糖尿病脑卒中与非糖尿病脑卒中的中医证候特点对照研究
摘要
中风病具有起病急、病情重、变化快的特点,因此,准确动态地评价病情尤为重要。西医常以成熟公认的量表作为客观评价神经功能缺损的指标,针对证候诊断特异性及敏感性高的特点,中医界广泛使用的《中风病辨证诊断标准》通过采集望闻问切四诊信息,对风、火、痰、瘀、气虚、阴虚阳亢六个证候进行评分,从整体观念出发,判断疾病的病因病机。中风病是消渴病的并发症之一,消渴病是中风病重要且独立的危险因素之一,随着中风病、消渴病发病率的增高,目前对消渴病合并中风患者的证类分布及证候规律演变尚缺少多中心、大样本的临床观察。
目的：初步探索消渴病中风与非消渴病中风急性期的证类分布情况、证候要素演变规律及其与西医量表、理化检查等方面的相关关系。
方法：前瞻研究2009年10月～2010年2月东方医院住院的中风病急性期患者88例,以公认的糖尿病诊断标准分为糖尿病组与非糖尿病组,对其入院当天、发病第7天、14天、28天四个时点的中医证候要素、美国国立卫生研究院卒中量表(NIHSS)、日常生活活动能力量表(ADL)进行评分,并收集其理化检查等相关资料,使用SPSS13.0软件进行统计分析。
结果：①证类诊断分析：两组证类分布无显著性差异。频数分布图显示风痰火亢证、风火上扰证分布为多,糖尿病组阴虚风动证分布高于非糖尿病组。
②证候要素分析：阴虚风动证在发病第7天、14天、28天的频数分布上有显著性差异,证候要素分值的变化仅在发病第28天有显著性差异。发病第28天痰证的频数分布有显著性差异。风证在两组四个时点的证候频数分布及分值变化上均有显著差异,痰证在糖尿病组四个时点的证候频数分布变化上有显著差异,血瘀证在两组的四个时点的证候要素分值变化上有显著差异。
③西医量表：非糖尿病组入院当天的NIHSS评分与发病第28天分值相比较有显著差异,糖尿病组四个时点的NIHSS评分无显著性差异。糖尿病组火热证证候要素分值在发病第7天、14天时与NIHSS分值呈线性相关且痰证、气虚证分值在发病第14天时与NIHSS分值呈线性相关。非糖尿病组风证及火热证三个时点的证候要素分值与NIHSS呈线性相关,且气虚证分值在入院当天与NIHSS分值呈线性相关。
④理化检查：入院当天、发病第7天的火热证及发病第28天的阴虚阳亢证证候要素分值与空腹血糖呈线性相关。糖尿病组脑干作为责任病灶,发病率高于非糖尿病组,且有显著性差异。
结论：发病第28天的两组阴虚风动证证候要素频数分布及分值均有显著差异,非糖尿病组入院当天的NIHSS评分与发病第28天分值相比较有显著差异,糖尿病组脑干作为责任病灶,其发病率高于非糖尿病组,且有显著性差异。
Stroke features with acute onset, severe condition and rapid change, therefore, the accurate and dynamic evaluation of condition are particularly important. Western medicine often clinically uses the recognized and mature scale as the guideline to objectively evaluate the default of neurological function, for the diagnosis of syndrome characterized by high specificity and sensitivity in traditional Chinese medicine," diagnostic criteria of stroke syndrome," in which the six syndromes such as the wind, fire, phlegm, blood stasis, qi deficiency,and yin deficiency with yang hyperactivity are evaluated by collected the information about the four diagnostic methods (inspection, listening and smelling examination, inquiry, palpation), from the overall concept, determines the pathogenesis and reason of disease, which is widely used in the traditional Chinese medicine in China. Stroke is a complication of Diabetes, with stroke the incidence of Diabetes is increased, the incidence of combined Diabetes and strokeis also increased, in recent years some literatures have presented the concept of "Diabetes Stroke". Rightnow, the type and regularity of Diabetestroke in Chinese Medicine are still lack of systematic researches, and it is still uncertain whether the syndrome elements has any relationship with those aspects such as the degree of neurological deficit, blood glucose and blood lipids,etc.
Object:Discuss the frequency distribution and dynamic changes of scores of acute syndrome elements of Diabetes stroke and non-diabetes stroke, as well as the relationship between those syndrome elements and the degree of neurological deficit, blood glucose, and lipids,etc.
Methods:Prospective study on 88 patients of acute stroke in Eastern hospital from October 2009 to February 2010. According to "Guide of Prevention and Treatment of type 2 diabetes in China", the diabetic group and non-diabetic group were divided, collected the related information such as the TCM syndrome evaluated scores on the day of admission,7 days after onset,14 days after onset,28 days after onset to evaluate, as well as the information about fasting blood glucose, blood lipids, and imaging, etc, and then which would be evaluated by the U.S. National Institutes of Health Stroke Scale (NIHSS), routine life activity scale (ADL), Rankin Scale revised (MRS),using the SPSS 13.0 software for statistical analysis.
