| ObjectsTo initially establish the rules for TCM main syndromes of post-stroke cognitive impairment, investigate characteristics of TCM main syndromes of post-stroke cognitive impairment, and lay a foundation for further study on diagnosis scale for TCM syndrome of post-stroke cognitive impairment.Methods1 The research group developed the questionaire. Researchers were trained in the same standard to collect information. Cases of post-stroke cognitive impairment were selected from multi-centers, including hospitals in Beijing, Shandong, Hebei, Changchun, Xiamen and so on.3000 cases were finally included in the study. Further more, the cases were divided into a group without cognitive impairment (Group 01,1496 cases), a group with mild cognitive impairment (Group 02,873 cases) and a group with mild dementia (Group 03,631 cases) according to the level of cognitive dysfunction.2 A data management plantform was established based on Browser/Server architecture. The data management plantform has the functions of data input, data output, data check and data management. Statistics was processed by SPSS21.0 and Matlab Software plantform. Factor analysis and MCL data mining model was separately constructed to extract syndrome factors by unsupervised clustering analysis method, fulfilling four diagnostic information dimension reduction. Based on the outcome that correlation degree between syndrome factors by mutual information computed, syndromes were established. A transition was completed from single flexible syndrome factors to stable complex syndromes. Under the guide of syndrome standard research, a concept of scale production was introduced to objectively carry out quantitative main syndromes research with post-stroke cognitive impairment. Combined the comparison of subjective, objective, subjective and objective combination model in the process of items selection, empowerment, threshold, the optimal diagnosis model was selected from the final outcome. Marking criterion of main syndromes with post-stroke cognitive impairment was established. On the basis of it, distribution characteristics of mian syndromes were analysed, as well as correlation analysis.Results1 Factor analysis and MCL model extracted 6 syndrome factors:qi deficiency, yin deficiency, phlegm, blood stasis, yang deficiency, fire. The comprehensive analysis showed that the empirical syndrome factor qi deficiency was of 20.0%, yin deficiency was of 19.3%. The empirical syndrome factor yin deficiency was of 19.1%, phlegm was of 18.6% in mild cognitive impairment group (Group 02). The empirical syndrome factor qi deficiency was of 22.2%, yin deficiency was of 19.5% in mild dementia group (Group 03). Deficiency syndrome was of 54.7%. The location of disease mainly with kidney and liver, spleen involved.2 After the correlation analysis between 6 syndrome factors above,7 main syndromes were combined:qi deficiency and blood stasis syndrome, phlegm obstruction and blood stasis syndrome, kidney deficiency and blood stasis syndrome, yin deficiency and fire syndrome, yang deficiency in spleen and kidney syndrome, yang deficiency and phlegm obstruction syndrome, yin deficiency and phlegm obstruction syndrome.5 main syndromes were extracted because of the frequency more than 10%:qi deficiency and blood stasis syndrome, yang deficiency in spleen and kidney syndrome, phlegm obstruction and blood stasis syndrome, yin deficiency and fire syndrome, kidney deficiency and blood stasis syndrome.3 Combined the comparison of subjective, objective, subjective and objective combination model in the process of empowerment, threshold computing, AUC of all three models was more than 0.89. Meanwhile,0.5 was not contained in 95% confidence interval and P=0.000<0.05, Ho hypothesis was rejected, the results above had significant statistical difference computed by ROC curve. AUC was compared among three models in 5 main syndromes. Then subjective and objective combination model was selected as the best quantitative research model. Marking criterion of main syndromes with post-stroke cognitive impairment was established by it in the process of empowerment, threshold. Retrospective validation showed that the accuracy, sensitivity and specificity of the marking criterion was between 86.8%-96.6%,85.1%-91.0% and 87.2%-97.7%.4 In general population, the highest proportion of qi deficiency and blood stasis syndrome was 25.3%, followed by yin deficiency and fire syndrome and phlegm obstruction and blood stasis syndrome, which proportion was 17.8%,17.0%. Significant differences can be found in comparison between different groups of detection rates in main syndromes, except yang deficiency in spleen and kidney syndrome. Mild dementia group (Group 03) was significantly higher than mild cognitive impairment group (Group 02) (P<0.01).5 The total scores in MoCA and MMSE tests of patients with main syndromes were significantly negatively correlated with disease progression (P<0.01). The correlation coefficient of yin deficiency and fire syndrome was the hightest one. In general population, the total scores in MoCA and MMSE tests of patients with qi deficiency and blood stasis syndrome, phlegm obstruction and blood stasis syndrome, yang deficiency in spleen and kidney syndrome, were significantly negatively correlated with age progression (P<0.01). The correlation coefficients of kidney deficiency and blood stasis syndrome and phlegm obstruction and blood stasis syndrome were the hightest ones. In mild cognitive impairment group (Group 02), the total scores in MMSE tests of patients with yang deficiency in spleen and kidney syndrome were significantly negatively correlated with age progression (P<0.05). In mild dementia group (Group 03), the total scores in MoCA tests of patients with phlegm obstruction and blood stasis syndrome were significantly negatively correlated with age progression (P<0.05).Conclusions1 The major syndrome factors of post-stroke cognitive impairment are qi deficiency, yin deficiency, phlegm, blood stasis, yang deficiency, fire. The diseased region is kidney, liver and spleen. In mild cognitive impairment group, the empirical syndrome factor is yin deficiency, which is followed by phlegm. In mild dementia group, the empirical syndrome factor is qi deficiency, which is followed by yin deficiency.2 Related syndrome factors are combined into 5 main syndromes:qi deficiency and blood stasis, yang deficiency in spleen and kidney, phlegm obstruction and blood stasis, yin deficiency and fire, kidney deficiency and blood stasis. Detection rate of qi deficiency and blood stasis syndrome was the highest one, which is followed by yin deficiency and fire syndrome and phlegm obstruction and blood stasis syndrome.3 The rules for TCM main syndromes of post-stroke cognitive impairment are established by subjective and objective combination model, which also lay a foundation for further study on diagnosis scale for TCM syndrome of post-stroke cognitive impairment.4 Cognitive function of patients with main syndromes is significantly correlated with disease and age progression. The feature of cognitive impairment between mild cognitive impairment group and mild dementia group is different. |
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