| Background:Stroke is the second cause of death and the first cause of disability in the world.Ischemic stroke,the most common type of stroke,accounts for 60%to 80%of the total number of stroke patients.According to reports,the recurrence rate of ischemic stroke within 1 year is about 17.7%,the case fatality rate is 5%to 15%,and the disability rate is 50%.Especially the recurrent ischemic stroke and subsequent vascular events cause stroke patients.The greatest harm is to bring serious economic burden and mental stress to the society and the family.Despite the standard treatments that are harmonized according to the medical guidelines for cerebrovascular disease,many patients have ischemic events.Analysis of the reasons may be due to differences in individual trends leading to disease progression.Therefore,predicting the risk of early recurrence of ischemic stroke according to different predictive scales and dialectical treatment can minimize the risk of recurrent ischemic stroke.The Essen Stroke Risk Score(ESRS),widely used in Europe and the United States,is a simple tool for predicting the risk of non-cardiac ischemic stroke recurrence.However,considering the original design of ESRS scores,it is based on the physiological characteristics and epidemiology of Westerners.There are many differences with the physiological characteristics and constitution of Chinese people,especially the lack of individualized TCM constitutions and TCM syndromes with Chinese characteristics.Factors,resulting in limited predictive validity.Different TCM constitutions have certain effects on the occurrence,development and outcome of human diseases,and the physical fitness of people in different regions has its own unique susceptibility.The TCM syndrome also affects the risk stratification of recurrent ischemic stroke.Due to the complex and variable incidence of ischemic stroke,the syndromes are intricate and complicated,which leads to the inaccuracy of TCM constitution type and TCM syndrome type,and it is difficult to reach the level of precision medicine.Therefore,in the early stage of the study,through the collation and analysis of the literature on the constitution and syndrome type of ischemic stroke,the relationship between TCM constitution,syndrome type and ischemic stroke occurrence,development and prognosis was comprehensively understood.Based on the above literature,This study intends to select 803 patients with ischemic stroke in Lingnan area to analyze the distribution of different constitution types and TCM syndromes in patients with ischemic stroke in Lingnan area and its correlation with compound endpoint events,in order to clarify different constitution types and Chinese medicine practitioners.The relationship between syndrome type and ischemic stroke recurrence and outcome;explore the predictive value of ESSEN score and its combination of different constitution types and TCM syndrome scales for ischemic stroke composite endpoints,with a view to excavation An ischemic stroke recurrence risk prediction model(ESRS-TCM)with clinical features of TCM.This thesis is divided into two parts:The first part:literature research and systematic evaluation of the relationship between TCM constitution,TCM syndrome and ischemic stroke;The second part:Different TCM syndrome types of ischemic stroke,TCM constitutional characteristics and Its relevance to the composite endpoint event.Objective:Systematic evaluation of the distribution of TCM constitution and TCM syndrome type in ischemic stroke,in order to understand the relationship between TCM constitution classification,TCM syndrome type and ischemic stroke occurrence,development and prognosis with TCM elements,The basis for the study of the TCM characteristic health assessment scale for stroke is provided.Methods:The system searches for PubMed,EMbase,The Cochrane Library,CNKI,CBM,WanFang,VIP database,and collects relevant literatures on the distribution of medical constitution and TCM syndromes in ischemic stroke.The search time is from self-built to 2018.month.The search uses a combination of subject terms and free words.Chinese searchThe words include:constitution,constitution type,syndrome type,syndrome differentiation,ischemic stroke;English search terms include:TCM constitution,constitution,syndrome type,Syndrome type of TCM,ischemic Stroke brain infarction.The TCM syndrome type uses SPSS17.0 statistical analysis software to integrate and analyze the data,and then performs frequency distribution and chi-square test.Because of the data of only one group of people,it is impossible to use the Review software for meta-analysis.Therefore,only the frequencies of different TCM constitutions are summarized and summarized,and the distribution law of TCM constitution is described.Results1.TCM constitution:A total of 1972 articles were searched according to the search strategy.After screening,12 studies