| Objective:1.To explore the fundus microvascular characteristics and clinical high-risk factors related to hypertensive cerebral hemorrhage(HICH)and the recurrence of HICH,which laid the foundation for further establishment of the prediction model of HICH and HICH recurrence based on fundus microvascular characteristics.2.To investigate the clinical effect of "Regulating Conception-Governor Vessel" acupuncture method on HICH patients,and to analyze its correlation with fundus microcirculation,so as to provide clinical evidence and theoretical basis for "Regulating Conception-Governor Vessel"acupuncture method in improving microcirculation and treating HICH.Methods:1.We retrospectively analyzed 75 inpatients with HICH in acupuncture department during 2018.05-2018.12,selected 75 inpatients with high blood pressure(HBP)who came from the cardiovascular department at the same time as the control group.The collected clinical data and fundus microcirculation characteristics were analyzed by logistic regression,and the diagnostic model of HICH was established.The receiver operating characteristie(ROC)curve was drawn to evaluate and compare the model efficacy.2.We retrospectively analyzed 43 inpatients with secondary stroke after HICH in the acupuncture department during 2017.11-2018.12 who met the inclusion and exclusion criteria,and every case matched 2 HICH inpatients without secondary stroke,similar course and recruited at the same time as the control group(86 cases).The collected clinical data and fundus microcirculation characteristics were analyzed by logistic regression,and the diagnostic model of HICH recurrence was established.ROC curve was drawn to evaluate and compare the model efficacy.3.Using a prospective cohort study,we analyzed the HICH patients who recruited to acupuncture department(outpatient department,inpatient department and rehabilitation center)who met the inclusion and exclusion criteria during 2017.11-2018.12.The patients were divided into the acupuncture group and the control group.The control group were given foundation treatment and rehabilitation treatment while the acupuncture group were given“Regulating Conception-Governor Vessel”acupuncture on the basis of foundation treatment and rehabilitation treatment.Three courses of treatment for both groups,21 days for every course.The national institutes of health Stroke Scale(NIHSS),Barthel Index and Stroke Specific Quality of Life Scale(SS-QOL)and retinal imaging were taken before and after 3 courses of treatment.Results:1.Risk factors of HICH(1)The clinical risk factors of HICH:The multivariate regression analysis showed a significant positive correlation between serum total cholesterol level and HICH(OR=3.142,95%CI:1.792-5.51,P=0.000<0.01).The history of chronic kidney disease was positively correlated with HICH(OR=3.534,95%CI:1.026-12.166,P=0.045<0.05).The hypertension of grade 3 was positively correlated with HICH(OR=1.833,95%CI:1.074-3.13,P=0.026<0.05).High mean systolic blood pressure(SBP)was positively correlated with HICH(OR=1.045,95%CI:1.014-1.077,P=0.004<0.01).High homocysteinemia(?15?mol/L)was positively correlated with HICH(OR=6.416,95%CI:1.697-24.255,P=0.006<0.01).(2)The fundus risk factors of HICH:The multivariate regression analysis showed that the standardized value of left branching coefficient of artery(ZLBCA)was negatively correlated with HICH(OR=0.566,95%CI:0.353-0.908,P=0.018<0.05).The standardized value of left fractal dimension of artery(ZLFDa)was negatively correlated with HICH(OR=0.539,95%CI:0.347-0.837,P=0.006<0.01).The standardized value of right vein branch Angle(ZRVangle)was negatively correlated with HICH(OR=0.366,95%CI:0.219-0.61,P=0.000<0.01).(3)Evaluation of diagnostic efficacy of HICH model:The area under the curve(AUC)of the logistic regression model based on fundus and clinical characteristics was 0.899(95%CI:0.849-0.949),with a sensitivity of 84.0%,specificity of 82.7%and accuracy of 83.3%.The AUC of logistic regression model based on clinical characteristics was 0.863(95%CI:0.803-0.922),with a sensitivity of 80.0%,a specificity of 80.0%,and an accuracy of 80.0%.Logistic regression model based on fundus features had an AUC of 0.746(95%CI:0.667-0.826),a sensitivity of 70.7%,a specificity of 68.0%,and an accuracy of 69.3%.2.Risk factors of HICH recurrence(1)The clinical risk factors of HICH recurrence:The multivariate regression analysis showed that lacunar infarction was positively correlated with HICH recurrence(OR=5.798,95%CI:2.030-16.558,P=0.001<0.05.The history of hyperlipidemia was positively correlated with HICH recurrence(OR=3.494,95%CI:1.166-10.466,P=0.025<0.05).Cerebral artery-stenosis or occlusion was positively correlated with HICH recurrence(OR=9.597,95%CI:1.446-63.683,P=0.019<0.05).