Results:①syndrome diagnosis:the syndrome type distribution of diabetic group and non-diabetic group was mainly consist of the wind phlegm with excessive fire and the mental confusion causing by wind fire, the frequency distribution of the stirring of wind due to deficiency of YIN in diabetes group was higher than non-diabetic group's. However, the distribution of those seven syndrome types had no significant difference.
②Analysises of syndrome elements:the frequency distribution of stirring of wind due to deficiency of YIN on 7 days after onset,14 days after onset,28 days after onset were significantly different, but only on 28 days after onset the scores of syndrome elements would be significantly different. The frequency distribution of phlegm would have significant difference on 28 days after onset. The frequency distribution and scores of wind syndrome in both groups would have significant difference on those four periods, the frequency distribution of phlegm syndrome in the diabetes group would have significant difference on those four periods,the scores of syndrome elements of blood stasis syndrome in both groups would have significant difference on those four periods.
③Western scale:comparing the evaluated score of NIHSS on the day of admission and 28 days after onset in non-diabetic group, the significant different would be found, while the NIHSS scores of those four periods in diabetic had no significant difference. The element score of hot syndrome in diabetic group have linearly correlated with the NIHSS score on 7 days after onset and 14 days after onset, while the element score of phlegm and qi deficiency syndrome have linearly correlated with the NIHSS score on 14 days after onset.The element scores of wind syndrome and hot syndrome in non-diabetic group have linearly correlated with the NIHSS score on three periods, while the score of qi deficiency syndrome have linearly correlated with the NIHSS score on the day of admission.
④Physical and chemical examination:the elemet scores of hot syndrome on the admission day and 7 days after onset, as well as the yin deficiency with yang hyperactivity on 28 days after onset, have linearly corralated with fasting blood glucose, the brainstem was the the responsibe lesion in diabetes group, whose incidence rate was higher than non-diabetic group's, and there was significant difference.
Conclusion:The element frequency distribution and scores of the stirring of wind due to deficiency of YIN in both groups were significant different on 28 days after onset, the score of the NIHSS on the day of admission was sinigicant different to the score of 28 days after onset in non-diabetic group, the brainstem was the the responsibe lesion in diabetes group, whose incidence rate was higher than non-diabetic group's, and there was significant difference.
目的：初步探索消渴病中风与非消渴病中风急性期的证类分布情况、证候要素演变规律及其与西医量表、理化检查等方面的相关关系。
方法：前瞻研究2009年10月～2010年2月东方医院住院的中风病急性期患者88例,以公认的糖尿病诊断标准分为糖尿病组与非糖尿病组,对其入院当天、发病第7天、14天、28天四个时点的中医证候要素、美国国立卫生研究院卒中量表(NIHSS)、日常生活活动能力量表(ADL)进行评分,并收集其理化检查等相关资料,使用SPSS13.0软件进行统计分析。
结果：①证类诊断分析：两组证类分布无显著性差异。频数分布图显示风痰火亢证、风火上扰证分布为多,糖尿病组阴虚风动证分布高于非糖尿病组。
②证候要素分析：阴虚风动证在发病第7天、14天、28天的频数分布上有显著性差异,证候要素分值的变化仅在发病第28天有显著性差异。发病第28天痰证的频数分布有显著性差异。风证在两组四个时点的证候频数分布及分值变化上均有显著差异,痰证在糖尿病组四个时点的证候频数分布变化上有显著差异,血瘀证在两组的四个时点的证候要素分值变化上有显著差异。
③西医量表：非糖尿病组入院当天的NIHSS评分与发病第28天分值相比较有显著差异,糖尿病组四个时点的NIHSS评分无显著性差异。糖尿病组火热证证候要素分值在发病第7天、14天时与NIHSS分值呈线性相关且痰证、气虚证分值在发病第14天时与NIHSS分值呈线性相关。非糖尿病组风证及火热证三个时点的证候要素分值与NIHSS呈线性相关,且气虚证分值在入院当天与NIHSS分值呈线性相关。
④理化检查：入院当天、发病第7天的火热证及发病第28天的阴虚阳亢证证候要素分值与空腹血糖呈线性相关。糖尿病组脑干作为责任病灶,发病率高于非糖尿病组,且有显著性差异。
结论：发病第28天的两组阴虚风动证证候要素频数分布及分值均有显著差异,非糖尿病组入院当天的NIHSS评分与发病第28天分值相比较有显著差异,糖尿病组脑干作为责任病灶,其发病率高于非糖尿病组,且有显著性差异。
Stroke features with acute onset, severe condition and rapid change, therefore, the accurate and dynamic evaluation of condition are particularly important. Western medicine often clinically uses the recognized and mature scale as the guideline to objectively evaluate the default of neurological function, for the diagnosis of syndrome characterized by high specificity and sensitivity in traditional Chinese medicine," diagnostic criteria of stroke syndrome," in which the six syndromes such as the wind, fire, phlegm, blood stasis, qi deficiency,and yin deficiency with yang hyperactivity are evaluated by collected the information about the four diagnostic methods (inspection, listening and smelling examination, inquiry, palpation), from the overall concept, determines the pathogenesis and reason of disease, which is widely used in the traditional Chinese medicine in China. Stroke is a complication of Diabetes, with stroke the incidence of Diabetes is increased, the incidence of combined Diabetes and strokeis also increased, in recent years some literatures have presented the concept of "Diabetes Stroke". Rightnow, the type and regularity of Diabetestroke in Chinese Medicine are still lack of systematic researches, and it is still uncertain whether the syndrome elements has any relationship with those aspects such as the degree of neurological deficit, blood glucose and blood lipids,etc.
