Study On The Correlation Between Collateral Circulation And Syndrome Elements In Patients With Middle Cerebral Artery Stenosis And Cerebral Infarction

Objective To study the degree and influencing factors of collateral circulation opening in patients with MCA stenosis cerebral infarction;to explore the relationship between collateral circulation opening and short-term prognosis of patients,and to further observe the correlation between collateral circulation establishment and TCM syndrome elementsMethods In this cross-sectional study,84 patients with cerebral infarction diagnosed as unilateral MCA stenosis by MRA/CTA were included,and the patients were divided into moderate stenosis group,severe stenosis group and occlusion group according to warwarin-aspirin symptomatic intracranial arterial lesion(WASID)measurement criteria.According to MRA/CTA image data,determine the opening degree of primary collateral circulation;The imaging data of 51 patients with severe stenosis and occlusion of unilateral MCA diagnosed by CTA were analyzed to judge the establishment of collateral circulation of pia.We collected patient’s clinical data,syndrome elements,NIHSS score,BI score and MRS score at two points on the day of admission and the 28th day of onset.Then,The factors affecting the opening of collateral circulation were analyzed.the effect of collateral circulation opening on the changes of NIHSS score,BI score and MRS score at two time points was investigated and the relationship between collateral circulation and distribution of TCM syndromes was observed.Results 1.The opening of primary collateral circulation was more in patients with severe MCA and occlusion group than in patients with moderate stenosis group(P<0.05).The occlusion group had better establishment of collateral circulation of pia than stenosis group(P<0.05).In the Willis,ACOA were mainly open,and the occlusion group were more than those in the moderate and severe stenosis groups(P<0.05).While there was no statistical significance in PCOA of the three groups(P>0.05).2.The non-open primary collateral circulation group had more coronary heart disease,and the difference between the groups was statistically significant(P<0.05).Compared with the rich group,the fasting blood glucose was higher in the poor collateral circulation of pia,and the difference was statistically significant(P<0.05).There was no significant difference among the others(P>0.05)3.The NIHSS score in the primary collateral circulation open group was lower than that in the non-open group on the day of admission(P<0.05).The NIHSS、MRS score of the patients in the well-established pia group were lower and BI score was higher than those in the poor group on the 28th day of onset,with statistically significant differences(P<0.05).The NIHSS score on the 28th day of onset of all enrolled patients was lower than that on the day of admission(P<0.05).The MRS score on the 28th day of onset of the well-established pia was lower than that on the day of admission,and the BI score was higher(P<0.05).4.In the acute stage of cerebral infarction,the proportion of phlegm-dampness syndrome in the primary collateral circulation open group was higher than that in the non-open group(P<0.05),but the difference of syndrome elements was not statistically significant about collateral circulation of pia(P>0.05).During the recovery period,the proportion of Yin deficiency syndrome in the primary collateral circulation open group was higher than that in the non-open group(P<0.05),and the proportion of qi deficiency syndrome in the poor collateral circulation of pia group was larger than that in the well group(P<0.05).5.In the patients with acute cerebral infarction,the syndrome elements of wind syndrome,blood stasis syndrome,phlegm and dampness syndrome were mostly distributed.During the recovery period,syndrome elements are mainly qi deficiency syndrome,blood stasis syndrome,phlegm-dampness syndrome.The wind syndrome decreased most obviously and qi deficiency syndrome increased significantly within 28 days,while the proportion of phlegm-dampness syndrome and blood-stasis syndrome did not change significantly at the two time points.Conclusion 1.The degree of collateral circulation opening is correlated with the degree of MCA stenosis.The higher the degree of MCA stenosis is,the better the collateral circulation opening is.In the primary collateral opening,patients with ACOA opening were more.2.Patients with coronary heart disease had poor primary collateral opening;Elevated fasting glucose is an adverse factor in the establishment of collateral circulation of pia.3.The well-established collateral circulation of pia has an obvious positive effect on short-term prognosis of cerebral infarction.Primary collateral circulation can reduce the degree of nerve defect in patients with acute cerebral infarction.4.Phlegm-dampness syndrome is an adverse syndrome factor of primary collateral opening in patients with acute cerebral infarction.During the recovery period,Yin deficiency syndrome is an unfavorable factor for the opening of primary collateral and qi deficiency syndrome is an unfavorable factor for the establishment of collateral circulation of pia.5.In patients with MCA stenosis cerebral infarction,the main symptoms in the acute phase were wind syndrome,blood stasis syndrome and phlegm and dampness syndrome.In the recovery period,qi deficiency syndrome,blood stasis syndrome,phlegm and dampness syndrome were the main symptoms.Wind syndrome and qi deficiency syndrome fluctuated significantly within 28 days,while phlegm-dampness syndrome and blood stasis syndrome were not easy to change,and blood stasis syndrome was the most important syndrome characteristic of stroke.