(2)The fundus risk factors of HICH recurrence:The multivariate regression analysis showed that the standardized value of left AVR was positively correlated with HICH recurrence(OR=1.757,95%CI:1.017-3.033,P=0.043<0.05).The standardized value of right arteriovenous nipping(ZRNipping)was positively correlated with HICH recurrence(OR=4.201,95%CI:2.221-7.944,P=0.000<0.01.(3)Evaluation of diagnostic efficacy of HICH recurrence model:The logistic regression model based on fundus and clinical characteristics had an AUC value of 0.888(0.827-0.949),a sensitivity of 90.7%,a specificity of 69.8%,and an accuracy of 83.7%.The AUC of the logistic regression model based on clinical characteristics was 0.729(0.632-0.826),with a sensitivity of 97.7%,a specificity of 25.6%and an accuracy of 73.6%.The logistic regression model based on fundus features had an AUC of 0.819(0.740-0.897),a sensitivity of 89.5%,a specificity of 53.5%,and an accuracy of 77.5%.3.Acupuncture study(1)Scales and blood pressure:The Barthel index and SS-QOL score of patients in the acupuncture group and the control group were significantly improved after treatment(P<0.01).The Barthel index and SS-QOL score in the acupuncture group were higher than those in the control group(p<0.05).The Barthel index and SS-QOL score difference of before and after in the acupuncture group was greater than that in the control group(P<0.01).(2)Fundus vascular diameter:The Central Retinal Artery Equivalent(CRAE)?Central Retinal Vein Equivalent(CRVE)and AVR before and after treatment showed no significant difference(P>0.05)in both the two groups.(3)Fundus vascular geometry:The index of arterioles asymmetry(Aasym),bifurcation angle of arterioles(Aangle),bifurcation angle of venules(Vangle)and bifurcation coefficient of arterioles(BCA)before and after treatment showed no significant difference(P>0.05).(4)Arteriole occlusion:The Arteriole occlusion of left eye and right eye(LAocclusion,RAocclusion)were significantly improved in the acupuncture group after treatment(P<0.01),and the RAocclusion was significantly improved in the control group(P<0.05),but the LAocclusion in the control group showed no significant difference(P>0.05).The LAocclusion of acupuncture group was lower than that of the control group after treatment(P<0.01);The LAocclusion difference before and after treatment in the acupuncture group was greater than that of the control group(P<0.05).There was no significant difference in RAocclusion between the two groups after treatment(P>0.05),and no significant difference in RAocclusion difference before and after between the two groups(P>0.05).(5)Tortuosity:Compared with before treatment,the RTortuosity in the acupuncture group was significantly improved after treatment(P<0.01),however,there was no significant difference in LTortuosity in the acupuncture group and the LTortuosity,RTortuosity in the control group(P>0.05).Compared with the control group,there was no significant difference in LTortuosity after treatment between the two groups(P>0.05).After treatment,the RTortuosity in acupuncture group was lower than that in the control group(P<0.05)and the RTortuosity difference before and after treatment in the acupuncture group was greater than that in the control group(P<0.05),(6)Arteriovenous Nipping:The left and right arteriole-venous Nipping(LNipping,RNipping)in the acupuncture group and the control group were significantly improved(P<0.01 or P<0.05)after treatment compa.red with before.Compared with the control group,the LNipping and RNipping in the acupuncture group after treatment was less than that in the control group(P<0.05),and the LNipping difference before and after treatment in the acupuncture group was greater than that in the control group(P<0.05).There was no significant difference in the RNipping difference before and after treatment between the two groups(P>0.05).Conclusion:1.Hypercholesterolemia,chronic renal disease,grade 3 of hypertension,high mean SBP,high homocysteinemia,decreasing branching coefficient of arterial,decreasing fractal dimension of arterial,decreasing branching Angle of venous were risk factors for HICH.The logistic regression model for diagnosing HICH based on fundus and clinical characteristics was significantly better than the model based on clinical characteristics and the model based on fundus only.2.Lacunar infarction,cerebral artery stenosis or obstruction,hyperlipidemia,increasing AVR and arteriole-venous Nipping are risk factors for HICH recurrence.The logistic regression model based on fundus and clinical features was significantly better than the model based on clinical features and fundus only.Moreover,the fundus feature-based model is superior to the clinical feature-based model3.The improvement of Barthel index and SS-QOL score of patients treated by Combined“Regulating Conception-Governor Vessel”acupuncture and conventional therapy was better than that treated by conventional therapy alone.So did the fundus arteriole occlusion and the arteriole-venous Nipping.However,further studies are still needed in other aspects such as arterial Tortuosity. |
PDF Full Text Request