急性大动脉粥样硬化型脑梗死颈动脉超声特征与中医证型关联及相关影响因素分析OA

Objective To investigate the relationship between carotid ultrasonographic features and traditional Chinese medicine(TCM)syndrome patterns in patients with acute large-artery atherosclerotic(LAA)cerebral infarction,and to analyze the influencing factors associated with the degree of carotid artery lesions.Methods A total of 108 patients with acute LAA cerebral infarction were enrolled.Four diagnostic data were collected and TCM syndrome differentiation was performed.Carotid ultrasonographic features were summarized according to different TCM syndrome patterns.Carotid ultrasonographic features,general information,laboratory indicators,China Stroke Scale(CSS)score,National Institutes of Health Stroke Scale(NIHSS)score,Barthel Index(BI),and modified Rankin Scale(mRS)score were collected.Univariate analysis combined with multivariate logistic regression was used to identify risk and protective factors related to carotid ultrasonographic features.Results Among the 108 patients with acute LAA cerebral infarction,28 cases(25.93%)had the wind-yang stirring upward syndrome,26 cases(24.07%)had the wind-phlegm-blood stasis syndrome,16 cases(14.81%)had the phlegm-heat and fu-organ excess syndrome,21 cases(19.44%)had the qi deficiency and blood stasis syndrome,and 17 cases(15.74%)had the yin deficiency and wind stirring syndrome.Among the 108 patients,carotid intima thickening was found in 3 cases(2.78%),plaques in 17 cases(15.74%),mild stenosis in 33 cases(30.56%),moderate stenosis in 31 cases(28.70%),severe stenosis in 14 cases(12.96%),and occlusion in 10 cases(9.26%).Carotid ultrasonographic features differed across TCM syndrome patterns:moderate stenosis was most common in the wind-yang stirring upward syndrome;mild stenosis was more common in the wind-phlegm-blood stasis syndrome and phlegm-heat and fu-organ excess syndrome;severe stenosis and occlusion were more common in the qi deficiency and blood stasis syndrome;and plaques were more common in the yin deficiency and wind stirring syndrome.Univariate analysis showed significant differences among different carotid ultrasonographic feature groups in sex,age,smoking history,drinking history,hypertension,diabetes,total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),homocysteine(Hcy),and CSS,NIHSS,BI,and mRS scores(P<0.05).Multivariate logistic regression analysis showed that sex was an independent risk factor for mild stenosis;age,hypertension,diabetes,TC,LDL-C,and Hcy were independent risk factors for moderate stenosis(all P<0.05);smoking history and drinking history were independent risk factors for moderate and severe stenosis(P<0.05);TG was an independent risk factor for mild and severe stenosis(both P<0.05);CSS and NIHSS scores were independent risk factors for severe stenosis and occlusion(P<0.05);and mRS score was an independent risk factor for occlusion(P<0.05).HDL-C was a protective factor for moderate stenosis(P<0.05),and BI was a protective factor for severe stenosis(P<0.05).Conclusion In patients with acute LAA cerebral infarction,TCM syndrome patterns are associated with carotid ultrasonographic features.The severity of carotid lesions is influenced by sex,age,smoking history,drinking history,hypertension,diabetes,dyslipidemia,Hcy,neurological function,and activities-of-daily-living scores.