【摘要】 目的研究症状性颈动脉重度狭窄/闭塞患者证候要素与前交通动脉开放的关系。方法采集36例症状性颈动脉重度狭窄/闭塞患者,含脑梗死26例、短暂性脑缺血发作(TIA)10例。采集5个时点证候要素,利用CT血管造影(CTA)联合磁共振血管成像(MRA)评估一级侧支循环,按前交通动脉是否开放分组,对预后以及证候要素进行统计学分析。结果症状性重度颈动脉狭窄/闭塞患者中,一级侧支循环以前交通动脉开放较多,前交通开放组较未开放组在第90天美国国立卫生研究院率中量表(NIHSS)评分改善及预后良好(m RS≤2)方面均存在统计学差异(P <0.05)。同时前交通未开放组内火证、血瘀证、气虚证、阴虚证比例均高于开放组。结论症状性颈动脉重度狭窄/闭塞患者中,前交通动脉开放组较未开放组预后好。前交通动脉未开放组,证候要素特点更复杂。气虚证在前交通动脉未开放组比例较高。提示侧支循环的影像学评估,可为辨证论治提供指导。更多还原

【Abstract】 Objective To study the relationship between syndrome elements and anterior communicating artery(ACo A) opening in patients with symptomatic severe carotid artery stenosis/occlusion.Methods Thirty-six patients with symptomatic severe carotid stenosis/occlusion were collected, including 26 patients with cerebral infarction and 10 patients with transient ischemic attack(TIA). Syndrome elements at five time points were collected.Computer tomography angiography(CTA) combined with magenic resonance angiograp(MRA) was used to evaluate the primary collateral circulation, and the prognosis and syndrome elements were statistically analyzed according to whether the ACoA was open or not.Results The ACo A was open more in the primary collateral circulation among patients with symptomatic severe carotid stenosis/occlusion. There was a statistically significant difference in national institute of health stroke scale(NIHSS) score improvement and good prognosis [the modified rankin scale(m RS) ≤ 2] between the ACo A open group and the ACo A nonopen group on the 90 th day(P < 0.05). The proportion of patients with internal wind syndrome, blood stasis syndrome, Qi deficiency syndrome, and Yin deficiency syndrome in the ACo A non-open group was higher than that in the open group.Conclusion In the patients with severe carotid artery stenosis/occlusion, the group with presence of anterior communicating artery had better prognosis. The syndrome elements are more complex in the group without the presence of anterior communicating artery. The proportion of Qi deficiency syndrome was positively correlated with the non-opening of anterior communicating artery. The imaging evaluation of collateral circulation can provide guidance for syndrome differentiation and treatment.更多还原