were included,and 6203 patients were tested.The results showed that the classification of TCM constitution in the ischemic stroke occurred in order of frequency,from h igh to low,followed by qi deficiency,phlegm,yin deficiency and blood sp utum.The other five constitutions are distributed in patients with ischem ic stroke(5%).From high to low,they are yang deficiency,peace and yin,y in deficiency,qi stagnation,qi stagnation,and special traits.quality.A ccording to the different research areas,the three regions of North Chin a,South China and East China have more qi,phlegm,dampness and damp heat,with the highest in North China,the second in South China and the lowest in East China.2.TCM syndrome type:A total of 1726 articles were searched according to the search strategy.After screening,38 studies were included,involving 10399 subjects.Twenty-seven kinds of TCM syndromes of different ischemic strokes were used in 38 studies,and some common syndromes were obtained after the combination of some similar syndromes.In terms of the frequency of TCM syndromes,the frequency of wind-stagnation,qi deficiency and blood-sucking syndromes is higher;in the comparison of the frequency of TCM compound syndromes,there is no difference between wind stagnation and qi deficiency and blood stasis syndrome.Significant differences,there is a significant difference between the two and other syndromes.Conclusion1.TCM constitution:qi deficiency,phlegm and dampness,yin deficiency and blood sputum are highly distributed in ischemic stroke;TCM constitution has certain regional differences,especially qi deficiency,phlegm and dampness The type of syndrome is more obvious,mostly in North China,followed by South China and East China.However,because the literature included in this study differs due to factors such as the region,sample size,diagnostic criteria,and measurement methods of each study,the analyzed results may also have a certain risk of bias.However,unlike the clinical trials of Western medicine,TCM physiology believes that there are differences in various factors such as geography and living habits.2.TCM syndrome type:phlegm stasis syndrome and qi deficiency and blood stasis syndrome are the basic syndromes of ischemic stroke,with the highest frequency of distribution.And there may be two or two or two syndrome types in the pathogenesis.In view of the large number of TCM syndromes in ischemic stroke,and the subjectiveness of the syndrome judges are strong,the judgment results may exist,so it is difficult to objectively summarize the distribution of TCM syndromes of ischemic stroke.Therefore,the development of an objective,comprehensive,Chinese medicine assessment scale that meets the characteristics of the Chinese population can provide a basis for clinical syndrome differentiation treatment of ischemic stroke.Second,clinical researchObjectiveProspective cohort study was used to analyze the correlation between TCM syndrome types and TCM constitution and its evolution and compound endpoint events in patients with ischemic stroke,in order to clarify the recurrence and transformation of TCM syndromes,TCM constitution and ischemic stroke.Relevant degree of return;explore the predictive value of ESSEN score and its combination of TCM syndrome and TCM body mass scale on ischemic stroke composite end point,in order to explore an ischemic brain with clinical characteristics of TCM Stroke recurrence risk prediction model(ESSEN-TCM).MethodsIn this study,a prospective,multicenter,cohort study was conducted to select 803 patients with ischemic stroke from 18 county-level hospital s in Guangzhou.The baseline TCM physique identification and TCM syndromes were included.The judgment was conducted at the 4th weekend,the 12th wee kend,the 24th weekend,and the 48th weekend from the time of enrollment t o observe the recurrence and death of ischemic stroke within 1 year,and c ompare the recurrent group with non-recurrence.The distribution of TCM co nstitution and TCM syndromes in patients with different prognosis outcome s.Whether the recurrence is a dependent variable from the 1st year of th e onset of the disease,the patient's general information,family history,combined disease control,TOAST classification,life behavior,exercise,d rug intervention,TCM constitution,TCM syndrome,NIHSS Factors such as Ba rthel index and mRS were independent variables.One-way Cox proportional h azards regression analysis was performed to screen out the factors affect ing the recurrence of ischemic stroke.The introduced test standard was 0.10.Then the forward stepwise regression method was used to establish the Cox risk regression model.The equation,introduced to a test level of 0.05,screened for factors that influence the outcome of recurrent ischemic s troke.Results1.Recurrence and prognosisThis study included 803 patients with ischemic stroke in Lingnan,and observed recurrence