Object:Discuss the frequency distribution and dynamic changes of scores of acute syndrome elements of Diabetes stroke and non-diabetes stroke, as well as the relationship between those syndrome elements and the degree of neurological deficit, blood glucose, and lipids,etc.
Methods:Prospective study on 88 patients of acute stroke in Eastern hospital from October 2009 to February 2010. According to "Guide of Prevention and Treatment of type 2 diabetes in China", the diabetic group and non-diabetic group were divided, collected the related information such as the TCM syndrome evaluated scores on the day of admission,7 days after onset,14 days after onset,28 days after onset to evaluate, as well as the information about fasting blood glucose, blood lipids, and imaging, etc, and then which would be evaluated by the U.S. National Institutes of Health Stroke Scale (NIHSS), routine life activity scale (ADL), Rankin Scale revised (MRS),using the SPSS 13.0 software for statistical analysis.
Results:①syndrome diagnosis:the syndrome type distribution of diabetic group and non-diabetic group was mainly consist of the wind phlegm with excessive fire and the mental confusion causing by wind fire, the frequency distribution of the stirring of wind due to deficiency of YIN in diabetes group was higher than non-diabetic group's. However, the distribution of those seven syndrome types had no significant difference.
②Analysises of syndrome elements:the frequency distribution of stirring of wind due to deficiency of YIN on 7 days after onset,14 days after onset,28 days after onset were significantly different, but only on 28 days after onset the scores of syndrome elements would be significantly different. The frequency distribution of phlegm would have significant difference on 28 days after onset. The frequency distribution and scores of wind syndrome in both groups would have significant difference on those four periods, the frequency distribution of phlegm syndrome in the diabetes group would have significant difference on those four periods,the scores of syndrome elements of blood stasis syndrome in both groups would have significant difference on those four periods.
③Western scale:comparing the evaluated score of NIHSS on the day of admission and 28 days after onset in non-diabetic group, the significant different would be found, while the NIHSS scores of those four periods in diabetic had no significant difference. The element score of hot syndrome in diabetic group have linearly correlated with the NIHSS score on 7 days after onset and 14 days after onset, while the element score of phlegm and qi deficiency syndrome have linearly correlated with the NIHSS score on 14 days after onset.The element scores of wind syndrome and hot syndrome in non-diabetic group have linearly correlated with the NIHSS score on three periods, while the score of qi deficiency syndrome have linearly correlated with the NIHSS score on the day of admission.
④Physical and chemical examination:the elemet scores of hot syndrome on the admission day and 7 days after onset, as well as the yin deficiency with yang hyperactivity on 28 days after onset, have linearly corralated with fasting blood glucose, the brainstem was the the responsibe lesion in diabetes group, whose incidence rate was higher than non-diabetic group's, and there was significant difference.
Conclusion:The element frequency distribution and scores of the stirring of wind due to deficiency of YIN in both groups were significant different on 28 days after onset, the score of the NIHSS on the day of admission was sinigicant different to the score of 28 days after onset in non-diabetic group, the brainstem was the the responsibe lesion in diabetes group, whose incidence rate was higher than non-diabetic group's, and there was significant difference.
引文
[1]王永炎,刘炳林.中风病研究进展述评[J].湖南中医药学报,1998,1(4).
[2]王永炎.关于提高脑血管疾病疗效难点的思考[J].中国中西医结合杂志,1997,17(2)：195-196.
[3]田金洲,时晶,倪敬年.脑梗塞患者颈动脉斑块与血瘀证的相关性研究[J].中华中医药杂志,2007,22(3)：150-152.
[4]韩新民,毛惠明.缺血性脑卒中血瘀证患者不同病期血浆t-PA、PAI活性及其比值临床观察[J].中西医结合杂志,1991,11(1)：17-19.
[5]丁元庆,卢尚岭调气为主治疗急性中风经验[J].山东中医药大学学报,2000,24(1)：43-45.
