急性期脑梗死磁共振DWI序列影像学表现与中医辨证相关性研究

发布时间：2018-05-19 12:51

本文选题：脑梗死 + 急性期　；参考：《辽宁中医药大学》2017年硕士论文

【摘要】：目的：应用核磁共振成像(MRI)技术中DWI序列分析179例急性期脑梗死患者MRI影像学特点,探讨MRI在急性期脑梗死中医辨证中的应用价值,分析急性期脑梗死MRI表现与中医辨证分型的相关性,进而为急性期脑梗死患者中医辨证分型提供MRI影像学依据。方法：纳入患者在辽宁中医药大学附属第二医院住院且经临床医师诊断为急性期脑梗死患者179例,统计相关指标,运用统计学方法处理相关数据,进而对急性期脑梗死的MRI表现与中医辨证分型关系的相关性进行分析。结果：一般资料显示在179例患者中,男性98例,女性81例,男性略多于女性,年龄段在60-89岁的患者发病率高,其中年龄段在60-75岁的发病率最高。性别在急性期脑梗死的中医辨证分型中无统计学意义;年龄在急性期脑梗死中医辨证分型中无统计学意义。在本次纳入的急性期脑梗死患者中,其证型分布情况为风火上扰证17例,占9.5%,风痰阻络证80例,占44.7%,痰热腑实证11例,占6.1%,气虚血瘀证48例,占26.8%,阴虚风动证23例,占12.8%,其中风痰阻络证80例(44.7%)发病例数最多,其次为气虚血瘀证48例(26.8%),阴虚风动证23例(12.8%)。在179例急性期脑梗死患者中,就发病部位而言,风火上扰证22例(皮质病变4例占18.2%,放射冠病变3例占13.6%,基底节病变11例占50.0%,后循环病变4例占18.2%),风痰阻络证共116例(皮质病变18例占15.5%,放射冠病变30例占25.9%,基底节病变48例占41.4%,后循环区病变20例占17.2%),痰热腑实证16例(皮质病变5例占31.3%,放射冠病变4例占25.0%,基底节病变4例占25.0%,后循环病变3例占18%),气虚血瘀证85例(皮质病变13例占15.3%,放射冠病变21例占24.7%,基底节病变22例占25.9%,后循环病变29例占34.1%),阴虚风动证50例(皮质病变4例占8%,放射冠15例占30%,基底节病变13例占26.0%,后循环病变18例占36.0%),经统计学处理,差异有统计学意义,风火上扰证和风痰阻络证在基底节处多发,气虚血瘀证和阴虚风动证在后循环分布区多发。在179例急性期脑梗死患者中,就合并病而言,风火上扰证24例(伴高血压病12例占50.0%,伴糖尿病6例占25.0%,伴冠心病3例占12.5%,伴高脂血症3例占12.5%),风痰阻络证121例(伴高血压病45例占37.2%,伴糖尿病28例占23.1%,伴冠心病30例占24.8%,伴高脂血症18例占14.9%),痰热腑实证18例(伴高血压病5例占27.8%,伴糖尿病4例占22.2%,伴冠心病2例占11.1%,伴高脂血症7例占38.9%),气虚血瘀证85例(伴高血压病14例占16.5%,伴糖尿病28例占32.9%,伴冠心病22例占25.9%,伴高脂血症21例占24.7%),阴虚风动证52例(伴高血压病14例占26.9%,伴糖尿病17例占32.7%,伴冠心病15例占28.8%,伴高脂血症6例占11.5%),经统计学处理,差异有统计学意义,风火上扰证和风痰阻络证合并高血压病较其他合并病多,阴虚风动证和气虚血瘀证合并糖尿病较其他合并病较多,痰热腑实证合并高脂血症较其他合并症病较多。在179例急性期脑梗死患者中,单发病灶91例,占50.9%,多发病例88例,占49.1%,风火上扰证17例(单发10例占58.8%,多发7例占41.2%),风痰阻络证80例(单发49例占61.3%,多发31例占38.7%),痰热腑实证11例(单发6例占54.5%,多发5例占45.5%)气虚血瘀证48例(单发17例占35.4%,多发31例占64.6%,阴虚风动证23例(单发9例占39.1%,多发14例占60.9%),经统计学处理,差异有统计学意义,故风火上扰证和风痰阻络证以单发病灶为主,气虚血瘀和阴虚风动证以多发病灶为主。结论：急性期脑梗死头颅MRI表现中的梗死灶部位与中医辨证分型存在相关关系;急性期脑梗死中医辨证分型与合并症存在相关关系;急性期脑梗死梗死灶类型与中医辨证份分型存在相关关系。影像学表现可以成为诊断急性期脑梗死中医临床辨证分型的参考依据。
[Abstract]:Objective: to analyze the MRI imaging characteristics of 179 patients with acute cerebral infarction by DWI sequence in MRI technique, explore the application value of MRI in TCM syndrome differentiation of acute cerebral infarction, analyze the correlation between MRI manifestations of acute cerebral infarction and TCM syndrome differentiation, and then provide MRI for TCM syndrome differentiation in acute cerebral infarction patients. Imaging basis. Methods: the patients were hospitalized in Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine and 179 patients were diagnosed as acute cerebral infarction by clinician. The related indexes were statistically analyzed. The correlation between the MRI performance of acute cerebral infarction and the relationship between TCM syndrome differentiation and classification was analyzed. General data showed that among the 179 patients, 98 were male, 81 women were female, male was slightly more than women, and the age group was 60-89 years old, with the highest incidence at the age of 60-75. There was no statistical significance in the TCM syndrome differentiation of acute cerebral infarction in the acute phase of cerebral infarction. Among the patients with acute cerebral infarction, the syndrome distribution was 17 cases of wind fire disturbance, 9.5%, 80 cases of wind phlegm obstructing collaterals, 11 cases of phlegm and Fu Fu, 48 cases of qi deficiency and blood stasis, 48 cases of qi deficiency and blood stasis, 26.8% of qi deficiency and blood stasis, 23 cases of yin deficiency and movement syndrome, and 12.8%, among them, 80 cases of wind phlegm obstructing collaterals (44.7%) were the most cases, followed by qi deficiency. There were 48 cases of blood stasis syndrome (26.8%) and 23 cases (12.8%) with Yin deficiency and wind movement syndrome. Among the 179 cases of acute cerebral infarction, 22 cases (4 cases of cortical lesions, 18.2%, 3 cases of radiological crown, 13.6%, 11 in basal ganglia, 50% of basal ganglia), and wind phlegm obstructing collaterals were in 179 cases of acute cerebral infarction. 