or death 1 year after onset.The results showed that 96 patients(11.96%)were lost in 1 year and 13 patients(1.6%)died.There were 2 cases(0.24%)died of cerebral hemorrhage,4 cases(0.49%)died of ischemic stroke,case died of pulmonary infection,1 case died of sudden death,5 cases died of other unknown causes,and the mortality rate was 1.67%.During the 1-year observation period,there were 53 cases(6.6%)with recurrent events,including 48 cases(6.0%)with ischemic stroke,3 cases(0.6%)with hemorrhagic stroke,and 2 cases(0.2%)with TIA.The recurrence rate was6.83%.2.Relationship between TCM constitution and recurrent events of ischemic strokeAmong the 803 patients in this study,the frequency of occurrence of 9 physical constitutions was 367 cases(45.70%)of blood stasis,316 cases(39.35%)of medulla;313 cases(38.98%)of qi deficiency;170 cases(21.17%);yang deficiency type 112 cases(13.95%);damp heat quality 100 cases(12.45%);qi stagnation 81 cases(10.09%);yin deficiency type 66 cases(8.22%);special sputum 49 Example(6.10%).Among the 53 patients with recurrence,the first three physical types were single blood stasis in 28 cases(52.83%),qi deficiency in 20 cases(37.74),and flatness in 19 cases(35.85%).When the two constitutions are combined,the number of recurrences of qi-deficiency inclusions is the highest,which is higher than other inclusions.When a variety of constitutions are combined,the reconciliation event occurs in the sputum and sputum inclusions,but the number of cases is small and is not affected by gender.Age distribution,the most common among patients<65 years old are bloody sputum,qi deficiency and peace and quality.Among the 65-year-old patients,qi deficiency,blood stasis and peace are the most common.Academic significance(P>0.05).In terms of gender distribution,male patients are less likely to be stagnation and yin deficiency,and female patients are less likely to be phlegm and sputum.The phlegm-dampness and qi stagnation decreased with age,and qi-deficiency and blood sputum increased with age.There was no significant difference between the two groups(P>0.05).In the distribution of body mass index,both normal weight and overweight are characterized by qi deficiency,blood stasis,peace and quality.Obese patients are more common with qi deficiency,blood sputum and qi stagnation,and the ratio of degassing to other constitutions is different.Statistically significant(P<0.05),there was no significant difference in the composition ratio of the remaining groups(P>0.05).3.Relationship between TCM Syndromes and Recurrent Ischemic StrokeAmong the 803 patients in this study,the frequency of the seven syndromes was 436(54.30%)from the blood stasis syndrome,and 144(17.93%)from the wind stagnation syndrome;Case(2.11%);wind sputum sputum in 8 cases(1%);phlegm and dampness syndrome in 4 cases(0.5%);phlegm and heat phlegm in 3 cases(0.37%);yin deficiency qi dynasty in 1 case(0.12%).The frequency of qi deficiency and blood stasis syndrome and wind phlegm blocking syndrome was the highest.In the different sex and age distribution of ischemic stroke,qi deficiency and blood stasis syndrome has always been a common syndrome,regardless of the highest frequency of males and females.With the increase of age,qi deficiency and blood stasis syndrome gradually increased.Among the 53 patients with recurrence,from high to low,46 cases(86.79%)were qi deficiency and blood stasis syndrome;13 cases(24.53%)were phlegm and blood stasis resistance;2 cases(3.77%)were on the fire-fighting disturbance syndrome and other syndrome types.The yin deficiency was 1 case(1.89%);the residual constitution did not appear in the recurrence group.In the relapsed patients,the normal weight and overweight were more common in qi deficiency and blood stasis syndrome and phlegm stasis syndrome;obese patients from high to low were yin deficiency wind motility syndrome(40.00%),phlegm and dampness syndrome(40.00%),Fengshen group card(20%),no recurrence of the remaining syndrome type.And whether ischemic stroke is the first or recurrence,acute or non-acute phase,qi deficiency and blood stasis syndrome are common syndromes,and are not affected by gender and age factors.There was no significant difference in age and gender between the two groups(P>0.05).4.Prediction of the risk of recurrent ischemic stroke with ESRS combined with TCM constitution and syndromeAmong the 803 patients in this study,407(58.31%)were in the low-risk group of 750 patients without recurrence.291 patients(41.69%)in the high-risk group.Of the 53 patients with recurrence,24(48%)were in the high-risk group and 26(52%)in the low-risk group.ESRS combined with ischemic stroke risk factors,found that high-risk group smoking,age,hypertension,diabetes,previous TIA or ischemic stroke were higher than the low-risk group,the difference was statistically significant(P<0.05).There were no significant differences in risk factors