【摘要】 目的 通过追踪急性脑梗死发生后1周内临床与弥散加权成像不匹配（CDM）的动态变化，进一步探讨与中医证候及预后之间的联系。方法 研究纳入336名发病<72 h的急性脑梗死患者，所有患者均在发病1周内完成头颅MRI检查，基于CDM的判定标准，即NIHSS评分≥8分且DWI-阿尔伯塔卒中项目早期CT评分（ASPECTS）≥8分，将患者分为有CDM组（96例）和无CDM组（240例）。在入院时、第7天、第15天及第30天进行NIHSS评分、mRS评分及中医证候评估。结果 有CDM组在入院7、15、30 d时NIHSS评分降低更明显，神经学结局优于无CDM组。早期中医证候以风证和血瘀为主，随时间演变，风证、痰证、瘀血减少，气虚症状好转。有CDM组mRS变化与抗血小板聚集呈负相关，无CDM组与活血化瘀法呈负相关。结论 急性脑梗死患者在发病1周内，脑组织仍有挽救的可能；患者若存在CDM，其神经功能预后更为理想；中医的证候表现主要为血瘀、气虚等证候的转变；存在CDM的患者，治疗上更倾向于抗血小板聚集，而无CDM的患者，则更注重活血化瘀法。更多还原

【Abstract】 Objective:To study deepen previous research findings by tracking the dynamic changes in clinicaldiffusion mismatch(CDM)within one week after acute cerebral infarction,and to further explore its relationship with TCM syndromes and prognosis. Methods:A total of 336 patients with acute cerebral infarction who were admitted within 72 hours of onset were included in this study. All patients underwent cranial MRI examination within one week of onset. Based on the criteria for CDM,i.e.,NIHSS score not less than 8 points and DWI-Alberta Stroke Program Early CT Score(ASPECTS)not less than 8 points,patients were divided into a CDM group(96 cases)and a non-CDM group(240 cases). The NIHSS scores,mRS scores,and TCM syndrome evaluations were conducted at admission,7,15,and 30 d. Results:The CDM group showed more significant reductions in NIHSS scores at 7,15,and 30 d after admission,with better neurological outcomes compared with the non-CDM group.Early TCM syndromes were mainly characterized by wind syndrome and blood stasis,which evolved over time with reductions in wind syndrome,phlegm syndrome,and blood stasis,while qi deficiency symptoms improved. In the CDM group,changes in mRS scores were negatively correlated with antiplatelet aggregation therapy,whereas in the non-CDM group,they were negatively correlated with promoting blood circulation and removing blood stasis therapy. Conclusion:Within one week of onset,there is still potential for salvaging brain tissue in patients with acute cerebral infarction. Patients with CDM have a more favorable neurological prognosis. The main TCM syndrome manifestations include transitions from blood stasis and qi deficiency. For patients with CDM,treatment tends more towards antiplatelet aggregation,while for those without CDM,emphasis is placed on promoting blood circulation and removing blood stasis.更多还原