| ObjectiveThis thesis establishes a classification model between TCM constitution distribution and age,gender,educational level,medical history,risk factors and test indicators of patients diagnosed with subjective cognitive decline(SCD)and mild cognitive impairment(MCI).The relationship between different physiques and various observation indicators in patients with SCD and MCI will be identified.The research results will find reasonable prevention suggestions for SCD,and provide new diagnostic ideas for clinical syndrome differentiation and treatment of SCD and MCI groups,and strive to provide a more optimized treatment plan for the patient group to lay the foundation,so as to reflect the advantages of traditional Chinese medicine "preventive treatment".MethodsGeneral data collection:By adopting the method of retrospective observational studies,collect data of patients who are aged 45 or above and complaining of memory loss and having completed cognitive function tests(including MMSE,MoCA evaluation)from Integrative Dept.1,(Geriatric Dept.Neurology),University Town Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine from January,2018 to June,2021,select 221 patients whose MMSE scores are≥27 and divide those with MocA≥26 into SCD group and those with MoCA<26 into MCI group,and set up a complete constitution including gender,age,level of education and medical history(hypertension,coronary heart disease,diabetes,hyperuraemic acid syndrome,hyperhomocysteinemia,history of general anesthesia,cerebral artery stenosis,carotid artery plaque,obstructive sleep apnea,smoking,alcoholism,significant hearing loss,anxiety or depression).Collect patients’ general information and screen out test results of total cholesterol(TC),Triglyceride(TG)High density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),High sensitivity C-reactive protein(HS-CRP),high homocysteine(HCY),Thyroid-stimulating hormone(TSH).Based on the above information,further refine data of patients with ApoE genotyping test and finally have 221 patients with complete data,among whom 131 have completed ApoE genotyping test.Statistical analysis:The collected data are sorted and checked,Excel database is established,and SPSS 26.0 statistical software is used for statistical analysis.Two sets of data(SCD:MoCA≥26,MCI:MoCA<26)are tested for normality using Shapiro-Wilktest.The measurement data did not conform to normal distribution,so the median M(P25,P75)is used for statistical description.Differences between the two groups are analyzed by Mann-Whitney U rank sum test.Enumeration data are expressed as frequency and percentage,and Chi-square test is used to compare the differences between the two sets of data.The variables(P<0.05)with statistical differences between the two groups are screened out,which are used as independent variable,whether MoCA score is<26 is used as the dependent variable,binary logistic regression analysis is used to screen the related factors affecting MoCA score<26.P<0.05 indicates the differences are statistically significant.Evaluation indicators:Both groups’distribution of TCM constitutions and the relationship between gender,age,level of education,medical history,Hcy,TG,TC,HDL-C,LDL-C,CRP,TSH,HbAlc,UA and ApoE genotyping.Results1.Data of 221 patients are collected in this study,including 109 males(49.3%)and 112 females(50.7%).There are 71 patients with SCD,including 37 males and 34 females,with an average age of 69.3 years and average years of education of 12.54 years.There are 150 patients with MCI,including 72 males and 78 females,with an average age of 75.59 years and an average length of education of 9.77 years.Chi-squared test shows that there is statistic difference(P<0.05)in age(P<0.001),education level(P=0.001),hypertension(P=0.029),diabetes(P=0.042)and cerebral artery stenosis(P=0.001)between SCD group and MCI group.There is no statistic difference in gender,coronary heart disease,hyperuricemia,hyperhomocysteinemia,history of surgical general anesthesia,carotid plaque,obstructive sleep apnea,smoking,alcoholism,significant hearing loss,and anxiety or depression.After substituting age,education level,hypertension,diabetes,and