[6]周仲瑛.出血性中风(瘀热阻窍证)证治的研究[J].中医药学刊,2002.20(6)：709-711
[7]陈可冀,宋军.病证结合的临床研究是中西医结合研究的重要模式[J].世界科学技术-中医药现代化,2006.8(2)：1-4.
[8]汪学军,陈孝银.缺血性脑血管病的中医研究基础-病证结合的动物模型[J].辽宁 中医杂志,2005.32(10)：1097-1099.
[9]田金洲,王永炎,时晶.证候的概念及其属性[J].北京中医药大学学报,2005,28(5)：6-8
[10]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996.19(1)：55-56.
[11]中华人民共和国中医药行业标准.中医病证诊断疗效标准.国家中医药管理局,1994：24-25.
[12]张聪,高颖.《中风病辩证诊断标准》应用现状存在问题及对策[J].天津中医药,2007,24(1)：12-15.
[13]杨利,黄燕等.1418例中风患者痰、瘀证候分布和演变规律探析[J].辽宁中医杂志,2004,31(6)：459-460.
[14]王顺道,杜梦华,解庆凡等.中风病急性期证候演变规律的研究[J].中国中医急症,1996,5(3)：121.
[15]王顺道,任占利等.中风病始发态证候发生与组合规律的临床研究[J].中国医药学报,1996,11(3)：17-19.
[16]王建华.出血性中风、缺血性中风急性期证候演变规律的研究[J].中国中医急症,2001,10(4)：215-217.
[17]梁伟雄,赖世隆,刘茂才等.中风病中医证候与相关因素的分析[J].广州中医药大学学报,1999,16(2)：81-84.
[18]秦骥.不同年龄组缺血性中风患者证候分布规律分析[J].河南中医,2007,27(12)：37-38.
[19]余学庆,李建生,庆慧.中风病证候影响因素的研究[J].新中医,2003,35(11)：20-22.
[20]司维,刘红梅等.中风病证候与相关因素的研究[J].中西医结合心脑血管病杂志,2007,5(6)：488-490.
[21]谌剑飞,关少侠,马雅玲等.急性脑梗死始发状态证候量值与神经内分泌免疫网络功能指标水平的相关性探讨[J].中国中西医结合急救杂志,2002,9(2)：81-83.
[22]孙文军,田金洲等.C反应蛋白与急性缺血性脑卒中血瘀证的相关性研究[J].北京中医药[J].2008,27(5)：328-330.
[23]黄粤,高颖,马斌.缺血性中风急性期生物学指标与病证关系研究思路初探[J].吉林中医药[J],2009,29(1)：15-17.
[1]张薇薇.重视血糖管理,完善卒中治疗[J].中国卒中杂志,2009,4(2)91-95.
[2]Goldstein LB, Jones MR, Matcher DB, et al. Improving the reliability of stroke subgroup classification using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST)criteria[J]. Stroke,2001,32(5):1091—1098.
[3]吴丽娥,刘鸣.缺血性脑卒中TOAST病因分型一致性分析[J].疑难病杂志,2006,5(2)：89-91.
[4]Dong Zhao, Jing Liu, et al. Epidemiological Transition of Stroke in China Twenty-One-Year Observational Study from the Sino-MONICA-Beijing Project. Stroke,2008,39:1668-1674.
[5]Bin Jiang, Wen-zhi Wang, et al. Incidence and Trends of Stroke and Its Subtypes in China:Results from Three Large Cities. Stroke,2006,37:63-65.
[6]王拥军.分层观念贯穿卒中防治始终.中国卒中杂志[J],2009,4(1)：10-12.
[7]American Heart Association prevention Conference IV:prevention and rehabilitation of stroke. Circulation,1997,96:701-707.
[8]Myzoon Ali, Sari Atula, et al. Stroke Outcome in Clinical Trial Patients Deriving From Different Countries. Stroke,2009,40:35-40.
[9]黄久仪,洪震等.我国四城市40岁以上样本人群脑卒中危险因素现况[J].中国慢性病预防与控制,2007,15(5)：416-418.
[10]Salina P. Waddy, et al. Racial Differences in Vascular Risk Factors and Outcomes of Patients with Intracranial Atherosclerotic Arterial Steno sis. Stroke 2009,40:719-725
[11]Kjell Asplund, Juha Karvanen, et al. Relative Risks for Stroke by Age, Sex, and Population Based on Follow-Up of 18 European Populations in the MORGAM Project. Stroke,2009,40:2319-2326.
[12]茹晓娟,王文志等.社区人群高血压类型与脑卒中发病关系研究[J].山东医药,2009,49(36)：6-8.
[13]Antonio Coca, Franz H. Messerli, et al. Predicting Stroke Risk in Hypertensive Patients With Coronary Artery Disease A Report From the INVEST. Stroke,2008,39:343-348.
[14]Staessen JA. Fagard R, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension: the Systolic Hypertension in Europe. Trial Investigators,1997.