30 cases of crown lesion accounted for 25.9%, basal ganglia 48 cases accounted for 41.4%, posterior circulation area 20 cases accounted for 17.2%), phlegm heat syndrome in 16 cases (5 cases of cortical lesions 31.3%, 4 cases of radial crown lesion 25%, basal ganglia 4 cases 25%, recurrent pathological changes in 3 cases), Qi deficiency and blood stasis syndrome, basal ganglia, basal ganglia There were 22 cases of pathological changes, 29 cases of posterior circulation disease (34.1%), 50 cases of yin deficiency and wind movement syndrome (4 cases of cortical lesions, 15 cases in 30%, 13 of basal ganglia and 13 cases 26% and 18 cases of posterior circulation lesion in 36%). The difference was statistically significant after statistical treatment. The symptoms of wind fire disturbance and wind phlegm obstructing collaterals were more frequent in basal ganglia, Qi deficiency and blood stasis and yin deficiency. In 179 cases of acute cerebral infarction, among the patients with acute cerebral infarction, there were 24 cases of wind fire disturbance (12 cases with hypertension, 6 cases with diabetes 25%, 3 cases with coronary heart disease in 12.5%, 3 cases with hyperlipidemia in 12.5%), 121 cases of wind phlegm obstructing collaterals (accompanied by hypertension, 45, 37.2%, accompanied with diabetes 28 taken up, accompanied by diabetes). 30 cases of coronary heart disease accounted for 24.8%, 18 cases with hyperlipidemia (14.9%), 18 cases of phlegm heat syndrome (5 cases with hypertension, 4 cases with 22.2%, 2 cases with coronary heart disease, 2 cases 11.1% and 7 cases of hyperlipidemia), Qi deficiency and blood stasis syndrome, accompanied by diabetes mellitus cases accounted for, accompanied by coronary heart disease, accompanied by hyperlipidemia, accompanied by hyperlipidemia. 1 cases accounted for 24.7%), 52 cases of yin deficiency and wind movement (14 cases with hypertension, 17 cases of diabetes with 32.7%, 15 cases with coronary heart disease in 28.8%, 6 cases with hyperlipidemia in 11.5%), the difference was statistically significant after statistical treatment, the wind fire disturbance and wind phlegm obstructing collaterals with high blood pressure were more than the other complications, yin deficiency wind and Qi deficiency and blood stasis syndrome In 179 cases of acute cerebral infarction, 91 cases, 50.9%, 88 cases, 49.1%, 17 cases (58.8%, 7 cases, 41.2%), and 80 cases of wind phlegm obstructing collaterals (49 cases accounted for 61.3%, multiple 31) in the acute cerebral infarction patients in 179 cases. Cases accounted for 38.7%), 11 cases of phlegm heat syndrome (6 cases in 54.5%, 5 cases 45.5%) Qi deficiency and blood stasis syndrome, 48 cases (17 cases, 35.4%, 31 cases 64.6%, 23 cases of yin deficiency and wind movement), and statistical processing, the difference has statistical significance, so the wind fire disturbance and wind phlegm obstructing collaterals are mainly single focus. There is a correlation between the location of the infarct area in the MRI manifestations of cerebral infarction in acute cerebral infarction and the syndrome differentiation of TCM; there is a correlation between TCM syndrome differentiation and syndrome differentiation in acute cerebral infarction, and there is a correlation between the acute cerebral infarction type and the TCM syndrome differentiation. Image manifestation can be used as a reference for diagnosis of acute cerebral infarction in TCM.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.7

【参考文献】