Lacunar Infarction Associated With Anxiety And Depression And Tcm Syndrome Correlation Analysis

Study objective(1) Through clinical observation, to conduct comparative study of the TCM symptom anddistribution characteristics of cerebral lacunar infarction (LI) and post-LI anxiety or depression.(2) Based upon this, to explore the pathogenesis of post-LI anxiety or depression andsearch for the relevant risk factors of post-LI anxiety or depression so as to provide theobjective rationales for TCM control regimen of post-LI anxiety or depression.Study methodThe subjects of clinical observation were the hospitalized patients at Dongfang Hospitaland Dongzhimen Hospital. The inclusion and exclusion criteria were formulated based upon thecommonly accepted diagnostic ones and considered in conjunctions with the auxiliary scales. Atotal of 43 LI patients were selected. Among which, there were 26 cases of LI accompanied byanxiety or depression in the observation group and 17 cases of simple LI in the control group.The comparative study of cases was adopted to perform comparative analysis upon such factorsas gender, age and hypertension, etc. of two patient groups. At the same time, the scale scoringand syndromatologic observation were used to formulate and standardize the case report form.The underlying standards were as follows: (1) The diagnostic criteria of cerebral lacunarinfarction were referred to those of Diagnostic Essential Points of MiscellaneousCerebrovascular Diseases as revised at the 4th CMA National Conference on CerebrovascularDiseases in 1995; (2) The diagnostic criteria of anxiety and depression were adopted from thoseof CCMD-3, widespread anxiety and depression as promulgated recently in China in 2001; (3)The diagnostic criteria of stroke and collateral stroke were in accordance with the Diagnosis andEfficacy Evaluation Standards of Stroke as prepared and formulated by the SATCMCooperative Group on Emergency Cerebropathies in 1996; (4) The diagnostic criteria of strokesyndromatology were based upon (State Science and Technology CommissionProblem-tackling Project "85-919-02-01 Stroke Syndromatology and Clinical Diagnosis Study"Topic Group, Diagnostic Criteria of Stroke Syndromatology as formulated by SATCMCooperative Research Group on Emergency Cerebropathies; The evaluative standard ofnervous function deficit degree was assessed with the National Institutes of Health Stroke Scale(NIHSS).The adopted scales included:(1) Symptom self-scoring scale (SCL-90);(2) The evaluative standard of nervous function deficit degree was assessed with NationalInstitutes of Healh Stroke Scale (NIHSS);(3) Diagnostic and evaluative scale of stroke syndromatology: Referred to the State Scienceand Technology Problem-tackling Project "85-919-02-01 Stroke Syndromatology and ClinicalDiagnosis Study" Topic Group, Diagnostic Criteria of Stroke Syndromatology as formulated bySATCM Cooperative Research Group on Emergency Cerebropathies, stroke could be divided into six major syndromatologic groups, wind syndrome, fire-heat syndrome, phlegm syndrome,blood-stasis syndrome, Qi-deficiency syndrome and Yin-deficiency-Yang-excess syndrome.Qi-stagnation and blood-deficiency syndromes were added upon this basis.The SPSS 12.0 statistic software was employed to analyze the above clinical and laboratoryresearch data.Results:A total of 43 LI patients were collected. There were 17(39.5%) of simple LI patients and26(60.5%) patients of LI accompanied by anxiety or depression.(1) The statistic analysis was performed for two patient groups in terms of gender, age andeducational level. P all＞0.05, no statistic difference.(2) The statistic analysis was performed for two patient groups in terms of basal diseases:history of hypertension, DM, CHD and hyperlipidemia. P all＞0.05, no statistic difference.(3) For two patient groups, t test was performed on the NIHSS scores. The results were asfollows: variance homogeneity test P=0.8703, so two data groups had the same variance. Whentwo groups of means were compared, P=0.84＞0.05, no statistic difference;(4) Correlation analysis of LI accompanied by anxiety or depression and nervous systemdeficit score: Because nervous system deficit scores for LI cases collected by now were allclassified as "mild", and the scores were classified into three grades: 0-5, 5-10 and 11-13 forstatistic convenience, and the statistic result showed p=0.9752＞0.05, that is, there was nostatistic correlation between the incidence rate of LI accompanied by anxiety or depression andnervous system deficit score "mild" grading.(5) Correlation analysis of LI accompanied by anxiety or depression and maximal lesiondiameter: The maximal lesion diameters were classified into four grades: 1-5mm, 6-10mm,11-15mm and 16-20mm. The statistic result showed P=0.2742＞0.05, that is, there was nocorrelation of occurrence of LI accompanied by anxiety or depression and maximal lesiondiameter.(6) Correlation analysis of LI accompanied by anxiety or depression and lesion foci: Thelesion foci classification was as follows: at left hemisphere, at right hemisphere, and at bothhemisphere, or in anterior part, in posterior part and in both parts. The statistic result showedp＞0.05, that is, there was no correlation of occurrence of LI accompanied by anxiety ordepression and disease foci (Note: The anterior part was the distance from lesion foci anteriorend to frontal pole＜40% frontal-occipital pole distance).(7) Correlation analysis of LI accompanied by anxiety or depression and daily smokingamount, activity level or occupation: The daily smoking amount was classified as＞10cigarettes/day and＜10 cigarettes/day, and the activity level three kinds: frequent exercise,normal activity, sedative or lazy, and the occupation three kinds: physical labor mainly, physicallabor or mental labor partly and mental labor mainly. The statistic results showed p value all＞0.05, that is, there was no correlation of occurrence of LI accompanied by anxiety ordepression and daily smoking amount, activity level or occupation.(8) The statistic analysis was performed for two patient groups in terms of occurringfrequencies of each syndrome, P all＞0.05, no statistic difference.(9) Correlation analysis of LI accompanied by anxiety or depression and TCMsyndromatology: ①Upon statistic analysis, the only syndrome with a linear relationship with anxiety was x6,i.e. Yin deficiency&: Yang excess syndrome. The linear regression equation was:Y=36.579+1.948x6.②The syndromes with a linear relationship with depression were x6 and x8, i.e. Yindeficiency & Yang excess syndrome and blood deficiency syndrome. The linear regressionequation was: Y=34.086+1.132x6+1.220x8.Conclusion:(1) The occurrence of post-LI anxiety or depression had no correlation with gender, age,educational level, basal disease history, nervous system deficit score, lesion diameter, smokinghistory, occupation, activity level, disease foci (AP) or disease foci (LR).(2) Simple LI and LI accompanied by anxiety or depression showed no difference indistribution of TCM syndromatology.(3) The scores of LI accompanied by depression and Yin deficiency & Yang excess syndromeand blood deficiency syndrome were positively correlated; The scores of post-LI accompaniedby anxiety and Yin deficiency & Yang excess syndrome were positively correlated.