The Study Of The Correlation About Risk Factors And TCM Syndromes Of Symptomatic Intracranial Artery Moderate And Severe Stenosis

ObjectiveSymptomatic intracranial artery stenosis is the important factor leading to ischemic stroke and transient ischemic attack in clinic. The etiology of that the occurrence of symptomatic intracranial arterial stenosis is the main cause of atherosclerosis. Therefore, symptomatic atherosclerotic intracranial arterial stenosis is often short for symptomatic intracranial artery stenosis. Clinical studies showed that the occurrence of symptomatic intracranial artery stenosis was associated with the risk factors of gender, age, family history, history of stroke, hypertension, diabetes, dyslipidemia, fibrinogen, homocysteine, smoking, obesity and so on. The main performance of lesions is intracranial,vascular intimal thickening. Intimal thickening or plaque forming can promote blood vessel lumen diameter reduced and gradually a series of ischemia syndromes appeared. There is a unique understanding for stroke caused by symptomatic intracranial artery stenosis in TCM. Many scholars, from the syndromestudy angle, studied by using the theory of syndromes about stroke on pathogenesis, pathological factors and pathogenesis, to fill the gaps in the physiological and pathological mechanism of ischemic stroke caused by symptomatic intracranial artery stenosis for modern medicine. And the therapies includes medical ones, surgical ones and endovascular ones. Traditional Chinese medicine has made certain achievements in the etiology and pathogenesis, syndrome differentiation and treatment on symptomatic intracranial arterial stenosis according to its adjustment superiority of multi way and multi target. Our hospital encephalopathy center research team, based on inheriting the ancient physicians clinical experience, modeled by the state administration of traditional Chinese medicine "diagnostic criteria of syndrome differentiation of stroke" in1994, combined with the projects of "Ninth Five-Year" and "Tenth Five-Year","stroke Yin and Yang Syndrome Differentiation Standard, put forward the academic thought of " Yin and Yang Syndrome" in the acute phase of stroke, which combines differentiation of diseases with that of syndromes. Accordingly, the TCM diagnosis and treatment on acute stage of stroke become more widely popularized and applied. However, the pathogenesis of symptomatic intracranial artery stenosis in medical profession has not been fully described at present. And the therapies have their own advantages and disadvantages, so the control of the risk factors of symptomatic intracranial artery stenosis and the secondary prevention become the focus of the treatment on the disease and an urgent problem, which has very important clinical significance. The purpose of this study is, based on studying the cases of symptomatic intracranial artery moderate and severe stenosis, to deep analyze the correlation among risk factors for stroke, stroke syndrome factors of TCM and the relevant blood vessels of symptomatic intracranial artery stenosis cases, and make a preliminary discussion about clinical efficacy of the treatment on symptomatic intracranial artery moderate and severe stenosis with the theory system of Yin and Yang syndromes, and provide theoretical basis on secondary prevention of stroke caused by symptomatic intracranial artery moderate and severe stenosis.MethodThis study reviewed251cases of encephalopathy center in our hospital from January2010to December2012in the diagnosis of ischemic cerebrovascular disease, which were confirmed by DSA in the diagnosis of intracranial artery moderate and severe stenosis. First of all, induced the distribution law of relevant vessels and the TCM syndromes according to the selected cases. Secondly, made a research on the correlation of the following aspects:risk factors and TCM syndromes; risk factors for stroke and the relevant vessels; risk factors and outcome; TCM syndromes and relevant vessels; Vs of the patients suffering from symptomatic middle cerebral artery moderate and severe stenosis and risk factors; Vs and TCM syndromes. Finally, divided the selected cases into2groups according to the therapies. One accecpted the therapy of combination of TCM and Western medicine, the other used PTAS. And then compared the TCM syndrome grade of the2groups. Result1. Distribution law of relevant vessels:Internal carotid artery stenosis accounted for22.70%; middle cerebral artery stenosis for44.22%; intracranial vertebral artery stenosis for11.55%; basilar artery stenosis for21.51%.2. Distribution law of TCM syndromes:among the251cases,104cases had single syndrome. Wind syndrome accounted for19.92%; heat syndrome for1.99%; phlegm syndrome for11.55%; blood stasis syndrome for1.59%; Qi deficiency for2.79%; Yin deficiency and yang hyperactivity accounted for3.59%. There were147cases of combination of syndromes, wind and phlegm syndrome accounted for34.26%; wind and heat syndrome accounted for12.75%; wind and Qi deficiency syndrome accounted for2.39%; phlegm and blood stasis syndrome accounted for5.98%; blood stasis and Qi deficiency syndrome accounted for0.40%; wind, phlegm and blood stasis syndrome accounted for2.79%.3. Correlation analysis:diabetes and phlegm syndrome were correlated (P<0.05), danger degree was1.329; age was correlated with Qi deficiency syndrome (P<0.05), danger degree was1.162; age was correlated with wind and phlegm syndrome (P<0.05), danger degree was0.966; age and coronary heart disease were both correlated with intracranial segment of internal carotid artery stenosis (P<0.05), danger degrees were1.049and2.783; gender.Age, hypertension, coronary heart disease and smoking were correlated with cerebral artery stenosis (P<0.05), the danger degrees were2.256、0.951、0.503、0.312和0.485; diabetes mellitus and intracranial vertebral artery stenosis were correlated (P<0.05), danger degree was2.619; hypertension and smoking were correlated with basilar artery stenosis (P<0.05), the danger degrees were3.023and2.481; there was correlation between the ischemic end events and stroke history (P<0.05), danger degree was3.505; compared the existence of wind syndrome with Vs of the middle cerebral artery stenosis, P<0.05..4. Effect of treatment with integrated traditional Chinese and Western medicine:TCM syndrome score:the discrepancy of the two groups before and after treatment did not exist, meant P>0.05; the internal discrepancy of the two groups before and after treatment existed, P<0.05. Clinical significance of TCM syndrome:there were236cases in the internal medicine group, which invalid35cases, the efficiency was87.08%; while there were133cases in the operation group, invalid9cases, efficiency was93.66%. compared with two groups the outcome showed P<0.05.Conclusion1. The most common syndromes of symptomatic intracranial artery moderate and severe stenosis were wind syndrome and wind associated with phlegm syndrome. In clinic, middle cerebral artery occurred severe stenosis is more common than other3intracranial vessel.2. Correlation study:diabetes was negatively correlated with phlegm; it shows positive correlation between age and Qi deficiency syndrome; age was negatively correlated with wind and phlegm syndrome; age and coronary heart disease was positively correlated with intracranial segment of internal carotid artery stenosis; age, hypertension, coronary heart disease and smoking are negatively correlated with cerebral artery stenosis, and gender is positively correlated with it; diabetes mellitus and intracranial segment of vertebral artery stenosis were positively correlated; gender and basilar artery stenosis was negatively correlated; hypertension and smoking are associated with basilar artery stenosis negatively; history of stroke is associated with recurrent ischemic stroke positively; syndromes and relevant vessels are not related. Wind syndrome exists or not is statistically difference from Vs in patints suffering middle cerebral artery stenosis.3. Chinese medicine intervention therapy is proved to improve the TCM syndrome of the patients with symptomatic intracranial artery moderate and severe stenosis, but the syndrome change rate than endovascular treatment.