cerebral artery stenosis into the binary logistic regression equation,the chi-square test results show that cerebral artery stenosis(P=0.004,OR=4.705)had statistic difference compared with other factors.Average CRP and HbAlc are above reference range in all patients.Using chi-square test to compare the proportion of normal figures of the two indicators in the SCD group and the MCI group,the results show that there is no statistical difference between the proportion of normal figures of CRP and HbAlc in the SCD group and the MCI group.Taking the gerontic age 65 as a boundary line and using chi-square test to compare the proportion of normal figures of the two indicators in the group whose members are aged≥65 and the group whose members are aged<65,the results suggest that there is no statistical difference between the proportion of normal figures of CRP and HbA1c in the two groups,namely there is no statistical difference between middle-aged and elderly groups.2.131 patients are tested for ApoE.Of these,34 are with SCD and 97 are with MCI.In the SCD group,4 persons are ApoE-ε2/ε3,accounting for 11.76%of the total number;1 person is ApoE-ε2/ε4,accounting for 2.94%of the total number;21 persons are ApoE-ε3/ε3,accounting for 61.76%of the total number;and 8 persons are ApoE-ε3/ε4,accounting for 23.53%of the total number.In the MCI group,1 person is ApoE-ε2/ε2,accounting for 1.03%of the total number;13 persons are ApoE-ε2/ε3)accounting for 13.40%of the total number;60 persons are ApoE-ε3/ε3,accounting for 61.86%of the total number;23 persons are ApoE-ε3/ε4,accounting for 20.62%of the total number;3 persons are ApoE-ε4/ε4,accounting for 3.09%of the total number.3.In the distribution law of TCM Constitution of subjects with SCD,Qi deficiency accounts for the highest proportion(26.76%),followed by phlegm dampness(22.54%),blood stasis(14.08%),Yang deficiency(9.86%)and Yin deficiency(8.45%);In the distribution law of TCM Constitution in patients with MCI,Qi deficiency accounts for the highest proportion(28.67%),followed by blood stasis(28.00%),phlegmy wet mass(12.05%),Yin deficiency(11.33%)and Yang deficiency(8.67%).In patients with SCD and MCI,Qi deficiency,blood stasis,phlegm dampness,Yin deficiency and Yang deficiency take up the five largest body types.The proportion of blood stasis constitution in MCI patients is higher than that of SCD patients.Using chi-square test to compare the proportion of patients with empirical constitution(phlegm dampness,damp heat constitution,blood stasis and Qi-stagnation)and patients with deficiency syndrome constitution(Qi deficiency,Yang deficiency and Yin deficiency)in the SCD group and the MCI group,the results show that there is no statistical difference between the two groups.Taking the gerontic age 65 as a boundary line and using chi-square test to compare the proportion of patients with with deficiency syndrome constitution(Qi deficiency,Yang deficiency and Yin deficiency)in the group whose members are aged≥65 and the group whose members are aged<65,the results indicate that there is no statistical difference between the two groups.4.As for medical history,compared with SCD group,in the MCI group,Qi deficiency patients’ constituent ratio of cases increases:hypertension(30 persons,69.77%),diabetes(14 persons,32.56%),cerebral artery stenosis(13 persons,30.23%),carotid artery plaque(34 persons,79.07%),anxiety or depression(7 persons,16.28%).Yin deficiency patients’constituent ratio of cases increases:hypertension(12 persons,70.59%),coronary heart disease(7 persons,41.18%),hyperhomocysteinemia(2 persons,11.76%),history of general anesthesia(8 persons,47.06%),cerebral artery stenosis(7 persons,41.18%),carotid artery plaque(12 persons,70.59%),smoking(4 persons,23.53%),alcoholism(2 persons,11.76%),significant hearing loss(1 person,5.88%),anxiety or depression(4 persons,23.53%).Yang deficiency patients’ constituent ratio of cases increases:hyperuricemia(3 persons,26.08%),hyperhomocysteinemia(2 persons,15.38%),history of general anesthesia(5 persons,38.46%),carotid artery plaque(13 persons,100%),significant hearing loss(2 persons,15.38%),anxiety or depression(2 persons,15.38%).Blood