[15]Wolf PA, Abbott RD, et al. Atria fibrillation as an independent risk factor for stoke. Stroke,1991,22:983—988.
[16]Gaede P, Vedel P, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med.2003,348:383-393.
[17]Colhoun HM, Betteridge DJ.et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study.Lancet,2004,364:685-696.
[18]Zhang X,Patel A,et al.Asia Pacific Cohort Studies Collaboration Cholesterol. Int Epidemiol,2003,32:563-572.
[19]Larry Goldstein,Robert Adams, et al. Primary Prevention of Ischemic Stroke. Stroke,2006,37:1583-1633.
[20]Amarenco P, Goldstein LB, Szarek M, et al. Effects of intense low density lipoprotein cholesterol reduction in patients with stroke or transient ischemic attack:the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Stroke,2007,38:3198—3204.
[21]饶明俐,王文志等.中国脑血管病防治指南.人民卫生出版社,2007： 10.
[22]Mackey AE, Abahamowicz M, et al. Outcome of asymptomatic patients with carotid disease.Neurology,1997,48:896-903.
[23]张茁,张薇薇等.缺血性卒中二级预防循证医学证据.人民卫生出版社,2007：128-134.
[24]Kurtz T, Kase CS, et al. Smoking and risk of hemorrhagic stroke in woman. Stroke,2003,34:2792-2795.
[25]Amytis Towfighi, Bruce Ovbiagele. The Impact of Body Mass Index on Mortality After Stroke. Stroke,2009,40:2704-2708.
[26]Bazzano LA,Serdula MK, et al. Dietary intake of fruit and vegetables and the risk of cardiovascular disease. Current Atherosclerotic Rep,2003,5:492-499.
[27]Tobian L, Lange JM, et al. Potassium prevents death from strokes in hypertensive rats without lowering blood pressure. J Hypertens,1984,2:363-366.
[28]陈金水,陈光辉[译].镰状细胞病患者卒中的预防和治疗.国外医学内科学分册,2003,30(1)：44.
[29]曲东锋,倪长江.第11届欧洲卒中会议概述.国外医学脑血管疾病分册,2002,10：476.
[30]Meiklejohn DJ,Vickers MA,et al. Plasma homocysteine concentration in the acute and convalescent periods of atherothrombotic stroke. Stroke, 2002,33(1)459-461.
[31]Schwartz SM, Siscovick DS, et al. USe of low-dose oral contraceptives and stroke in young women. Intern Med,1997,127(8):596-603.
[32]Janardhan V, Wolf PA, et al. Anticardiolipin antibodies and risk of ischemic stroke and transient ischemic attack:the Framingham cohort and offspring study. Stroke,2004,35:736-741.
[33]Fan J,Watanabe T. Inflammatory reactions in the pathogenesis of atherosclerosis.J Atheroscler Thromb,2003,10(2):63-71.
[34]Ridker P, Hennekens C,et al. C-reactive protein and other makers of inflammation in the prediction of cardiovascular disease in woman.N Engl J Med,2000,342:836-843.
[35]Espinola Klein C, Rupprecht HJ. Impact of infectious burden on progression of carotid atherosclerosis.Stroke,2002,33:2581-2586.
[36]Marie Softeland Sandvei, Pal Richard Romundstad, et al. Risk Factors for Aneurysmal Subarachnoid Hemorrhage in a Prospective Population Study:The HUNT Study in Norway. Stroke 2009;40; 1958-1962.
[37]黄久仪,王桂清.缺血性与出血性脑卒中危险因素及血流动力学指标的比较[J].上海医学,2006,29(11)：813-815.
[38]刘新峰,徐格林.急性缺血性与出血性卒中危险因素的对比研究[J].中华神经科杂志,2005,38(7)：421-424.
[39]崔丽英,陈琳.淀粉样变性脑血管病.神经内科疑难病诊断,中国协和医科大学出版社,2008.2：6.
[1]蒋国彦,等.实用糖尿病学(第1版 北京).人民卫生出版社,1992：241.
[2]王洗.糖尿病性脑血管病[J].天津医科大学学报,2002,8(2)：274-276.
[3]张茁,张薇薇.缺血性卒中二级预防循证医学证据.人民卫生出版社,2007：106.
[4]张斌,向红丁,等.北京、上海、天津、重庆四城市住院2型糖尿病患者糖尿病慢性并发症及相关大血管疾病的流行病学分析[J].中国医学科学院学报,2002,24(5)：452
[5]糖尿病合并急性脑血管病的中医诊疗方案.消渴病第五届学术研讨会论文集：124-126.
[6]杨晓辉.消渴病与中风-附84例临床分析[J].中国中医急症,1996,5(1)：25-27.
[7]张成.重视脑血管病的遗传学研究[J].中华经科杂志,1999,32(5)：262.
[8]王铭维.糖尿病与脑血管病.第三届全国老年内分泌代谢系统疾病学术会议：10-14.
