| ObjectsTo study the risk of the incidence and exacerbation of poststroke cognitive impairment,in order to provide evidence for prevention of the diseases;to study the charactristics of syndrome elements and dynamic changes of these elements,and investigate characteristics of TCM pathogenesis of poststroke cognitive impairment,so as to provide a foundation for further study on dialectical normalization of TCM on poststroke cognitive impairment and provide evidence for clinical treatment.Methods1The research group developed the questionaire.Researchers were trained in the same standard to collect information.Cases of post-stroke cognitive impairment were selected from multi-centers,including hospitals.3000 cases were finally included in the study.Further the cases were divided into a group without cognitive impairment,a group with mild cognitive impairment and a group with mild dementi according to the level of cognitive dysfunction.2A data management plantform was established based on Browser/Server architecture.The data management plantform has the functions of data input,data export,data check and data management.Statistics were processed by SPSS21.0.Introduce the diagnosis scale for TCM syndrome elements which were established in previous studies of our research team.Use structure program designing to determine the syndrome elements.3 Use SPSS21.0 to process the data statistically.When patients were enrolled,they were divided into stroke patients without cognitive impairment group,poststroke mild cognitive impairment group and poststroke mild dementia group.When they were followed up 6 months later,they were divided into cognitive impairment improvement group,cognitive impairment stable group and cognitive impairment decline group according to the changes of their cognitive impairment.Analyzed the relationship between diffferect prognosis and different risk factors.Analyzed single syndrome element,and syndrome elements combination characteristics when they were enrolled and followed up 6 months later and these characteristics changes between the two time points of the three prognosis groups.Then analyzed the relationship between syndrome elements and cognitive impairment prognosis from the perspective of each syndrome elements.Results1When the patients were enrolled,the risk factors of poststroke cognitive impairment were hypertension(OR=1.191),coronary heart disease(OR=1.282),cerebrovascular disease(OR=1.227).,moderate to severe stroke,low-literacy.In six months,the risk factor of the exacerbation of poststroke cognitive impairment patients were low-literacy(OR=1.128-2.909)and peripheral vascular disease(OR=2.773).Subgroup analysis showed that the risk factor of the exacerbation of the group without cognitive impairmen were low-literacy(OR=1.413-4.970)and peripheral vascular disease(OR=4.334).The risk factor of the exacerbation of poststroke cognitive impairmen was low-literacy(OR=4.334)2In the aspect of Single-syndrome element,.The elements of all the three groups were mainly phlegm and qi deficiency,and the proportion of Yin deficiency in the 03 group was greater than that of cognitive impairment stable group and 01(P<0.05).In the group of mild cognitive impairment,the proportion of Yin deficiency in cognitive impairment decline group was greater than that of cognitive impairment stable group and cognitive impairment improvement group(P<0.01).In the group of mild dementia,the proportion of phlegm in cognitive impairment decline group was significantly greater than that of cognitive impairment improvement group and cognitive impairment stable group(P<0.05).In 6 months,the proportion of fire and Yin deficiency in cognitive impairment decline group was greater than that of cognitive impairment stable group and 01(P<0.05).The proportion of phlegm,qi deficiency,fire and Yin deficiency was significantly lower than that in the group when the group was enrolled(P<0.05).3In the aspect of number of syndrome elements,in 6 months,the number of elements in cognitive impairment decline group was significantly greater than that in cognitive impairment stable group and 01(P<0.01).The number of syndrome elements in cognitive impairment improvement group and cognitive impairment stable group was significantly smaller than that in the group when the group was enrolled(P<0.01).4In the aspect of two syndrome elements,when the group was enrolled,in the mild cognitive jmpairment group,the proportion of qi deficiency+Yin deficiency and Yang deficiency+ Yin deficiency in cognitive impairment decline group was significantly greater than that of cognitive impairment improvement group and cognitive impairment stable group(P<0.05).In the mild dementia group,the proportion of phlegm+blood stasis and fire+Yang deficiency in cognitive impairment decline group was significantly geater than that in cognitive impairment improvement group and cognitive impairment stable group(P<0.05).In 6 months,the proportion of fire+phlegm,fire+Yang deficiency,fire+Yin deficiency,Yang deficiency+Yin deficiency,Phlegm+Yin deficiency,blood stasis + Yin deficiency,fire+Qi deficiency,fire+blood stasis in cognitive impairment decline group was greater than the proportion of 01 and 02 group.The difference was statistically significant(P<0.05).The proportion of Qi deficiency + phlegm,fire+phlegm,phlegm + blood stasis,phlegm + Yang deficiency and Phlegm + Yin deficiency in cognitive impairment improvement group and 02was significantly smaller than the proportion of the elements in the group when the group was enrolled(P<0.05).5The cognitive impairment prognosis of different syndrome elements group in poststroke cognitive impairment,in 6 months,The groups in which the qi deficiency or yang deficiency disappeared,had a greater proportion of recovery rate of cognitive impairment than the groups that qi deficiency or yang deficiency remained(P<0.05).Conclusions1The risk factors of poststroke cognitive impairment were hypertension,coronary heart disease,cerebrovascular disease.,Moderate to severe stroke,low-literacy.,the risk factor of the exacerbation of the group without cognitive impairmen were low-literacy and peripheral vascular disease.The risk factor of the exacerbation of poststroke cognitive impairment were low-literacy.2The elements of poststroke cognitive impairment were mainly phlegm and qi deficiency,and were the combination of Qi deficiency,Phlegm,fire+blood stasis,Yin deficiency and Yang deficiency.The decrease of the number of syndrome elements and the simplicity of syndrome elements combination helped prevent the exacerbation of cognitive impairment.The persistent existence of elements and its combination can promote the decline of cognitive ability.3In poststroke mild cognitive impairment,Yin deficiency would increase the risk of the decline of cognitive ability,especially with Qi deficiency+Yin deficiency,and Yin deficiency+Yang deficiency;In poststroke mild dementia,Phlegm or Yang deficiency+fire increased the risk of the decline of cognitive ability,especially with Phlegm+blood stasis.In the process of the disease,the persistent existence of Yin deficiency and fire,especially with the interaction of phlegm,would promote the decline of cognitive ability;while the decrease of Qi deficiency and Yang deficiency will promote the recovery of cognitive ability.To sum up,to treat the disease,on one hand,we should make up the deficiency of the body;on the other hand,we should adopt the method of clearing heat,dissipating phlegm and removing blood stasis. |
