| BackgroundIschemic stroke is characterized by high morbidity,high mortality,high disability,and high recurrence.At present,the traditional Chinese medicine(TCM)theory has achieved significant results in the treatment of acute ischemic stroke,but there is still no strong evidence in terms of its efficacy evaluation.And there is currently no large-scale registration study for the treatment of ischemic stroke in TCM in South China,and the status of application of TCM mediation is unclear.The Southern China Registry Study of Cerebrovascular Disease on Traditional Chinese Medicine(SECRETS-CODE-TCM)was a multi-center,prospective registry study on cerebrovascular disease in South China based on the evaluation of the efficacy of traditional Chinese medicine.While studying the demographics and epidemiological characteristics,the patients were followed up for a long time,and the comprehensive understanding of the use of TCM treatment during the hospitalization of patients with acute ischemic stroke,as well as end events such as survival and disease outcome,and further to analyze the factors affecting the short-term prognosis of patients with acute ischemic stroke in the region.This dissertation was a descriptive analysis and follow-up study of the SECRETS-CODE-TCM study that was prospectively continuous from May 15,2018 to January 8,2019.ObjectiveThe aim of this study was to conduct a study on the registration of acute ischemic stroke with TCM characteristics in South China,observe the distribution pattern of Traditional Chinese Medicine Syndrome Elements of acute ischemic stroke in the region,and explore the effects on TCM involved in ischemic stroke mediation based on real world research and explore the correlation between TCM treatment and short-term prognosis of patients.MethodsA registration study of 2313 patients with ischemic stroke(within 14 days of symptom onset)in southern China that met the inclusion exclusion criteria and the diagnostic criteria of TCM and Western medicine was performed.Questionnaires included the basic characteristics(personal history,family history,etc.),hospitalization questionnaires(admission date,admission,interventions,in-hospital outcomes and related assessment scales,etc.),and discharge status questionnaires(discharge date,discharge,final diagnosis,sub-type of etiology,TCM diagnosis and syndrome classification and related assessment scales);and TCM Syndrome and Syndrome Elements Questionnaire,National Institutes of Health Stroke Scale(NIHSS),modified Rankin Scale(mRS),Barthel Index Scale(BI),Glasgow Coma Scale(GCS),routine follow-up form including the patient's blood pressure,medication status,and occurrence of adverse events and key events.The adverse events report forms and endpoint events report forms should be filled on time.During 3 months' follow-up period,all-cause mortality,degree of neurological deficits,and activity of daily living should be collected and summarized.SPSS was used to perform the statistical analysis.Logistics regression was used to analyze the relationship between TCM intervention and short-term prognosis of 3 months after discharge.Results1.Descriptive analysis(1)General demographic characteristics of patients:a total of 2,351 patients with ischemic stroke were screened and enrolled,among whom 17 patients were excluded and voluntarily withdrew after informed consent,21 patients were not indicated whether they were enrolled in the study,and 2,313 patients who met the inclusion and exclusion criteria were finally included as subjects.The age group of patients is mainly concentrated between the ages of 50 and 80,accounting for 76.79%of all of the patients in the observation group;the proportion of young and middle-aged stroke patients under 50 is 8.43%,and patients over 80 years old accounted for 14.79%.(2)The top five risk factors for sexual stroke are hypertension,diabetes,dyslipidemia,history of coronary heart disease,and history of stroke;(3)The majority of ischemic stroke patients(within 14 days of symptom onset)in southern China are Yin syndrome.The overall distribution rule of Yin and Yang syndrome in 2107 patients was reflected in the 1223 cases of Yin syndrome(58.04%)and the 884 cases of Yang syndrome(41.96%),which was consistent with the research results of the national science and technology tenth five-year plan project undertaken by the encephalopathy center of Guangdong hospital of traditional Chinese medicine.(4)The percentage of patients with ischemic stroke in southern China who adhere to anti-platelet aggregation therapy is less than 50%.Only 59.78%of patients with hypertension can adhere to blood pressure control,only 145 in 305 patients can adhere to lipid-lowering and stable plaque treatment,and 66.29%of patients can adhere to blood glucose control.It is worth to note that the primary prevention of stroke in South China is not very satisfactory.Therefore,the corresponding risk factors for stroke should be actively controlled.(5)Pre-hospital treatment and intervention plan during hospitalization:Only 4.31%of patients with acute ischemic stroke received thrombolytic therapy,and only 1.53%of patients received endovascular treatment,suggesting that the publicity of stroke treatment should be actively promoted,and further Improve pre-hospital treatment rate.