Study On The Clinical Risk Factors And TCM Syndrome Characteristics Of Stroke-associated Pneumonia

Objective:Based on previous studies,we validated the early clinical risk factors for Stroke-Associated Pneumonia(SAP)and explored the high-frequency symptoms and symptoms of SAP based on the Chinese medicine system of diagnosis and treatment,deepened the understanding of the etiology and pathogenesis of SAP,and improved the clinical recognition of SAP and the early warning ability of poor stroke prognosis under the guidance of the theory of treating the disease.Method: The study is divided into two parts.Part One: We collected information from 205 patients with acute ischaemic stroke using a uniform observational tool and conducted a prospective survey.Collection of basic patient demographic data and basic case information(personal history,past history,family history,comorbid conditions and the Modified Rankin Scale(m RS));Routine blood indicators and TCM symptoms on admission and at the time of SAP;Swallowing Function Screening Scale and National Institutes of Health Stroke Scale(NIHSS);Patients information was collected and entered into CRF forms to create an electronic database.The chi-square test and non-parametric test were used to compare the two groups of indicators;Spearman correlation analysis and Kendall correlation analysis were used to explore the association between risk factors(age,NLR,NIHSS,dysphagia)and the occurrence of SAP as uncovered in the previous cohort study;Using Multifactorial logistic to analyse whether the risk factors(age,Neutrophil-to-Lymphocyte Ratio(NLR)value,NIHSS score,dysphagia condition)uncovered in the previous cohort study could also be used as independent risk factors for the development of SAP in the current cohort.Part Two: A uniform observational tool,the CRF scale,was used to capture the TCM symptoms of SAP patients at presentation.The 38 patients with SAP included in the previous cohort study and the 34 patients with SAP included in the current study cohort were combined.Qualitative information is described by frequencies and percentages;Factor analysis(principal component extraction)was used to extract the evidence elements of high frequency symptoms;Generalisation of symptom clusters by systematic clustering;Analytical mining of correlations between high frequency symptoms and between symptoms within symptom clusters using the association rule Apriori algorithm.To explore the clinical symptoms,symptomatic features and etiological mechanisms of high risk SAP.Result:Part One: 1 Analysis of variability in basic patient information: There was no statistical difference in the gender distribution,past history,family history and personal history between the two groups(P>0.05);24 Patients(70.6%)had a non-first stroke in the SAP group and 64patients(37.4%)had a non-first stroke in the non-SAP group,with a statistical difference in the non-first stroke status between the two groups(P<0.0001);The m RS score was 2(0-3)in the SAP group and 0(0-2)in the non-SAP group,with a statistical difference in the m RS score between the two groups(P<0.0001);There was a difference in the complication profile between the two groups(P<0.0001),with 28(82.4%)patients in the SAP group and 38(22.2%)patients in the non-SAP group having dysphagia.There was a statistical difference in the presence or absence of dysphagia between the two groups(P < 0.0001).2 Analysis of variability in patients’ laboratory indicators: Patients in the SAP group had NLR values of 3.6(2.45-4.83)and patients in the non-SAP group had NLR values of 2.242(2.0-3.63),with a statistical difference between the two groups(P < 0.05).3 Relevance analysis: NLR values,NIHSS scores,dysphagia and dysphagia grade were significantly different from SAP occurrence in both groups(P< 0.01),with dysphagia having a moderate correlation with SAP occurrence(correlation coefficient > 0.4)and NLR values,NIHSS scores and dysphagia grade weakly correlating with SAP occurrence(correlation coefficient < 0.4).4 Multi-factor Logistic Analysis: The risk factors of SAP is NIHSS score(OR=1.167,95%CI 1.039-1031,P<0.001),NLR value(OR=1.326,95%CI 1.021-1.722,P<0.05)and dysphagia condition(OR=16.583,95%CI 5.670-48.500,P<0.0001).5 Validation of the results of the previous cohort study: The risk factors of SAP are NLR,NIHSS score and dysphagia,the same as the results of the previous cohort study;age and dysphagia grade were not risk factors for SAP,unlike the results of the previous cohort study,where the difference in age distribution between the two groups was not statistically significant,the correlation between dysphagia grade and the development of SAP was weak,and multi-factor logistic regression analysis showed no statistically significant effect of dysphagia grade on the development of SAP.Part Two: 1 Frequency statistics of the number of symptoms in SAP patients at the time of admission: The minimum number of symptoms present was 7 with a frequency of 2 and the maximum number was 14 with a frequency of 11.All patients presented with multiple symptoms at the same time,with the majority presenting with 12-16 symptoms.2 