Study On The Risk Of Ischemic Stroke Recurrence Based On The Evolution Of Tradition Chinese Medicine Syndrome

Objectives The objective is to screen the factors influencing the recurrence of stroke through one-year prospective observation and explore the risk model of ischemic stroke recurrence based on the characteristics of Traditional Chinese Medicine(TCM)syndrome elements.Methods In this paper,we used the prospective study method and followed up one year to collect data of patients with acute ischemic stroke in neurology department of Shijiazhuang TCM Hospital.These data include various TCM symptoms of patients,especially the factors that may affect the recurrence of stroke.We applied survival analysis to these data,screened a variety of possible factors,studied their impact on the recurrence of ischemic stroke,and tried to establish a recurrence risk model.Results 1 According to clinical manifestations,imaging examination,onset age and time,363 patients were included in the acute stage of ischemic stroke,of which 40 recurred,and the recurrence rate was 11.0 %.Including 228 male patients,135 female patients,1.69:1male and female ratio,average age 63.3±9.0 years(36 to 80 years old),included in the NHISS score average(4.21±3.81)points.In terms of the syndrome distribution of stroke,the highest proportion of acute syndromes appeared,followed by phlegm syndrome and blood stasis syndrome,and yin and Yang syndrome.During the recovery period of stroke,phlegm syndrome,blood stasis syndrome,and Qi deficiency syndrome were ranked among the top three syndromes.In the stroke sequelae,Gas deficiency syndrome has become the main factor of syndrome,and phlegm syndrome and blood stasis syndrome persist.In the evolution of stroke symptoms,wind syndrome changes most significantly in the early stages,and the probability of occurrence decreases significantly with time.The second is the hot card,with the progress of time,the hot card gradually disappeared;What followed was the gradual appearance of QI deficiency syndrome and Yin deficiency syndrome,and Qi deficiency syndrome was the most significant in the sequelae period;Phlegm syndrome and blood stasis syndrome as the main syndrome throughout the onset of stroke.2 The single factor Kaplan-Meier survival analysis showed that: the recurrence risk of atherosclerotic infarction is higher than that of arterioocclusive infarction(P=0.002);The recurrence risk of multiple infarction is higher than that of single site infarction(P=0.021);The risk of recurrence of acute oral decoction is lower than that of oral treatment(P=0.001);The risk of relapse was higher in convalescent patients(P=0.000).The recurrence risk of the recovery period was higher than that of the patients who did not appear(P=0.000).The risk of relapse in patients with symptoms of sequelae is higher than that of patients without symptoms(P=0.008);The risk of recurrence is higher in patients with sequelae(P=0.002).3 Multi-factor Cox regression model analysis shows that: In the recovery period of stroke,the recurrence risk of atherosclerotic cerebral infarction is 2.56 times that of small artery occluded cerebral infarction;The risk of relapse in the recovery period is 2.35 times that of patients who have not appeared,2.94 times that of patients who have not appeared during the recovery period,and 34.7 % of patients who have not used the soup treatment.The recovery regression model is h(t)=h0(t)*exp(0.943*pathogenesis-1.059*decoction+0.855*wind syndrome+1.0779*Yin deficiency)The recurrence risk of multiple site infarction during stroke sequela is single site of 2.94 times,the appearance of wind symptoms in sequelae was 6.45 times that of patients who did not appear,and the appearance of blood stasis in sequelae was 4.15 times that of patients who did not appear,and the risk of recurrence in the treatment of decoction was 35.0 % of unused patients.The regression model for sequelae was h(t)=h0(t)*exp(1.079*infarction-1.051*decoction+ 1.865*wind syndrome+1.425*blood stasis).Conclusions 1 Disease type,the appearance of wind symptoms during the recovery period,and the appearance of Yin symptoms during the recovery period are the risk factors for relapse during the recovery period of ischemic stroke.Oral decoction is a protective factor 2 The appearance of wind syndrome in infarction,sequelae,and blood stasis in sequelae is a risk factor for recurrence of ischemic stroke sequelae.Oral decoction is a protective factor for recurrence.3 The establishment of recurrence risk models in different periods is helpful for providing a good reference basis for prognosis judgment of patients and for guiding clinical intervention measures combined with risk factors of syndromic evolution in different periods.4 The application of acute Chinese medicine decoction can reduce the recurrence rate,but it is still necessary to further observe the relationship between the length of application of Chinese medicine decoction and the long-term prognosis.Figure9;Table12;Reference 137.