Studies On The Correlation Between New Predictors,helicobacter Pylori Infection And TCM Syndrome Elements With Symptomatic Intracranial Atherosclerotic Stenosis In Guangdong

Study 1 Retrospective analysis of the correlation between new markers of inflammation and lipid and Traditional Chinese Medicine(TCM)syndrome elements with the degree of intracranial artery stenosis and neurological function deficit of symptomatic intracranial atherosclerotic stenosis(sICAS)patientsObjective:(1)The data of clinical characteristics and TCM syndrome elements of patients with sICAS in Guangdong were summarized based on the review of the information of electronic medical record system for 10 years,and the data of patients with different degrees of intracranial artery stenosis and neurological deficit were compared;(2)Exploring the correlation between the ratio of neutrophils to lymphocytes(NLR),the ratio of platelets to lymphocytes(PLR),the ratio of lymphocytes to monocytes(LMR),the ratio of monocytes to high density lipoprotein cholesterol(MHR),and the atherogenic index of plasma(AIP)with the degree of intracranial artery stenosis and neurological deficit in patients with sICAS,and their predictive value was evaluated to explore more simple,intuitive and stable clinical predictive indexes.Methods:(1)The medical records of patients diagnosed as sICAS who met the inclusion and exclusion criteria in the Encephalopathy Center of Guangdong Hospital of CM from January 2009 to December 2019 were collected.All of the patients were labeled to mild,moderate or severe groups according to the degree of intracranial artery stenosis and were labeled to mild,moderate or severe groups according to the degree of neurological deficit;(2)Collecting the patient's demographic data,neurological deficit score,laboratory and imaging examination results,as well as the four examinations and syndrome elements of TCM;(3)Chi-square test,t-test,one-way ANOVA,or nonparametric test were used to analyze the difference of clinical data and syndrome elements of patients with different degrees of intracranial artery stenosis and neurological deficit,and the receiver operating characteristic curve(ROC)was used to analyze the predictive value and best cut-in point of the above inflammation and lipid markers for the degree of intracranial artery stenosis and neurological deficit.Results:(1)A total of 649 patients were included in this retrospective study,including a high proportion of male patients.More cases get sick at the Beginning of Autumn,the Summer Solstice,and the Autumn Equinox.Smoking was the main personal history and all of them were assessed as mild or moderate neurological deficit at admission;(2)Most of the responsible vessels were assessed as moderate or severe stenosis and were assessed as type A according to Mori classification.The white matter lesions of patients were most assessed as mild;(3)The TCM syndrome differentiation types of the patients were mainly Wind-phlegm and Blood Stasis,Liver-yang Hyperactivity,and Qi Deficiency and Phlegm Stasis.The tongue image was mainly dark,dark red and dark purple tongue;the moss was mainly white greasy,thin white and yellow greasy fur;the pulse was mainly string pulse,rapid pulse and string slippery pulse,and wind,phlegm and blood stasis were the main syndrome factors;(4)There were significant differences in the proportion of patients of the different gender,Mori classification of A,B and C,white matter lesion grade of 0,1 and 3,IMT was 1 to 1.2 mm or greater,TCM syndrome was Wind-phlegm and Blood Stasis or Qi deficiency,Damp-heat and Phlegm Obstruction among patients with mild,moderate and severe intracranial arterial stenosis(P<0.05);and there were significant differences in the levels of onset time,BMI,National Institutes of Health Stroke Scale score,low density lipoprotein cholesterol,total cholesterol,homocysteine and NLR,PLR among patients with mild,moderate and severe intracranial arterial stenosis(P<0.05);(5)Multivariate disordered logistic regression analysis showed that only high homocysteine was an independent risk factor for moderate or severe intracranial artery stenosis inpatients with sICAS(B=0.301,P=0.006;B=0.330,P=0.002);(6)There were significant differences in the proportion of patients of the Mori classification of B,white matter lesion grade of 1,carotid plaque confirmed,IMT was 1 to 1.2 mm or greater,history of diabetes between patients with mild and moderate neurological deficit(P<0.05);and there were significant differences in the levels of BMI,LDL-C,triglyceride,total cholesterol,homocysteine,NLR,PLR,MHR,AIP between patients with mild and moderate neurological deficit(P<0.05);(7)Binary logistic regression analysis showed that the history of diabetes(B=1.055,P=0.009),high triglyceride(B=1.477,P=0.033),high homo-cysteine(B=0.093,P=0.000),high NLR ratio(B=0.504,P=0.000)and high LMR ratio(B--0.293,P=0.0008)were independent risk factors for the degree of neurological deficit in patients with sICAS.High NLR ratio was proved to be a certain predictive element for the degree of neurological deficit in patients with sICAS based on the results of ROC curve(P=0.000),while high LMR ratio had a lower predictive value(P=0.489).Conclusion:The main findings of this retrospective study show that the main TCM syndrome factors of sICAS patients are wind,phlegm and blood stasis in Guangdong.Hyperhomocysteinemia is an independent risk factor for the degree of intracranial artery stenosis and history of diabetes,high triglyceride,hyperhomocysteinemia and high NLR,LMR are independent risk factors affecting the degree of the neurological deficit but only high NLR has a certain predictive value.Study 2 Helicobacter pylori infection and the risk of ischemic stroke and stroke subtypes:a meta-analysisObjective:To explore the relationship between Helicobacter pylori(Hp)infection and the risk of IS and its subtypes,so as to provide newer and higher quality evidence-based medicine basis for diagnosis and