颈性眩晕中医证型与经颅超声脑动脉血流检测结果的相关性分析

摘要 目的：分析颈性眩晕中医证型与经颅超声脑动脉血流检测结果的相关性。方法：选取2021年5月-2023年5月收治颈性眩晕患者作为研究对象，根据不同中医证型分为痰湿中阻组、肝阳上亢组、肝肾阴虚组和气血亏虚组，每组各纳入20例；并另选取健康体检患者30例作为对照组，均给予多普勒超声检查。分析不同中医证型者与对照组者多普勒超声检查特征与脑动脉血流变化[左右椎动脉、基底动脉及大脑中动脉收缩期峰值血流速度（VS）、平均血流速度(Vm)、舒张期峰值血流速度(Vd)及搏动指数(PI)]。结果：痰湿中阻组、肝肾阴虚组和气血亏虚组左右椎动脉、基底动脉及大脑中动脉VS均低于对照组（P＜0.05）；肝阳上亢组左右椎动脉、基底动脉及大脑中动脉VS均高于对照组（P＜0.05）；不同中医证型组间VS比较，肝阳上亢组＞痰湿中阻组＞肝肾阴虚组＞气血亏虚组；痰湿中阻组左右椎动脉、基底动脉均高于对照组（P＜0.05），大脑中动脉Vm均低于对照组（P＜0.05）；肝阳上亢组左右椎动脉、基底动脉及大脑中动脉Vm均高于对照组（P＜0.05）；肝肾阴虚组左右椎动脉、基底动脉及大脑中动脉Vm均低于对照组（P＜0.05）；气血亏虚组大脑中动脉Vm均低于对照组（P＜0.05），左右椎动脉、基底动脉Vm和对照组无显著性差异（P>0.05）；不同中医证型组间Vm比较，肝阳上亢组＞痰湿中阻组＞气血亏虚组＞肝肾阴虚组；痰湿中阻组左右椎动脉、基底动脉Vd均低于对照组（P＜0.05），大脑中动脉Vd均高于对照组（P＜0.05）；肝阳上亢组左右椎动脉、基底动脉及大脑中动脉Vd均低于对照组（P＜0.05）；肝肾阴虚组左右椎动脉及大脑中动脉Vd均低于对照组（P＜0.05），基底动脉Vd和对照组无差异（P＞0.05）；气血亏虚组左右椎动脉Vd均低于对照组（P＜0.05），基底动脉Vd和对照组无差异（P＞0.05），大脑中动脉Vd均高于对照组（P＜0.05）；不同中医证型组间Vd比较，气血亏虚组＞痰湿中阻组＞肝肾阴虚组＞肝阳上亢组；痰湿中阻组和气血亏虚组左右椎动脉、基底动脉及大脑中动脉PI均低于对照组（P＜0.05）；肝阳上亢组和肝肾阴虚组左右椎动脉、基底动脉及大脑中动脉PI均高于对照组（P＜0.05）；不同中医证型组间PI比较，肝阳上亢组＞肝肾阴虚组＞痰湿中阻组＞气血亏虚组。结论：不同中医证型的眩晕患者会出现不同程度脑动脉血流动力学异常，且不同组间存在差异，通过经颅多普勒超声检查，可以对眩晕中医证型提供参考价值。

Correlation between TCM Syndromes Types of Cervical Vertigo and Detection Results of Transcranial Ultrasound Cerebral Artery Blood Flow

ABSTRACT Objective: To analyze the correlation between TCM syndromes types of cervical vertigo and detection results of transcranial ultrasound cerebral artery blood flow. Methods: Patients with cervical vertigo admitted from May 2021 to May 2023 were selected as the research subjects. According to different TCM syndromes types, they were divided into phlegm-dampness retention group, liver-yang hyperactivity group, liver-kidney yin-deficiency group and qi-blood deficiency group, with 20 cases in each group. 30 patients with healthy physical examination were included in control group, and they were given Doppler ultrasound examination. The Doppler ultrasound features and cerebral artery blood flow changes [peak systolic blood flow velocity (Vs), mean blood flow velocity (Vm), peak diastolic blood flow velocity (Vd) and pulsatility index (PI) of left and right vertebral arteries, basilar artery and left and right middle cerebral arteries were analyzed among patients with different TCM syndromes types and control group. Results: Vs values of left and right vertebral arteries, basilar artery and left and right middle cerebral arteries in phlegm-dampness retention group, liver-kidney yin-deficiency group and qi-blood deficiency group were lower than those in control group(P<0.05). The Vs values of left and right vertebral arteries, basilar artery and left and right middle cerebral arteries in liver-yang hyperactivity group were higher than those in control group (P<0.05). Comparison of Vs among different TCM syndromes types groups was as follows: liver-yang hyperactivity group> phlegm-dampness retention group> liver-kidney yin-deficiency group > qi-blood deficiency group, and the Vs values of left and right vertebral arteries and basilar artery in phlegm-dampness retention group were significantly higher than those in control group (P<0.05) while the Vm values of left right middle cerebral artery were significantly lower(P<0.05). The Vm values of left and right vertebral arteries, basilar artery and left and right middle cerebral arteries were higher in liver-yang hyperactivity group than those in control group (P<0.05), and were lower in liver-kidney yin-deficiency group than those in control group(P<0.05). The Vm values of left and right middle cerebral arteries in qi-blood deficiency group were lower compared with those in control group(P<0.05), and there were no significant differences in Vm values of left and right vertebral arteries and basilar artery compared to control group (P>0.05). Vm comparison of different TCM syndromes types groups was shown as liver-yang hyperactivity group> phlegm-dampness retention group > qi-blood deficiency group > liver-kidney yin-deficiency group. Compared with control group, the Vd values of left and right vertebral arteries and basilar artery in phlegm-dampness retention group were lower (P<0.05) while the Vd values of left and right middle cerebral arteries were higher(P<0.05). The Vd values of left and right vertebral arteries, basilar artery and left and right middle cerebral arteries were lower in liver-yang hyperactivity group than those in control group (P<0.05). The Vd values of left and right vertebral arteries and middle cerebral artery in liver-kidney yin-deficiency group were lower than those in control group (P<0.05), and there was no difference in basilar artery Vd compared to control group(P>0.05). The Vd values of left and right vertebral arteries in qi-blood deficiency group were lower than those in control group (P<0.05), and there was no significant difference in basilar artery Vd compared with that in control group (P>0.05), and the Vd values of left and right middle cerebral arteries were significantly higher than those in control group(P<0.05). Vd in different TCM syndromes types groups was as follows: qi-blood deficiency group > phlegm-dampness retention group> liver-kidney yin-deficiency group > liver-yang hyperactivity group. The PI values of left and right vertebral arteries, basilar artery and left and right middle cerebral arteries in phlegm-dampness retention group and qi-blood deficiency groups were lower than those in control group (P<0.05). The PI values of left and right vertebral arteries, basilar artery and left and right middle cerebral arteries were higher in liver-yang hyperactivity group and liver-kidney yin-deficiency group than those in control group(P<0.05). Comparison of PI in different TCM syndromes types groups was manifested as liver-yang hyperactivity group> liver-kidney yin-deficiency group> phlegm-dampness retention group> qi-blood deficiency group. Conclusion: Patients with vertigo of different TCM syndromes types have different degrees of cerebral arterial hemodynamic abnormalities, and there are differences among different groups. Transcranial Doppler ultrasound examination can provide reference value for the TCM syndromes types of vertigo.