Study On The Effect Of Traditional Chinese Medicine On The Recurrence Of Ischemic Stroke

Objective:Firstly, to systematically evaluate the effect of Tradi-tional Chinese Medicine (TCM) on the recurrence of ischemic stroke; Secondly, to review the Risk factors of ischemic stroke recurrence; Finally, our study basing on the TCM syndrome elements, is intend to discuss the availability of risk predictive model of ischemic stroke recurrence by survival analysis.Methods:Firstly, we search the CBM, CNKI, Wan fang, CENTRAL, PubMed and WoS. Randomized controlled trials (RCTs) treating acute ischemic stroke by TCM were collected. Secondly, review the Risk factors of ischemic stroke recurrence reported in the latest journals. Finally, we analyze the relationship between the TCM Syndrome elements and the long-term outcome of ischemic stroke inpatients by survival anal-ysis. SPSS 20.0 is used as the data statistics software.Results:9180 publications were retrieved by search strategy and a total of 14 RCTs were included. According to the Meta analysis, patients with recurrent ischemic stroke are less than the control group. Statistical difference existed between the TCM group and con-trol group. The occurrence frequencies of blood stasis syndrome and phlegm syndrome were higher than other TCM Syndrome elements. TCM treatments of invigorating the circulation of blood, Qi, phlegm could reduce the recurrence rate ischemic stroke. Risk factor for ischemic stroke recurrence is presently clear and the study on the risk factor of ischemic stroke is comparatively mature. We need more research focusing on the relationship between the TCM syndrome elements and the long-term risk of recurrent ischemic stroke.246 patients are collected in our clinical study,211 cases have completed the follow-up work by the end of December 2014, and the dropout rate was 14.2%. The follow-up time was from 5 days to 8.6 years. Take no relapse time as outcome variable, influencing factors of relapse are:Multiple sites of inf arct ion (X,), Oral decoction in acute stage(X2), Occurrence of phlegm syndrome 14 days after stroke (X3). Then build the risk model as below:h(t)=h0 (t) exp (1.598X1-0.818X2+1.501X3). In Subgroup analysis, influencing factors of relapse in patients with a NIHSS score bellow 4 points are:Multiple sites of infarction(X1), Oral decoction in acute stage(X2), Acupuncture therapy in acute stage (X3). Then build the risk model as below:h (t)=h0 (t) exp (1.499X1-0.581X2-0.938X3). In-fluencing factors of relapse in patients with a NIHSS score more than or equal to 4 points are:History of drinking (X1), Oral decoction in acute stage (X2), Occurrence of phlegm syndrome 14 days after stroke(X3). Then build the risk model as below:h0 (t) exp (-1.833X1-0.451X2+2.874X3).Conclusion:Treatments of TCM might reduce the incidence of secondary stroke. Furthermore, to reveal the advantage of TCM in treating is-chemic stroke, we should improve the design of RCTs and pay more attention to the long-term follow-up results. The evolution of syn-drome elements is an important factor affecting the recurrence of ischemic.The appearance of phlegm syndrome in acute stage is suggested to be an risk factor for recurrence in patients, so we should pay more attention to the identification of phlegm syndrome and the applica-tion of resolving phlegm in the early stage.