(6)Among the 2,313 hospitalized patients effectively enrolled,1,865(80.63%)were treated with aspirin and 130(56.25%)were treated with clopidogrel to prevent platelet aggregation,and 80.11%of patients used lipid-regulating plaque drugs,of which atorvastatin was the most commonly used lipid-lowering and spot-stabilizing drug;TCM decoction and injection were the preferred intervention methods in 1268 patients(54.82%)and 1371 patients(59.27%),respectively.(7)There are differences in TCM use and acupuncture rehabilitation between TCM hospital and western hospital.The utilization rate of TCM in TCM hospital is generally higher than that in western hospital,but the overall treatment ratio of acupuncture and rehabilitation in stroke patients of the same level in western hospital is higher than that in TCM hospital.(8)TOAST classification:aortic atherosclerotic stroke is the most common type of stroke in South China,and treatment capacity should be strengthened to reduce the mortality and disability of stroke.Moreover,patients with IS in South China have more than moderate vascular stenosis,and occlusion is more common in the MI,M2 segment of the brain,and the anterior and posterior cerebral arteries.The infarcts basically coincide with the vascular stenosis,and patients with symptomatic intracranial stenosis should be actively treated Grade prevention and the expanded application of traditional Chinese medicine treatment and endovascular treatment.2.Results of prospective registration study:(1)A total of 2112 patients were effectively collected in the follow-up study 3 months after discharge.During the follow-up 3 months after stroke,a total of 26 patients(1.23%)had all-cause death,58(2.7%)had recurrent ischemic stroke,18(0.85%)had cerebral hemorrhage,and 368(17.42%)had intermediate or higher disability(mRS>3).(2)The results of univariate analysis and multivariate analysis suggested that Chinese medicine,acupuncture treatment,anti-platelet treatment,and blood pressure regulation were not related to the degree of disability three months after discharge,and neuroprotective treatment might have a protective effect on the disability three months after stroke(P=0.031).Although there was no statistical difference between Chinese medicine during hospitalization and short-term neurological deficits,the trend was more towards a protective effect.(3)The association between different types of intervention during hospitalization and all-cause death at 3 months after discharge:the results of multivariate analysis suggested that cerebral protective treatment during hospitalization may have a protective effect on all-cause death at 3 months after stroke(P<0.05).Although proprietary Chinese medicine intervention with acupuncture did not reduce all-cause mortality after 3 months(P>0.05).(4)The relationship between different interventions during hospitalization and the recurrence of ischemic stroke 3 months after hospitalization:the results of multivariate analysis suggested that antiplatelet aggregation and blood pressure control during hospitalization may reduce the risk of recurrent ischemic stroke 3 months after stroke(P<0.05).Although the relationship between Chinese medicine intervention and acupuncture treatment and the reduction of ischemic stroke recurrence at 3 months after stroke did not reach statistical difference(P>0.05),the trend tended to have a certain protective effect.Conclusion1.The population of acute ischemic stroke in south China is mainly adults between 50 and 80 years old.The proportion of middle-aged stroke patients under 50 years old is 8.43%.The secondary prevention of ischemic stroke in young and middle-aged people should be concerned.2.The top five risk factors for ischemic stroke are hypertension,diabetes,dyslipidemia,history of coronary heart disease,and history of stroke.3.The majority of ischemic stroke patients in southern China are Yin syndrome.The overall distribution rule of Yin and Yang syndrome in 2107 patients was reflected in the 1223 cases of Yin syndrome(58.04%)and the 884 cases of Yang syndrome(41.96%),which was consistent with the research results of the national science and technology tenth five-year plan project undertaken by the encephalopathy center of Guangdong Provincial Hospital of Traditional Chinese medicine.4.The prescription of Chinese medicine including Chinese patent drugs,traditional Chinese medicine decoction,acupuncture and rehabilitation of stroke patients in different hospitals in southern China,mainly represented by Guangdong province,were different.The use of Chinese medicine and acupuncture and rehabilitation in the pearl river delta region were significantly higher than those in western Guangdong,eastern Guangdong and northern Guangdong,suggesting that regional development had a certain impact on the treatment of Chinese medicine.5.For the patients with ischemic stroke(within 14 days of onset)in south China,more than half of the patients were able to live independently 3 months after discharge with effective integrated treatment of traditional Chinese and western medicine.Although the improvement of the disability rate and the recurrence of stroke 3 months after stroke by Chinese medicine is not statistically significant,it has a tendency to reduce the disability rate and the recurrence of stroke,which should be further studied. |
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