stasis patients’ constituent ratio of cases increases:hypertension(29 persons,69.05%),coronary heart disease(9 persons,21.43%),diabetes(14 persons,33.33%),hyperhomocysteinemia(3 persons,7.14%),cerebral artery stenosis(13 persons,30.95%),carotid artery plaque(34 persons,80.95%),smoking(10 persons,23.81%),significant hearing loss(6 persons,14.29%),anxiety or depression(8 persons,19.05%).Phlegm dampness patients’ constituent ratio of cases increases:hypertension(11 persons,61.11%),diabetes(6 persons,33.33%),hyperhomocysteinemia(1 person,5.56%),history of general anesthesia(8 persons,44.44%),cerebral artery stenosis(3 persons,16.67%),obstructive sleep apnea(3 persons,16.67%),smoking(5 persons,27.78%),alcoholism(2 persons,11.11%),significant hearing loss(1 person,5.56%),anxiety or depression(3 persons,16.67%).Qi-stagnation constitution patients’constituent ratio of cases increases:hypertension(4 persons,80.00%),coronary heart disease(1 person,20.00%),hyperhomocysteinemia(1 person,20.00%),history of general anesthesia(2 persons,40.00%),cerebral artery stenosis(1 person,20.00%),carotid artery plaque(4 persons,80.00%),smoking(1 person,20.00%).Damp heat constitution patients’ constituent ratio of cases increases:coronary heart disease(1 person,14.29%),hyperhomocysteinemia(4 persons,57.14%),history of general anesthesia(3 persons,42.86%),cerebral artery stenosis(2 persons,28.57%),carotid artery plaque(5 persons,71.43%).5.As for test indicators,compared with the SCD group,in the MCI group,Qi deficiency patients’proportion of normal range decreases:Hcy(36 persons,83.72%),TC(32persons,74.42%),HDL-C(16persons,37.21%),LDL-C(33persons,76.74%),CRP(28persons,65.12%),HbAlc(23persons,53.49%).Yin deficiency patients’ proportion of normal range decreases:TG(11 persons,64.71%),TC(15 persons,88.24%),LDL-C(13 persons,76.47%),CRP(7 persons,41.18%),TSH(5 persons,83.33%),HbAlc(8 persons,47.06%),UA male(6 persons,35.29%),UA female(4 persons,23.53%).Yang deficiency patients’ proportion of normal range decreases:Hcy(9 persons,69.23%),HDL-C(7 persons,53.85%),CRP(8 persons,61.54%),TSH(11 persons,84.62%),HbA1c(7 persons,53.85%),UA female(7 persons,53.85%).Blood stasis patients’ proportion of normal range decreases:TSH(34 persons,80.95%),HbAlc(24 persons,57.14%),UA female(13 persons,30.95%).Phlegm dampness patients’ proportion of normal range decreases:Hcy(15 persons,83.33%),TG(10 persons,55.56%),TC(11 persons,61.11%),LDL-C(12 persons,66.67%),CRP(6 persons,33.33%),TSH(14 persons,77.78%).Qi depression patients’proportion of normal range decreases:Hcy(4 persons,80.00%),CRP(2 persons,20.00%).Damp heat patients’proportion of normal range decreases:Hcy(4 persons,57.14%),TG(5 persons,71.43%),HDL-C(2 persons,28.57%),LDL-C(5 persons,71.43%),TSH(6 persons,85.71%),UA male(2 persons,28.57%).Conclusion1.Qi deficiency,blood stasis and phlegm dampness are the top three types of constitutions among patients with cognitive impairment.The proportion of phlegm dampness is higher than that of blood stasis in the constitutions of SCD patients;the proportion of blood stasis is higher than that of phlegm dampness in the constitutions of CI patients.2.There is a trend of proportion convergence in the proportions of empirical constitutions and deficiency syndrome constitutions in middle and elderly aged groups with cognitive impairment.Constitution of bias takes up the largest proportion in middle and elderly aged groups with cognitive impairment.The proportion of presenting constitution of bias in CI patients is higher than that of SCD patients.3.As the course of disease develop from SCD phase to CI phase,diabetes,hypertension and cerebral artery stenosis show an upward trend,which is especially typical for cerebral artery stenosis.4.The degrees of severity of cognitive impairment diseases generally show a positive correlation trend with age and have a negative correlation with years of education.The indicators of CRP and HbAlc are relatively high in middle and elderly aged patients cognitive decline.5.The proportions of the high risk genes ApoE-ε3/ε4 and ApoE-ε4/ε4 are similar in SCD patients and CI patients. |
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