Effect Of Acupuncture For Motor Dysfunction In Ischemic Stroke And Analysis Of Prognostic Factors

ObjectiveThe aim of the study is to observe the effect of acupuncture on motor dysfunction in different stages of ischemic stroke.By means of real-world evidence,this paper aims to explore the correlation between early acupuncture intervention and long-term motor function and evaluate the optimal time to intervention in acute stage.The study analyzes the correlation between TCM symptoms and the prognosis of stroke so as to provide clinical evidence for the establishment of early prognosis scales based on TCM evaluation system.Meanwhile,by means of prospective evidence,to evaluate the clinical effect and safety of acupuncture on motor function in patients with chronic ischemic stroke.On the other hand,the SSTCM scale will be tested to evaluate its application in sequelae phase so as to provide evidence for the basis of TCM evaluation system.MethodsIn the retrospective cohort study,a secondary data analysis was performed on 315 patients screened from 1610 patients in Longhua hospital affiliated to Shanghai University of traditional Chinese medicine according to the criteria.All the cases were divided into three groups(A:within 2 days,n=105;B:within 3 to 7 days,n=109;and C:within 8 to 14 days,n=101)according to the acupuncture intervention time after stroke onset.All patients received standard treatments and acupuncture therapy,including electro-acupuncture based on syndrome differentiation of Yin and Yang and scalp acupuncture The long-term efficacy was mainly based on mRS,MBI,FMA,hs-CRP and FIB one year after stroke onset.The prognostic indicators including TCM symptoms were recorded at the first day in the hospital.Meanwhile,in the randomized controlled study,124 patients with chronic ischemic stroke were collected and randomly divided into 62 cases in control group(rehabilitation)and 62 cases in treatment group(acupuncture plus rehabilitation)The acupuncture therapy included electro-acupuncture based on syndrome differentiation of Yin and Yang and scalp acupuncture.FMA,MBI and mRS scales were measured in baseline,1 month,2 months and 6 months to compare the improvements of motor function in two groups,while SS-QOL and SSTCM scales were measured in baseline and 6 months to compare the improvements of the quality of life and TCM symptoms Meanwhile,the reliability,validity,sensitivity and principal component analysis of the SSTCM scale were carried out to evaluate the value of its applicationResultsIn the retrospective study,the results are as follows:(1)in one-year follow-up,the overall mortality rate,the recurrent rate and the number of mRS(0-2)were 0%,20.3%and 74.3%,respectively.(2)By nonparametric test(KW test),in part of FMA,MBI mRS and FIB,A>C,B>C(P<0.05)and no statistical difference between A and B(P>0.05).In part of hs-CRP,A>B>C(P<0.05).(3)In multiple linear regression,10 TCM symptoms(MBI regression model)were related to the prognosis of MBI(DW 1.409,Ad.R20.654)and 10 TCM symptoms(FMA regression model)were related to the FMA outcome(DW 1.446,Ad R2 0.620).The two models were selected to have 9 repeated symptoms(repeated model).In ROC curves,the three models were compared with the NIHSS score,and the MBI regression model reflected the highest efficiency.(4)By binary logistic regression,4 stroke risk factors,including atrial fibrillation(Ad.OR 3.156),chronic renal insufficiency(Ad.OR 2.563),diabetes(Ad.OR 2.174)and stroke history(Ad.OR 1.883)were related to the outcome(mRS score)(P<0.05).Meanwhile,atrial fibrillation(Ad.OR 2.449),stroke history(Ad.OR 2.039)and chronic renal insufficiency(Ad.OR 1.030)were related to the reoccurrence(P<0.05).On the other hand,the prospective study are as follows:(1)In 4-months follow-up,5 cases(4.03%)dropped totally and 119 cases were in PP set,59 in control group and 60 in treatment group,respectively.(2)By one-way repeated measures ANOVA in PP set,the total score of FMA(F=11.766,P<0.01)and MBI(F=4.072,P=0.046)between groups were significantly different over time,which FMA scores in treatment group were higher than in control group at three time points(P<0.05),same as MBI scores at 2 months and 6 months(P<0.05).In all cases,FMA(Roy's largest root Eta2 0.813,P<0.01)and MBI(Roy's largest root Eta2 0.719,P<0.01)had a significant difference over time.In ITT set,the mean score of upper-limb FMA,lower-limb FMA,total FMA,MBI and mRS were all better in treatment group than in control group(P<0.05).(3)After the follow-up(6 months),the SS-QOL scale,including physical function,psychological function,social function and symptoms,and the SSTCM scale,both severity of symptoms and effect on life,were improved significantly,which treatment group was superior to control group(P<0.01).(4)In the scale of severity of symptoms,the Cronbach' a coefficient was 0.619-0.632,of which 19 entries were sensitive,while in the scale of effect on life,the Cronbach' ? coefficient was 0.615-0.630,of which 21 entries were sensitive.Both KMO value were more than 0.5,and the significance of Bartlett's sphericity test were less than 0.05.In principal component analysis,two parts were classified into 7 dimensions,respectively,and the cumulative contribution rates were more than 70%.In addition to the special symptoms and concomitant symptoms of stroke,the remaining main factors were five TCM syndromes,including Qi deficiency,Yin deficiency,spleen and stomach,liver fire and intestinal heat.ConclusionAcupuncture intervention begin within 2 days after onset in acute ischemic stroke is the optimal time to improve inflammation and recovery of long-term motor function.Meanwhile,acupuncture is effective and fairly safe in patients with chronic ischemic stroke,which can significantly improve motor function,quality of life and TCM symptoms,with good long-term effect.Once onset,the combination of 10 TCM symptoms,such as wheezing due to phlegm retention,constipation and short breath,may affect the prognosis of motor function.Meanwhile,Qi deficiency,Yin deficiency,liver fire and stomach fire are common in sequelae stage.In addition,it has been suggested that atrial fibrillation,chronic renal insufficiency,diabetes and stroke history are independent risk factors for stroke prognosis.Moreover,stroke history and chronic renal insufficiency are independent risk factors for recurrence events.