本文選題：CT腦灌注 + 腦梗死��； 參考：《北京中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:通過觀察缺血性中風病亞急性期CT腦灌注成像(perfusion computed tomography,CTP)和中醫(yī)演變規(guī)律,探索梗死后腦灌注特點和中醫(yī)證候演變規(guī)律之間的關(guān)系,為診斷提供依據(jù),為中醫(yī)治療尋找更好切入點。方法:納入發(fā)病72h內(nèi)的急性腦梗死患者30例,入院完善常規(guī)CT平掃、MRI,發(fā)病3-5天完成CT腦灌注檢查,一站式獲取全腦灌注成像、全腦血管成像(CT angiography,CTA),測量梗死部位及健側(cè)鏡像區(qū)的主要灌注參數(shù),包括對比劑平均通過時間(mean transt time,MTT)、腦血流量(cerebral blood flow,CBF)、腦血容量(cerebral blood volume,CBV)。選取入院第1、3、5、7、14天作為觀察時點,依據(jù)《缺血性中風證候要素診斷量表》采集中醫(yī)證候信息,同時根據(jù)NIHSS量表評價神經(jīng)功能。綜合各項數(shù)據(jù)與臨床信息,進行統(tǒng)計學分析。結(jié)果:1.CTP成像分析納入的30例患者中,28例存在梗死部位灌注異常。梗死部位灌注異常存在三種情況:①MTT延長,CBF下降,CBV下降;②MTT延長,CBF下降,CBV正常或上升;③MTT延長,CBF正�；蛏仙�,CBV下降。將MTT延長,CBF下降,CBV正�；蛏仙暈楣Ｋ啦课辉俟嘧�,納入患者再灌注率為42.7%。梗死部位與健側(cè)的MTT、CBF、CBV差異均有統(tǒng)計學意義(P0.05)。2.再灌注與各時點神經(jīng)功能的相關(guān)性將前循環(huán)梗死的患者按有、無再灌注分為兩組,再灌注組NIHSS評分低于無再灌注組,在入院第5、7、14天差異有統(tǒng)計學意義(P0.05)。3.影響腦灌注情況的相關(guān)因素①梗死部位:30例患者中,位于基底節(jié)、腦干的梗死再灌注發(fā)生率為10.0%,位于放射冠、皮層、小腦的梗死再灌注發(fā)生率為80.0%,且基底節(jié)、腦干的相對腦血容量(relative cerebral blood volume,rCBV)顯著低于放射冠、皮層、小腦(P0.05)。②一級側(cè)支循環(huán)和CTA最大密度投影(maximal intensity projections,MIP)成像血流情況:按病變側(cè)的交通動脈是否開放分為兩組,兩組間各灌注參數(shù)無顯著差異。TIMI分級0-1級和2-3級兩組間比較,各灌注參數(shù)、再灌注發(fā)生率差異無統(tǒng)計學意義。③其他因素:再灌注組與無再灌注組之間在年齡,高血壓、糖尿病、冠心病病史,收縮壓以及舒張壓方面差異均無統(tǒng)計學意義。4.中風證候要素演變規(guī)律①證候比例變化:入院第1天證候以內(nèi)風證為主導,占比內(nèi)風證痰濕證血瘀證內(nèi)火證;入院第3、第5和第7天以血瘀證痰濕證內(nèi)火證為主;氣虛、陰虛證在觀察時段中始終占比較低。②單證候演變趨勢:內(nèi)風證入院第1天至第3天迅速下降,此后保持較低水平。痰濕證發(fā)病初期比例較高,第3天為分值最高峰,隨后逐步下降。血瘀證呈現(xiàn)緩慢上升趨勢,在第7天為分值最高峰。內(nèi)火證、氣虛證呈現(xiàn)逐步下降的趨勢。陰虛證基本保持平穩(wěn)。5.證候演變與腦灌注情況相關(guān)性經(jīng)非參數(shù)檢驗,第1天氣虛組患者健側(cè)CBF參數(shù)低于無氣虛組,第5天、第7天氣虛組患者的rCBV低于無氣虛組,差異有統(tǒng)計學意義(P0.05),經(jīng)Spearman雙變量相關(guān)分析,第5天氣虛證分值與rCBV呈負相關(guān)(相關(guān)系數(shù)rs=-0.397,P=0.030),第1天氣虛證分值與健側(cè)CBF參數(shù)、第7天氣虛證分值與rCBV的相關(guān)性未發(fā)現(xiàn)統(tǒng)計學意義。各時點內(nèi)風證、內(nèi)火證、痰濕證、血瘀證、陰虛證組間比較梗死區(qū)CBF、健側(cè)CBF、梗死區(qū)CBV、健側(cè)CBV、rCBV差異無統(tǒng)計學意義。結(jié)論:1.CT灌注成像可以定性、定量顯示腦梗死亞急性期腦灌注情況。部分患者梗死部位出現(xiàn)自發(fā)性再灌注,對患者早期癥狀改善有積極影響。再灌注發(fā)生率與梗死部位有關(guān),皮層、放射冠、小腦的再灌注率高于基底節(jié)和腦干;再灌注發(fā)生率與一級側(cè)枝循環(huán)開放情況、CTA-MIP像血流情況、年齡、高血壓、冠心病、高血脂、糖尿病、收縮壓、舒張壓未發(fā)現(xiàn)相關(guān)性。2.缺血性中風病證候演變存在一定特征規(guī)律。證候表現(xiàn)及嚴重程度與腦灌注情況之間存在一定相關(guān)性,氣虛證患者可能比無氣虛證患者腦灌注水平更低,發(fā)生自發(fā)性再灌注的幾率也更低。
[Abstract]:Objective: To explore the relationship between the characteristics of cerebral perfusion after cerebral infarction (perfusion computed tomography (CTP) and the evolution of traditional Chinese medicine (TCM) in the subacute phase of ischemic apoplexy, to explore the relationship between the characteristics of cerebral perfusion after infarction and the law of the evolution of TCM syndrome, to provide a basis for diagnosis and to find a better entry point for the treatment of traditional Chinese medicine. Method: to include the acute cerebral infarction in the pathogenesis of 72h. 30 patients were admitted to the hospital to complete the routine CT scan, MRI, to complete the CT cerebral perfusion examination on the 3-5 day of onset, and one station to obtain the whole brain perfusion imaging, the whole brain angiography (CT angiography, CTA), to measure the main perfusion parameters of the infarct site and the healthy side mirror area, including the average pass time of the contrast agent (mean transt time, MTT), and the cerebral blood flow (cerebral blood). CBF), cerebral blood volume (cerebral blood volume, CBV). Select the admission day 1,3,5,7,14 as the observation time point, collect the TCM syndrome information according to the diagnostic scale of ischemic stroke syndrome factor, and evaluate the nerve function according to the NIHSS scale. The comprehensive data and clinical information, carry on statistical analysis. Results: 1.CTP imaging analysis included 30 Among the patients, 28 cases had abnormal perfusion of infarct site. There were three cases of infarction site perfusion abnormality: (1) MTT prolonged, CBF decreased, CBV decreased; MTT prolonged, CBF decreased, CBV was normal or ascending; MTT prolonged, CBF normal or ascending, CBV decreased. MTT extended, CBF decreased, CBV normal or rise was reperfused as infarction site, included reperfusion in patients. The difference of MTT, CBF, CBV in 42.7%. infarct site and the healthy side was statistically significant (P0.05) the correlation between.2. reperfusion and nerve function at each time