[9]Stehouwer C, Lambert J, et al. Endothelial dysfunction and pathogenesis of diabetic angiopathy. Cardiovascular Research, 1997,34:55.
[10]赵晓红,蒋绍军.胰岛素抵抗与缺血性脑卒中大小血管病变的研究[J].中西医结合心脑血管病杂志,2008,11(6)：1298-1301.
[11]闫明,张敬秋.糖尿病性脑血管病的发病机制.消渴病第五届学术研讨会论文集：128-132.
[12]张薇薇.重视血糖管理,完善卒中治疗[J].中国卒中杂志,2009,4(2)91-95.
[13]周炯,王百辰.糖尿病性脑血管病流行病学与发病机理研究进展[J].浙江医学,2005,27(12)：955-958.
[14]黄海波,赵雪春.糖尿病性脑血管病发病机制研究的最新进展[J].内科,2007,3(2)：407-410.
[15]龙丹.糖尿病性脑血管病危险因素及预防研究现状[J].中国实用医药,2009,9(4)：227-229.
[16]张曼云.老年糖尿病性脑血管病58例临床分析[J].实用老年医学,1995,9(6)：274-276.
[17]吴茂红,吕志中.糖尿病性脑血管病易患因素分析[J].实用心脑肺血管杂志,2002,10(2)：84-86.
[18]许燕.糖尿病性脑血管病203例临床分析[J].临床医学,1999,19(5)：37-39.
[1]中华医学会全国第四届脑血管病学术会议.各类脑血管病疾病诊断要点.中华神经科杂志,1996,29(6)：379.
[2]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2007).中华医学杂志,2008,88(18)：1227-1230.
[3]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行).北京中医药大学学报,1996,19(1)： 55-56.
[4]国家中医药管理局脑病急症科研组.中风病辨证诊断标准(试行).北京中医药大学学报,1994,17(3)：64-66.
[5]谌剑飞,马雅玲等.急性脑梗死患者血浆内皮素胰岛激素水平及与中医证候量值的关系研究[J].中国中西医结合急救杂志,2002,9(2)：108-110.
[2]王永炎.关于提高脑血管疾病疗效难点的思考[J].中国中西医结合杂志,1997,17(2)：195-196.
[3]田金洲,时晶,倪敬年.脑梗塞患者颈动脉斑块与血瘀证的相关性研究[J].中华中医药杂志,2007,22(3)：150-152.
[4]韩新民,毛惠明.缺血性脑卒中血瘀证患者不同病期血浆t-PA、PAI活性及其比值临床观察[J].中西医结合杂志,1991,11(1)：17-19.
[5]丁元庆,卢尚岭调气为主治疗急性中风经验[J].山东中医药大学学报,2000,24(1)：43-45.
[6]周仲瑛.出血性中风(瘀热阻窍证)证治的研究[J].中医药学刊,2002.20(6)：709-711
[7]陈可冀,宋军.病证结合的临床研究是中西医结合研究的重要模式[J].世界科学技术-中医药现代化,2006.8(2)：1-4.
[8]汪学军,陈孝银.缺血性脑血管病的中医研究基础-病证结合的动物模型[J].辽宁 中医杂志,2005.32(10)：1097-1099.
[9]田金洲,王永炎,时晶.证候的概念及其属性[J].北京中医药大学学报,2005,28(5)：6-8
[10]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996.19(1)：55-56.
[11]中华人民共和国中医药行业标准.中医病证诊断疗效标准.国家中医药管理局,1994：24-25.
[12]张聪,高颖.《中风病辩证诊断标准》应用现状存在问题及对策[J].天津中医药,2007,24(1)：12-15.
[13]杨利,黄燕等.1418例中风患者痰、瘀证候分布和演变规律探析[J].辽宁中医杂志,2004,31(6)：459-460.
[14]王顺道,杜梦华,解庆凡等.中风病急性期证候演变规律的研究[J].中国中医急症,1996,5(3)：121.
[15]王顺道,任占利等.中风病始发态证候发生与组合规律的临床研究[J].中国医药学报,1996,11(3)：17-19.
[16]王建华.出血性中风、缺血性中风急性期证候演变规律的研究[J].中国中医急症,2001,10(4)：215-217.
[17]梁伟雄,赖世隆,刘茂才等.中风病中医证候与相关因素的分析[J].广州中医药大学学报,1999,16(2)：81-84.
[18]秦骥.不同年龄组缺血性中风患者证候分布规律分析[J].河南中医,2007,27(12)：37-38.
[19]余学庆,李建生,庆慧.中风病证候影响因素的研究[J].新中医,2003,35(11)：20-22.
[20]司维,刘红梅等.中风病证候与相关因素的研究[J].中西医结合心脑血管病杂志,2007,5(6)：488-490.
[21]谌剑飞,关少侠,马雅玲等.急性脑梗死始发状态证候量值与神经内分泌免疫网络功能指标水平的相关性探讨[J].中国中西医结合急救杂志,2002,9(2)：81-83.
