Study On High Risk State Of Pregnancy Based On TCM Clinical Characterization

Research on precursory symptoms of stroke based on Traditional Chinese Medicine clinical manifestation classificationObjective:To study pre-stroke high risk status with measurable clinical symptoms, and to study its syndrome feature and pathological changes. Guided by the principle of " treat the disease before it happens", this study provides method, evidence to stroke prevention and to enhance TCM understanding to the causes and mechanism of stroke.Methods:This research consists of two parts.Part one:A cross-sectional survey collect information such as general condition, susceptibility factors, incentive and TCM clinical manifestations by using "Stroke precursory warning questionnaire"---including retrospective study of 250 acute ischemic stroke cases and 98 high risk cases with recent unstable conditions or with high risk factors in the prospective study. To discuss the clinical manifestation, syndrome factors, syndrome characteristics, development patterns and incentives of the precursory state of stroke.Statistic analysis is done by SPSS17.0 and SPSS Clementine 12.0. Using frequency and percentage to conduct descriptive statistical analysis on qualitative data. Factors in precursory state is extracted by factor analysis, and the syndrome characteristics were categorized by methods of system clustering, K-maens clustering analysis. Syndrome patterns analyzed by single factor and multiplicity with Spearman and Logistic regression methods. Enumeration data data groups (gender, age, season of onset...etc) were compared by chi-square.Part two:Randomly select 30 subects from High stroke risk group and 19 healthy subjects then compare and analyze the lp-PLA2, LPAj level in plasma between two groups, and to harvest hs-CRP and Hcy. The level of lp-PLA2,LPA,hs-CRP in plasma were parallel compared by Wilcoxon rank sum test and t-test. The correlation of indications and indication-symptoms were analyzed Spearman methods to discuss the level of lp-PLA2 and LPA change under high-risk status; and the correlation between stroke pre-warning factor and clinical manifestations.Statistic analysis is done by SPSS 17.0 and SPSS Clementine 12.0. lp-PLA2 level were described by x±s; and LPA level were disbribed by the median and four percentile interval; The level of lp-PLA2 and LPA in plasma were parallel compared by Wilcoxon rank sum test. The correlation of indications and indication-symptoms were analyzed by Pearson and Spearman methods. The correlations across factors such as susceptibility, incentive, unstable symptoms, initial symptoms were analyzed by GRI algorithm.Result:Part one:1.There are 4 syndrome groups stand out in the pre-stroke high risk status; they are Yin deficiency and wind disturbance, mental derangement, phlegm heat and Fu organ excessive, and Wind-phlegm stagnation. They are the key syndrome in pre-stroke status; and they show positive correlation with the onset of stroke.2.The pathological factors in pre-stroke high risk status are:internal wind, phlegm turbid, internal fire, blood stagnation, qi deficiency, yin deficiency; the location of the disease is in the brain and involved with ZangFu organs such as liver, kidney, spleen and heart. The emerge of the precursory syndromes is related to stagnated blood blocking meridians. Mental derangement and phlegm-heat excessive are independent factors that were first established. These are the theory of Mr. Wang Yong Yan, and are the actual manifestations of the pathological hypothesis of the pre-stroke high risk status.3.Pre-stroke high risk syndrome features with excessive secondary symptoms, and the mixture of excessive and deficiency follow by that; few cases of root deficient can be seen. The combination of " wind", "phlegm", "stagnation" and "fire" occupied 65-85%, and "wind" is the most important pathological factor in the onset of stroke. The combination of wind, phlegm and fire are the most important syndrome combination.4.Female, age in 56-65 and 66-75 group, summer and winter has significant influence in certain pre-stroke manifestation. Pre-stroke unstable conditions, such as:frequent headache, eye dryness, bitter taste and dry mouth and drunken gait happens more frequent in female patients than male. Symptoms, susceptibility factors and incentives has positive correlation (eg. Mental and physical overstrain, irritability and uneasiness have combo pattern.).Blood stasis syndrome, fullness in head, foul breath, constipation and fatigue after meal are risk factors of initial symptom factor "Fire. Initial symptom factor " Qi deficiency" has positive correlation with pre-stroke state heart fire syndrome, and with symptoms such as type A behavior, irritability, lethargy, turbid complexion, intermitted numbness or numbness in extremities are risk factors. Symptoms such as irritability, mental overstrain and atrial fibrillation are risk factors of initial symptom factor " Yin deficiency"Part two:1. Rank-sum analysis shows that the level of Lp-PLA2 and LPA in case groups are higher than control group, and the data shows significant statistical difference.2. Frequently symptoms in pre-stroke state such as bitter taste, dry mouth, dry eyes, blurred vision, drowsiness, sudden dizziness and hung up shows connection with microscopic index.3.Rise of LPA, hsCRPshows connection with symptoms in "Wind" syndrome; such as sudden loss of balance while walking, temporary dizziness, transient symptoms, intermitted numbness or numbness in extremities; rise in HCY shows connection with symptoms in " Deficient heat" syndrome, such as insomnia, lethargy, blurred vision.Conclusion:1. Yin deficiency and wind disturbance, Phlegm heat and Fu organ excessive and mental derangement can appear by single or combo among stroke high-risk patients and could be used as early-warning signals of stroke.2.Early warning factor LPA with TCM factors in 1 shows consistency and could be used as a early-warning of stroke.3.Pre-stroke high risk status and stroke has same pathological base; that are wind, fire, phlegm, stagnation and deficiency.4."Poison damaging brain meridian" is the core pathological factor of pre-stroke high risk status, and internal wind is the initial mechanism in the onset of stroke.Innovation points:1.Guided by analogical thinking to discuss pre-stroke high risk status pathological factors, mechanism and syndrome differentiation.2.Discuss the syndrome characteristics and pathophysiology base of the high-risk pre-stroke state.