【作者】 刘强；

【导师】 江勋源；

【作者基本信息】 广州中医药大学 ， 影像医学与核医学， 2008， 硕士

【摘要】 目的通过回顾性调查研究,分析206例急性缺血性中风的颅脑MRI表现及中医临床辩证分型资料,观察急性缺血性中风MRI-DWI影像表现的特点,及其与中医辩证分型之间的关系,探讨MRI-DWI在急性缺血性中风中的应用,及ADC值与中医证型的关系,以期为中医临床辩证提供客观辩证指标。方法选择206例(男123例,女83例)急性缺血性中风患者,按1993年颁布的《中药新药临床研究指导原则》将急性缺血性脑中风分组:中经络分为:①肝阳暴亢、风火上扰;②风痰瘀血、痹阻脉络;⑧痰热腑实、风痰上扰;④气虚血瘀;⑤阴虚风动;中脏腑分为:①肝火上扰清窍;②痰湿蒙塞心神;③痰热内闭心窍;④元气败脱、心神散乱。分析其MRI-DWI图像资料,并测量病灶大小、ADC值及病变部位等信息。根据试验数据,应用SPSS13.0统计软件进行统计学分析。结果1.急性脑梗塞发生时,梗塞区ADC值降低,DWI呈高信号。超急性期ADC值与正常脑组织比较,P=0.0000＜0.05;急性期ADC值与正常脑组织比较,P=0.0000＜0.05;亚急性期ADC值与正常脑组织比较,P=0.0000＜0.05,差异具有统计学意义。2.各中医证型ADC值之间比较,P＞0.05,差异无统计学意义。3.急性缺血性中风的中医辩证分型以中经络为主,占94.7%;其中又以风痰瘀血、痹阻脉络为最常见证型,占59.7%;各部位中医证型分布以风痰瘀血、痹组脉络为最常见证型。4.大面积脑梗塞中,中医分型中经络占84.8%,其中风痰瘀血、痹组脉络14例(42.4%),肝阳暴亢、风火上扰12例(36.4%);中脏腑仅5例(15.2%)。结论1.MRI-DWI是观察急性缺血性脑梗塞的有效手段。2.不同中医证型之间ADC值的差异未见特异性,ADC值作为中医分型的客观指标有待进一步探讨。3.急性缺血性中风中医分型中经络较中脏腑常见,中经络各亚型中以风痰瘀血、痹组脉络为最常见证型;缺血性中风对人体的损害不仅与梗塞面积相关,与病灶的部位亦有密切关系。4.大面积脑梗塞中医分型,中经络较中脏腑更为常见。更多还原

【Abstract】 ObjectiveTo investigate the relationship between MRI-DWI appearance and different TCM diagnosis, 206 cases of acute ischemia stroke were retrospectively analyzed. MRI-DWI is aimed to be used as an objective index for TCM classifications in this study.Methods206 patients (male 123, female 83) were selected and grouped according to ’Guide principles on clinical research of New TCM drugs ’ .Their MRI imaging were interpreted on the location, size, ADC value et al of lesion. SPSS 13.0 was employed for Statistical analysis.Results1. ADC value of infarcted area shows a sharp declination in acute stage, therefore acute infarction appears as hyper-intensity on MRI-DWI. The differences between ADC values of acute infarcted area and normal tissue are statistically significant(P=0.0000 < 0.05).2. The ADC values between different TCM patterns showed no statistical significance (P>0.05).3. In TCM diagnosis of the study, Zhongjingluo was more common than zhongzangfu, the ratio is 19:1. The predilection of specific subtype TCM patterns were found in this study.4. In patients of large area cerebral infarction, TCM diagnosis showed the same predilection: zhongjingluo-84.8%, zhongzangfu-15.2%.Conclusion1. The MRI-DWI is effective in detecting acute ischemia infarction.2. The ADC values between different TCM patterns are not specific, therefore, ADC value as an objective index in TCM diagnosis classification is required to be further studied. 3. Zhongjingluo is the more common pattern than zhongzangfu in acute ischemia apoplexy and a special subtype of TCM patterns predominates in Zhongjingluo. The injury to body of acute stroke was related to location and size of infarction.4. In large area cerebral infarction, Zhongjingluo is more frequent than zhongzangfu in TCM diagnosis.更多还原