treatment of IS etiology,and provide theoretical basis for further clinical research through the present meta-analysis of the observational study.Methods:PubMed,EMBASE,Cochrane library(including CENTRAL),Chinese Biological Medical Literature,CNKI,WANFANG and Chongqing VIP databases were searched independently.Observational studies were included into the study if they reported quantitative estimates of the multivariate-adjusted odds ratio(OR)and corresponding 95%confidence interval(CI)concerning the relationship.The random effect model was finally selected to calculate the overall combined risk.Sensitivity analyses,heterogeneity,and publication bias tests were performed.Results:(1)Twenty-four observational studies were included of which 17 were case-control studies and 7 were cohort studies.The overall combined results showed that Hp infection was significantly associated with an increased risk of IS[OR(95%CI)=1.52(1.31-1.77)];(2)The results of subgroup analysis suggested that factors such as study type,patient background,test method of Hp infection and regional differences might be the reasons for the greater heterogeneity among studies.Besides,results of the subgroup analysis based on the type of stroke and the detection of Hp infection showed that Hp infection was significantly associated with the increased risk of large artery atherosclerotic stroke[OR(95%CI)=2.69(1.63-4.44)],and patients with positive Hp IgG antibody or cytotoxin associated protein A IgG antibody infection were both positively correlated with risk of IS([OR(95%CI)=2.09(1.23-3.56)];[OR(95%CI)=1.42(1.18-1.70)]);(3)Although there was great heterogeneity among studies(I2=65.8%,P=0.000),but the sensitivity analysis suggested that the combined results of effect sizes were stable and Begg's test suggested that there is no significant publication bias in this meta-analysis(P=0.112).Conclusion:The present meta-analysis indicates a strong association between Hp infection and risk of IS and the large artery atherosclerotic stroke.However,the correlation between Hp infection and intracranial artery stenosis still needs further study.Study 3 Study on the correlation between Hp infection with the degree of intracranial artery stenosis and the distribution of TCM syndrome elements in sICAS patientsObjective:To evaluate the correlation between Hp infection with the degree of intracranial artery stenosis,the distribution of TCM syndrome elements,and the Yin and Yang syndrome elements in sICAS patients in Guangdong based on the conclusions of the meta-analysis,so as to increase the theoretical basis for the etiology,prevention,and treatment of sICAS and TCM syndrome differentiation through the present case series analysis.Methods:(1)Patients with sICAS were continuously enrolled in the Encephalopathy Center of Guangdong Hospital of CM from January 2020 to December 2020.All of the patients were labeled to mild,moderate or severe groups according to the degree of intracranial artery stenosis;and were labeled to type ?,type ? infected groups and negative Hp group according to the type of pathogenic strains infection;(2)Collecting the demographic data,results of laboratory and imaging examination,information of TCM syndrome elements and Yin and Yang syndrome of the patients;(3)Chi-square test,t-test,one-way ANOVA,or nonparametric test were used to analyze the differences in clinical data distribution of sICAS patients with different levels of intracranial artery stenosis,and the correlation between Hp infection and clinical data characteristics.Multiple logistic regression analysis was used to investigate the correlation between Hp infection and the degree of intracranial artery stenosis in patients with sICAS.Results:(1)A total of 148 patients were recruited in the present study,including 49 cases of mild,27 cases of moderate,and 72 cases of severe intracranial stenosis.Eighty-eight cases were assessed as type ? Hp infection,12 cases was assessed as type II Hp infection and 48 cases were assessed as negative.Phlegm-dampness,Internal Fire syndrome,and Yin syndrome were the main syndrome elements of TCM;(2)There were significant differences of patients with different degrees of intracranial stenosis in the constituent ratio of farmers in occupation,type I or negative Hp infection,as well as the levels of hypersensitive C-reactive protein,lipoprotein a,D-dimer and ApoA1/ApoB ratio(P<0.05).And significant differences were observed in the constituent ratio of farmers,type ? or negative Hp infection,the levels of ApoA1/ApoB and lipoprotein a between the severe and mild stenosis group(P<0.05);(3)There were significant differences in the BMI score,detection rate of echo plaques of the carotid artery,and the proportion of patients whose syndrome elements were Internal Fire among the three groups with different Hp infection types(P<0.05).Significant differences were observed in the BMI score,detection rate of echo plaques of carotid artery and the proportion of patients with Internal Fire syndrome between the type ?Hp infection group and the negative infection group(P<0.05).A similar trend was observed in the detection rate of echo plaques of the carotid artery and the proportion of patients whose syndrome elements were Internal Fire between the type ? Hp infection group and the negative infection group(P<0.05);(4)Multiple disordered logistlic regression analysis showed that ApoA1/ApoB ratio and type ? Hp infection were independent risk factors for severe stenosis of intracranial artery,and the infection severity of Hp was positively correlated with the stenosis degree of vessels(B=0.959,P=0.038).Conclusion:Hp infection is an independent risk factor for severe intracranial stenosis of sICAS patients.The more severe the infection,the higher the degree of stenosis.The TCM syndrome elements of sICAS patients with Hp infection are mainly Phlegm-dampness and Internal Fire syndrome,and Yin syndrome is the main syndrome based on the classified method of Yin and Yang.