point, the patients with anterior circulation infarction were divided into two groups without reperfusion, and the NIHSS score in the reperfusion group was lower than that in the non reperfusion group, and the difference in the day 5,7,14 day was statistically significant (P0.05).3. influenced the brain. Related factors of perfusion (1): Infarct Sites in the basal ganglia in 30 patients, the incidence of infarct reperfusion in the brain stem was 10%, in the radiological crown, in the cortex and in the cerebellum, the incidence of reperfusion was 80%, and the relative cerebral blood volume (relative cerebral blood volume, rCBV) in the basal ganglia was significantly lower than that in the corona, cortex, and cerebellum (P0.05). The blood flow status of the first grade collateral circulation and CTA maximum density projection (maximal intensity projections, MIP) was divided into two groups according to the opening of the communicating artery on the diseased side. There was no significant difference in the perfusion parameters between the two groups in the two groups of grade 0-1 and 2-3, and there was no statistical difference between the perfusion parameters and the incidence of reperfusion. His factors: there was no significant difference in age, hypertension, diabetes, coronary heart disease history, systolic pressure and diastolic pressure between the reperfusion group and the non reperfusion group, and there was no statistical significance in the evolution of the syndrome factors of.4. stroke syndrome (1) the change of syndrome ratio: the first days of admission to the hospital was guided by the wind syndrome, which accounted for the internal fire syndrome of the phlegm dampness syndrome and blood stasis syndrome, and the admission was third, Fifth and seventh days with blood stasis syndrome of phlegm damp syndrome mainly, Qi deficiency and yin deficiency syndrome was always low in the observation period. (2) the evolution trend of syndrome syndrome: internal wind syndrome declined rapidly from first days to third days, and then maintained a lower level. The proportion of phlegm damp syndrome in the early stage was higher, third days was the highest peak, and then gradually decreased. Blood stasis syndrome showed slowly. The rising trend was the highest peak at seventh days. Internal fire syndrome and Qi deficiency showed a gradual decline. The correlation between.5. syndrome and cerebral perfusion was tested by non parameter test. The CBF parameters of the patients in the first weather asthenia group were lower than that of the non Qi deficiency group, fifth days, and the seventh weather asthenia group were lower than the non Qi deficiency group, the difference has the difference. Statistical significance (P0.05), after Spearman bivariate correlation analysis, the score of fifth weather deficiency syndrome was negatively correlated with rCBV (correlation coefficient rs=-0.397, P=0.030), first weather deficiency syndrome scores and the healthy side CBF parameters, and the correlation between seventh weather deficiency syndrome scores and rCBV was not statistically significant. There was no statistical difference between CBF in infarct area, CBF in the healthy side, CBV in infarct area and CBV in the healthy side. Conclusion: 1.CT perfusion imaging can qualitatively and quantitatively show cerebral perfusion in subacute cerebral infarction. Spontaneous reperfusion has a positive effect on the improvement of early symptoms in some patients. The incidence of reperfusion and the location of infarct area are positive. The rate of reperfusion in the cerebellum is higher than that of the basal ganglia and brain stem. The incidence of reperfusion and the opening of the first grade collateral circulation, CTA-MIP like blood flow, age, hypertension, coronary heart disease, hyperlipidemia, diabetes, systolic pressure, diastolic pressure and diastolic pressure are not found to have certain characteristics in the evolution of the syndrome of.2. ischemic stroke. There is a certain correlation between the severity and the cerebral perfusion, and the patients with Qi deficiency may have lower cerebral perfusion than those without Qi deficiency, and the probability of spontaneous reperfusion is lower.

【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R277.7

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