[22]孙文军,田金洲等.C反应蛋白与急性缺血性脑卒中血瘀证的相关性研究[J].北京中医药[J].2008,27(5)：328-330.
[23]黄粤,高颖,马斌.缺血性中风急性期生物学指标与病证关系研究思路初探[J].吉林中医药[J],2009,29(1)：15-17.
[1]张薇薇.重视血糖管理,完善卒中治疗[J].中国卒中杂志,2009,4(2)91-95.
[2]Goldstein LB, Jones MR, Matcher DB, et al. Improving the reliability of stroke subgroup classification using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST)criteria[J]. Stroke,2001,32(5):1091—1098.
[3]吴丽娥,刘鸣.缺血性脑卒中TOAST病因分型一致性分析[J].疑难病杂志,2006,5(2)：89-91.
[4]Dong Zhao, Jing Liu, et al. Epidemiological Transition of Stroke in China Twenty-One-Year Observational Study from the Sino-MONICA-Beijing Project. Stroke,2008,39:1668-1674.
[5]Bin Jiang, Wen-zhi Wang, et al. Incidence and Trends of Stroke and Its Subtypes in China:Results from Three Large Cities. Stroke,2006,37:63-65.
[6]王拥军.分层观念贯穿卒中防治始终.中国卒中杂志[J],2009,4(1)：10-12.
[7]American Heart Association prevention Conference IV:prevention and rehabilitation of stroke. Circulation,1997,96:701-707.
[8]Myzoon Ali, Sari Atula, et al. Stroke Outcome in Clinical Trial Patients Deriving From Different Countries. Stroke,2009,40:35-40.
[9]黄久仪,洪震等.我国四城市40岁以上样本人群脑卒中危险因素现况[J].中国慢性病预防与控制,2007,15(5)：416-418.
[10]Salina P. Waddy, et al. Racial Differences in Vascular Risk Factors and Outcomes of Patients with Intracranial Atherosclerotic Arterial Steno sis. Stroke 2009,40:719-725
[11]Kjell Asplund, Juha Karvanen, et al. Relative Risks for Stroke by Age, Sex, and Population Based on Follow-Up of 18 European Populations in the MORGAM Project. Stroke,2009,40:2319-2326.
[12]茹晓娟,王文志等.社区人群高血压类型与脑卒中发病关系研究[J].山东医药,2009,49(36)：6-8.
[13]Antonio Coca, Franz H. Messerli, et al. Predicting Stroke Risk in Hypertensive Patients With Coronary Artery Disease A Report From the INVEST. Stroke,2008,39:343-348.
[14]Staessen JA. Fagard R, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension: the Systolic Hypertension in Europe. Trial Investigators,1997.
[15]Wolf PA, Abbott RD, et al. Atria fibrillation as an independent risk factor for stoke. Stroke,1991,22:983—988.
[16]Gaede P, Vedel P, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med.2003,348:383-393.
[17]Colhoun HM, Betteridge DJ.et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study.Lancet,2004,364:685-696.
[18]Zhang X,Patel A,et al.Asia Pacific Cohort Studies Collaboration Cholesterol. Int Epidemiol,2003,32:563-572.
[19]Larry Goldstein,Robert Adams, et al. Primary Prevention of Ischemic Stroke. Stroke,2006,37:1583-1633.
[20]Amarenco P, Goldstein LB, Szarek M, et al. Effects of intense low density lipoprotein cholesterol reduction in patients with stroke or transient ischemic attack:the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Stroke,2007,38:3198—3204.
[21]饶明俐,王文志等.中国脑血管病防治指南.人民卫生出版社,2007： 10.
[22]Mackey AE, Abahamowicz M, et al. Outcome of asymptomatic patients with carotid disease.Neurology,1997,48:896-903.
[23]张茁,张薇薇等.缺血性卒中二级预防循证医学证据.人民卫生出版社,2007：128-134.
[24]Kurtz T, Kase CS, et al. Smoking and risk of hemorrhagic stroke in woman. Stroke,2003,34:2792-2795.
[25]Amytis Towfighi, Bruce Ovbiagele. The Impact of Body Mass Index on Mortality After Stroke. Stroke,2009,40:2704-2708.
[26]Bazzano LA,Serdula MK, et al. Dietary intake of fruit and vegetables and the risk of cardiovascular disease. Current Atherosclerotic Rep,2003,5:492-499.
[27]Tobian L, Lange JM, et al. Potassium prevents death from strokes in hypertensive rats without lowering blood pressure. J Hypertens,1984,2:363-366.
[28]陈金水,陈光辉[译].镰状细胞病患者卒中的预防和治疗.国外医学内科学分册,2003,30(1)：44.
[29]曲东锋,倪长江.第11届欧洲卒中会议概述.国外医学脑血管疾病分册,2002,10：476.