between high-risk group and low-risk group in patients with previous myocardial infarction,peripheral arterial disease and other heart disease(except myocardial infarction and atrial fibrillation)(P>0.05).ESRS combined with TCM constitution,found that the most common types of physical fitness in the high-risk group were qi deficiency(46.18%),bloody sputum(39.17%)and peace(37.9%),and the least common physique was yin deficiency(8.28%).The most common types of constitution in the low-risk group were blood stasis(46.84%),qi deficiency(40.52%)and peace(39.58%).The least common constitution was sputum(4.68%).There was no difference between the two groups.Statistical significance(P>0.05).ESRS combined with TCM syndrome types,found that the common TCM syndromes of low-risk group and high-risk group were qi deficiency and blood stasis syndrome and wind-stagnation syndrome.In the high-risk group,there was no wind and phlegm,and the yin-deficiency syndrome was less common.In the low-risk group,there was no yin-deficiency syndrome,and the phlegm-heat syndrome was rare.There was no significant difference between the two groups(P>0.05).5.Single factor Cox regression analysis of drug interventionOf the 803 patients in the study,the drug intervention was performed with a monoclonal antibody(aspirin enteric-coated tablets or clopidogrel tablets),a double-antibody(aspirin enteric-coated tablets+clopidogrel tablets),and a combination of statins in up to 610 patients.Among them,82 cases of one or two Western medicine patients were used,accounting for 13.44%,the risk ratio(HR)was 1.0,P value was not shown;155 cases of one or two western medicine combined with traditional Chinese medicine,accounting for 25.41%,the risk ratio(HR)was 0.51(95%CI:0.20,1.30);84 patients were treated with three drugs(aspirin/clopidogrel+statin+any Chinese medicine),accounting for 13.77%,hazard ratio(HR)0.42(95%CI:0.13,1.37);289 patients with three drugs combined with Chinese medicine,accounting for 47.38%,the risk ratio(HR)was 0.42(95%CI:0.30,1.42).It can be seen that compared with western medicine alone(either alone or in combination),the combined use of traditional Chinese medicine is the most common,more than two-thirds of the total number of cases.Compared with the simple application of one or two Western medicine treatments,the combination of aspirin+clopidogrel+statin can reduce the risk of recurrence;compared with Western medicine alone or in combination,Western medicine combined with traditional Chinese medicine can reduce the risk of recurrence by 43%.However,there was no statistically significant difference between the drugs(P>0.05).6.Multivariate Cox regression analysis of recurrent episodes of ischemic strokeIn this study,survival analysis-Cox regression analysis-forward stepwise regression,a variable of P<0.10 in Cox univariate analysis of all patients with ischemic stroke recurrence(age?65,gender,TIA,history of atrial fibrillation,The phlegm-dampness,NIHSS score,mRS medium-heavy,BI score,wind-swift syndrome,qi-deficiency and blood stasis syndrome were introduced into the Cox multi-factor regression analysis,and the full-factor predictive model was drawn.Regression method to construct a prognostic regression equation:h(t)=h0(t)exp(0.642X2+1.043X4-0.605X5+1.350X6+0.653 X10),suggesting gender,TIA history,phlegm dampness,severe MRS,qi deficiency blood Sputum syndrome is an independent risk factor for recurrent ischemic stroke.Among them,gender(HR=1.901,95%CI:1.109,3.260),TIA(HR=2.836,950%CI:1.265,6.358),mRS medium severity(HR=3.856,95%CI:2.215 6.712),phlegm Quality(HR=0.546,95%CI:0.230,1.298),Qi deficiency and blood stasis syndrome(HR=0.546,95%CI:0.853,4.330).ConclusionIn terms of recurrence rate,the recurrence rate of ischemic stroke patients in Lingnan area was 6.60%in one year,which was lower than that in other regions in China,which may be related to the regional and dietary structure of Lingnan.In terms of drug application,the three drugs(aspirin enteric-coated tablets+clopidogrel tablets+statins)combined with traditional Chinese medicine can significantly reduce the risk of recurrence.In terms of the distribution of constitution and syndrome type,the physical types of relapsed people are more common in qi deficiency,blood stasis and peace.The syndromes of recurrence are mostly qi deficiency and blood stasis syndrome,wind stasis syndrome and qi deficiency and blood stasis.The syndrome of mixed wind and phlegm is more common,and the syndrome of qi deficiency and blood stasis is not affected by gender and age.In terms of survival time and risk of recurrence,the recurrence rate showed an increasing trend with time.After multivariate Cox regression analysis,gender,TIA history,qi deficiency and blood stasis syndrome and mRS were also predictive of the incidence of recurrent episodes of ischemic stroke. |
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