Frequency statistics for each symptom of SAP patients at admission: The top 15 symptoms were weakness,stringent pulse,white face,acute onset within the last 48 h,fatigue,purple or dark tongue,muffled speech,slippery pulse,purple or dark red lips,greasy coating,dullness,worsening or fluctuating disease within the last 48 h,indifferent or few words,dry stools,coughing or phlegm in the throat.3 Cluster analysis of symptoms: The clustering results highlight five main clusters of symptoms,The first group of symptoms of Yin deficiency and fire(thirst without desire to drink,night sweats,thin and thin tongue,acid swallowing,red or reddish tongue,red face,thirst for cold drinks,yellow and red urine,dry tongue,red tongue without moss,heat in the heart of the hands and feet,dry mouth,restlessness,disturbed heart,hot and bothered heart,coughing phlegm or phlegm in the throat,dry stool,string pulse,bitter mouth,bad breath);The second group of symptoms of phlegm and stagnation(yellow phlegm,obesity,sticky mouth,spontaneous sweating,strong limbs,fat tongue,tongue with teeth marks,thick moss,varicose veins under the tongue,slippery moss,heavy head,petechiae and bruises on the tongue,blue veins under the tongue,dull or sallow complexion);The third group of symptoms of internal movement of liver wind(dry moss,astringent pulse,trembling of the hands,feet or jaws,convulsions,dizziness,thin pulse,restrained limbs,yellow moss,pain with a definite location,knotted or substituted pulse,pale tongue,sunken pulse,acute onset within the last 48 h,aggravation or fluctuation within the last 48 h,shortened tongue);The fourth group of symptoms of Qi deficiency and dampness(yellowish complexion,dullness,loose stools,hard stools at first and then loose stools,incontinence of stools or urine,counted pulse,dullness and pain in the head,weakness,whispering,swelling of the hands or feet,slow pulse,indifferent expression or little speech,dullness,toil,breathing difficulties);Group 5manifestations of Qi deficiency and blood stasis(dry and cracked skin,slippery pulse,purple or dark red lips,purple or dark tongue,white face,greasy moss,eyes deviating from transient,pale white lips).4 Rules for association of symptoms:(1)The explanatory power of the extracted common factors for the original variables is strong and representative,with the minimum degree of explanation being 50.3% and the maximum degree of explanation being 78.1%;(2)There are six common factors with eigenvalues > 1.The proportion of variance explained by the first factor is 15,444%,the second factor is 11.532%,the third factor is 10.626%,the fourth factor is 9.621%,the fifth factor is 9.621%,and the sixth factor is 9.312%.The cumulative contribution of the first six factors is 66.16%,and the minimum eigenvalue is1.072,indicating that the information contained in these six communal factors provides a good response to the original variables;(3)Common factor F1 is Qi deficiency and blood stasis,common factor F2 is Qi deficiency,common factor F3 is wind-phlegm stasis,common factor F4 is phlegm-heat interconnection,common factor F5 is phlegm-fire,and common factor F6 is wind-phlegm obstruction(correlation coefficient > 0.3).Conclusion1 In this study cohort,there were statistically significant differences in non-first stroke,m Rs score,NLR,NIHSS score,comorbidity status,dysphagia status and dysphagia grade between the two groups.NLR,NIHSS score,dysphagia status and dysphagia grade were correlated with the development of SAP.Among them,NIHSS score and NLR values were positively correlated with the risk of developing SAP,and the risk of developing SAP was increased when accompanied by dysphagia.Validating the results of the previous cohort study,it was concluded that NIHSS score,NLR and dysphagia were independent risk factors for the development of SAP and had early warning value in both cohorts,and that age was not a risk factor for the development of SAP.2 Patients with SAP often had a mixture of multiple symptoms on admission(7-14),with most patients presenting with 12-16 symptoms;High frequency symptoms before the onset of SAP were weakness,stringent pulse,white face,acute onset within the last 48 h,fatigue,purple or dark tongue,whispering voice,slippery pulse,purple or dark red lips,greasy moss,dullness,worsening or fluctuating condition within the last 48 h,indifferent expression or few words,and most of the symptoms were clearly correlated with each other;The high-risk symptom groups of SAP patients were Yin-deficiency and fire symptoms,Phlegm-stasis obstruction,Qi-deficiency and dampness,Liver-wind internal movement,Qi-deficiency and blood stasis,among which the symptoms of Yin-deficiency and fire symptoms,dampness and Qi-deficiency symptoms,and Qi-deficiency and blood stasis symptoms had a very close correlation pattern;The high-risk factors before the onset of SAP patients were the pathological factors before the onset of SAP include Qi deficiency,blood stasis,dampness-phlegm,internal fire and internal wind.This indicates that SAP is not caused by a single pathological factor,but is the result of the interaction of multiple pathological factors.