本文選題：急性腦梗死 + 中醫(yī)辨證分型�。� 參考：《大連醫(yī)科大學》2016年碩士論文

【摘要】：目的:本次研究旨在探討急性腦梗死中醫(yī)辨證分型與血脂、頸動脈斑塊及狹窄之間的關系,為急性腦梗死中醫(yī)微觀辨證分型提供客觀依據(jù),使急性腦梗死的中醫(yī)辨證分型和治療更加客觀化、準確化、個體化。方法:制定統(tǒng)一的納入標準和排除標準,參照《中醫(yī)病證診斷療效標準》[1],將符合標準的156例急性腦梗死患者進行辨證分型。收集所有患者的血脂及頸動脈彩超的結果,應用SPSS 22.0進行數(shù)據(jù)的錄入和統(tǒng)計。比較各證型間血脂、頸動脈彩超結果,探討急性腦梗死患者各證型與血脂、頸動脈斑塊及狹窄之間的關系。結果:1.急性腦梗死中醫(yī)證型分布依次為:風痰阻絡型(32.69%)氣虛血瘀型(25.64%)肝陽暴亢型(16.03%)痰熱腑實型(14.10%)陰虛風動型(11.54%)。2.各證型男女構成及年齡的差異無統(tǒng)計學意義(P0.05)。3.各證型合并高血壓的差異有統(tǒng)計學意義:肝陽暴亢型明顯高于其他四個證型(P0.05或P0.01),風痰阻絡型高于陰虛風動型(P0.05),合并冠心病與糖尿病在各證型分布的差異無統(tǒng)計學意義(P0.05)。4.各證型間血脂異常的差異有統(tǒng)計學意義:其中肝陽暴亢型與陰虛風動型血脂異常所占比例明顯低于風痰阻絡型、痰熱腑實型、氣虛血瘀型(P0.01)。各證型之間血脂平均水平的差異有統(tǒng)計學意義:從TC上看:風痰阻絡型和痰熱腑實型明顯高于肝陽暴亢型(P0.05或P0.01),痰熱腑實型明顯高于陰虛風動型(P0.05);從TG上看:各證候間差別無統(tǒng)計學意義(P0.05);從HDL-C上看:氣虛血瘀型與其余四型相比顯著降低(P0.01);從LDL-C上看:風痰阻絡型和痰熱腑實型明顯高于陰虛風動型(P0.05或P0.01)。5.各證型頸動脈斑塊發(fā)生率的差異有統(tǒng)計學意義:與肝陽暴亢型和陰虛風動型比較,其余三型的斑塊檢出率較高(P0.05或P0.01);各證型頸動脈斑塊分布的差異無統(tǒng)計學意義(P0.05)。6.各證型頸動脈狹窄率的差異有統(tǒng)計學意義:其中肝陽暴亢型與陰虛風動型狹窄率明顯低于其他三個證型(P0.05或P0.01);各證型頸動脈狹窄程度分布的差異無統(tǒng)計學意義(P0.05)。結論:1.急性腦梗死中醫(yī)證型與血脂的分布及其平均水平、斑塊的形成率、頸動脈狹窄率、合并高血壓之間存在關系,與年齡、性別、斑塊性質的分布、頸動脈狹窄程度的分布、合并冠心病和糖尿病無關;2.急性腦梗死患者TC、LDL-C的升高可作為痰證、瘀證辨證的參考指標,HDL-C的降低可作為氣虛血瘀型辨證的參考指標;3.急性腦梗死患者頸動脈斑塊及狹窄的形成與中醫(yī)證型間存在關系,其形成率在與痰證、瘀證相關的證型中較高。
[Abstract]:Objective: to explore the relationship between TCM syndrome differentiation and blood lipid, carotid plaque and stenosis in acute cerebral infarction, and to provide objective basis for TCM micro syndrome differentiation of acute cerebral infarction. To make the acute cerebral infarction syndrome differentiation and treatment more objective, accurate, individualized. Methods: according to the criteria of diagnosis and curative effect of TCM disease syndrome, 156 patients with acute cerebral infarction were classified according to the criteria of inclusion and exclusion. The results of blood lipid and carotid ultrasound were collected, and SPSS 22.0 was used to input and statistics the data. To compare the blood lipids and the results of carotid artery color Doppler sonography among different syndrome types, and to explore the relationship between each syndrome type and blood lipid, carotid plaque and stenosis in patients with acute cerebral infarction. The result is 1: 1. The distribution of TCM syndromes of acute cerebral infarction was as follows: wind phlegm blocking collaterals (32.69%), qi deficiency and blood stasis (25.64%), hyperactivity of liver-yang (16.03%), phlegm and heat (14.10%), yin deficiency (11.54%) .2. There was no significant difference in composition and age between men and women of each syndrome type (P0.05). 3. There were significant differences between the syndrome types and hypertension: the type of hyperactivity of liver-yang was significantly higher than that of the other four syndrome types (P0.05 or P0.01), the type of wind-phlegm blocking collaterals was higher than that of the type of Yin deficiency wind movement (P0.05), and the distribution of coronary heart disease and diabetes mellitus in each syndrome type had no statistical significance (P0.05). 4. The difference of dyslipidemia among different syndromes was statistically significant: the proportion of dyslipidemia in hyperactive liver-yang type and wind-asthenia type was significantly lower than that in wind-phlegm blocking collaterals type, phlegm and heat entrails type, Qi deficiency and blood stasis type (P0.01). The difference of average level of blood lipids among different syndromes was statistically significant: from the TC point of view, the types of wind-phlegm blocking collaterals and phlegm-heat entrails were significantly higher than those of liver-yang violent hyperactivity (P0.05 or P0.01), and the phlegm and heat entrails were significantly higher than those of yin deficiency and wind movement (P0.05); from the TG point of view: There was no significant difference between syndromes (P0.05); from the point of view of HDL-C: Qi deficiency and blood stasis compared with the other four types significantly decreased (P0.01); from LDL-C: wind phlegm blocking collaterals and phlegm heat Fu solid type was significantly higher than Yin deficiency wind movement (P0.05 or P0.01) .5. The incidence rate of carotid plaques in each syndrome type was statistically significant: compared with the hyperactive type of liver-yang and the wind movement type of Yin deficiency, the detection rate of plaque in the other three types was higher (P0.05 or P0.01), and there was no significant difference in the distribution of carotid plaques in each syndrome type (P0.05). 6. The rate of carotid artery stenosis in each syndrome type was significantly lower than that in the other three syndrome types (P0.05 or P0.01), and there was no significant difference in the degree distribution of carotid artery stenosis between different syndromes (P0.05). Conclusion 1. The distribution and average level of blood lipid, plaque formation rate, carotid artery stenosis rate, hypertension, age, sex, the distribution of plaque nature, the degree of carotid artery stenosis, the distribution of TCM syndrome type of acute cerebral infarction, the degree of carotid artery stenosis, and the relationship between TCM syndrome type and blood lipid distribution, plaque formation rate, carotid artery stenosis rate, and hypertension. Coronary heart disease is not associated with diabetes. The increase of LDL-C in acute cerebral infarction can be used as the reference index of phlegm syndrome and the decrease of HDL-C in syndrome differentiation of blood stasis can be used as the reference index of syndrome differentiation of qi deficiency and blood stasis. The formation of carotid artery plaque and stenosis in patients with acute cerebral infarction was related to TCM syndrome type, and its formation rate was higher in the syndromes related to phlegm syndrome and stasis syndrome.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R277.7

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