[30]Meiklejohn DJ,Vickers MA,et al. Plasma homocysteine concentration in the acute and convalescent periods of atherothrombotic stroke. Stroke, 2002,33(1)459-461.
[31]Schwartz SM, Siscovick DS, et al. USe of low-dose oral contraceptives and stroke in young women. Intern Med,1997,127(8):596-603.
[32]Janardhan V, Wolf PA, et al. Anticardiolipin antibodies and risk of ischemic stroke and transient ischemic attack:the Framingham cohort and offspring study. Stroke,2004,35:736-741.
[33]Fan J,Watanabe T. Inflammatory reactions in the pathogenesis of atherosclerosis.J Atheroscler Thromb,2003,10(2):63-71.
[34]Ridker P, Hennekens C,et al. C-reactive protein and other makers of inflammation in the prediction of cardiovascular disease in woman.N Engl J Med,2000,342:836-843.
[35]Espinola Klein C, Rupprecht HJ. Impact of infectious burden on progression of carotid atherosclerosis.Stroke,2002,33:2581-2586.
[36]Marie Softeland Sandvei, Pal Richard Romundstad, et al. Risk Factors for Aneurysmal Subarachnoid Hemorrhage in a Prospective Population Study:The HUNT Study in Norway. Stroke 2009;40; 1958-1962.
[37]黄久仪,王桂清.缺血性与出血性脑卒中危险因素及血流动力学指标的比较[J].上海医学,2006,29(11)：813-815.
[38]刘新峰,徐格林.急性缺血性与出血性卒中危险因素的对比研究[J].中华神经科杂志,2005,38(7)：421-424.
[39]崔丽英,陈琳.淀粉样变性脑血管病.神经内科疑难病诊断,中国协和医科大学出版社,2008.2：6.
[1]蒋国彦,等.实用糖尿病学(第1版 北京).人民卫生出版社,1992：241.
[2]王洗.糖尿病性脑血管病[J].天津医科大学学报,2002,8(2)：274-276.
[3]张茁,张薇薇.缺血性卒中二级预防循证医学证据.人民卫生出版社,2007：106.
[4]张斌,向红丁,等.北京、上海、天津、重庆四城市住院2型糖尿病患者糖尿病慢性并发症及相关大血管疾病的流行病学分析[J].中国医学科学院学报,2002,24(5)：452
[5]糖尿病合并急性脑血管病的中医诊疗方案.消渴病第五届学术研讨会论文集：124-126.
[6]杨晓辉.消渴病与中风-附84例临床分析[J].中国中医急症,1996,5(1)：25-27.
[7]张成.重视脑血管病的遗传学研究[J].中华经科杂志,1999,32(5)：262.
[8]王铭维.糖尿病与脑血管病.第三届全国老年内分泌代谢系统疾病学术会议：10-14.
[9]Stehouwer C, Lambert J, et al. Endothelial dysfunction and pathogenesis of diabetic angiopathy. Cardiovascular Research, 1997,34:55.
[10]赵晓红,蒋绍军.胰岛素抵抗与缺血性脑卒中大小血管病变的研究[J].中西医结合心脑血管病杂志,2008,11(6)：1298-1301.
[11]闫明,张敬秋.糖尿病性脑血管病的发病机制.消渴病第五届学术研讨会论文集：128-132.
[12]张薇薇.重视血糖管理,完善卒中治疗[J].中国卒中杂志,2009,4(2)91-95.
[13]周炯,王百辰.糖尿病性脑血管病流行病学与发病机理研究进展[J].浙江医学,2005,27(12)：955-958.
[14]黄海波,赵雪春.糖尿病性脑血管病发病机制研究的最新进展[J].内科,2007,3(2)：407-410.
[15]龙丹.糖尿病性脑血管病危险因素及预防研究现状[J].中国实用医药,2009,9(4)：227-229.
[16]张曼云.老年糖尿病性脑血管病58例临床分析[J].实用老年医学,1995,9(6)：274-276.
[17]吴茂红,吕志中.糖尿病性脑血管病易患因素分析[J].实用心脑肺血管杂志,2002,10(2)：84-86.
[18]许燕.糖尿病性脑血管病203例临床分析[J].临床医学,1999,19(5)：37-39.
[1]中华医学会全国第四届脑血管病学术会议.各类脑血管病疾病诊断要点.中华神经科杂志,1996,29(6)：379.
[2]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2007).中华医学杂志,2008,88(18)：1227-1230.
[3]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行).北京中医药大学学报,1996,19(1)： 55-56.
[4]国家中医药管理局脑病急症科研组.中风病辨证诊断标准(试行).北京中医药大学学报,1994,17(3)：64-66.
[5]谌剑飞,马雅玲等.急性脑梗死患者血浆内皮素胰岛激素水平及与中医证候量值的关系研究[J].中国中西医结合急救杂志,2002,9(2)：108-110.