA, We may consider the sign of ADC value reducing greatly a referential objective target of Ganyangbaokang syndrome in AIA.5. MR-DWI may provide helpful supplement to the study on relationship between the image appearance and the differentiation of TCM syndrome in AIA.更多还原