Prelimary Discussion On The Stroke Outcome Location Of Syndrome Effect Evaluation

ObjectiveTake stroke for example, to explore and solve the issues that the confusing application in syndrome diagnostic indicators and syndrome effect evaluation indicators by reviewing the researches and papers on the basic constitute elements of syndrome diagnosis. And the location of outcome level measured by syndromes is unclear,by analyzing the relationship between syndrome scores variation with other outcomes indicators (NIHSS, QOL-BREF and ADL).Method1. Literature analysis1.1 From the view of Clinical Epidemiology/DME,study the textbooks "Diagnostics of Chinese Medicine"," criteria of diagnosis and therapeutic effect of diseases and Syndromes in Traditional Chinese Medicine"(1994)published by State Administration of Traditional Chinese medicine and concepts of syndrome related literature, to analyze the basic constitute elements of syndrome diagnosis; Study the criteria of stroke syndrome diagnosis and efficacy evaluation and compare their characteristics, composition and relationships.1.2 To study the location of outcome level measured by syndromes through sorting the documents about classification of modern medicine disease outcomes, outcomes indicators, evaluation methods and combing the contents of syndrome study.2. Clinical data of stroke StudyApply statistical methods of cluster analysis, Bayesian network, canonical correlation, generalized estimating equations to reanalyze the stroke database with 522 cases in order to discuss the dynamic changes of syndrome evaluation elements of stroke syndrome and its relationship with other outcomes indicators (NIHSS, QOL-BREF and ADL). Result1. Five classification elements of syndrome diagnosis (cause of disease, disease-bit, disease properties, disease potential and pathogenesis) are selected and analyze their connotation by a literature study;2. The classification of diseases outcome includes 3 categories:impairment, disability, handicap; the evaluation of impairment conclude the evaluation of biological indicator, evaluation of important symptoms and signs and the evaluation of laboratory equipment inspection; the evaluation of disability is mainly the assessment of activities of daily living; while, the evaluation of handicap is mainly to assess the quality of life or other special scales for certain diseases;3. The syndrome admission diagnosis of Stroke mainly include single syndrome diagnosis, composite syndrome diagnosis.the frequencies of tan syndrome, feng syndrome,huore syndrome are relative taller in single symdrome;while in the composite syndrome diagnosis the most common combination are fengtan syndrome, fengtan qixu syndrome, fenghuotanyu syndrome, fenghuotanyuqixu syndrome, fenghuo syndrome,tanhuo syndrome, tan qixu syndrome, fengtanyuqixu syndrome.4.Screening several items of syndrome diagnosis of stroke which are not suitable for syndrome effect evaluation as follows:the disease is more abrupt onseto(?)the condition of disease reached the peak in 24 hours o(?) he condition of disease reached the peak in 48 hours;5. The correlation analysis of syndrome scores variation and NIHSS scores variation at different observation points: 6. The correlation analysis of variation between syndrome scores and ADL, QOL-BREF scores at the observation points from 28d to 3m feng syndrome,qi deficiency syndromeof ischemic strokes and hemorrhagic stroke integrally have relationship with ADL score variation.7. The 6 syndromes of stroke and the average NIHSS scores have same change trend, all changes with time were downtrend. the change of NIHSS scores have significant effect on the wind syndrome, the fire syndrome, phlegm syndrome, deficiency syndrome, Yin deficiency with yang excess syndrome except blood stasis syndrome; With the extension the average scores of the six syndromes of all patients at treatment are declining, and the wind syndrome, the fire syndrome, the blood stasis syndrome, Yin deficiency with yang excess syndrome,the change of syndrome scores are not significant after the fourth treatment (14d); the change of Phlegm-syndrome in the treatment of the fifth times(after 28d)is not significant; the significant change of qi deficiency syndrome has no cut-time pionts.8.Canonical correlation analysis concluded that certain symptoms of stroke,for example feng symdrome-eyes have a strong correlation with eye movements of NIHSS scale;qi deficiency syndrome-limbs also have a strong correlation with the items taking medicine,having meals,clothing, using public transportation of ADL scale; Phlegmy syndrome -the tongue body have a strong correlation with the items questions,dysarthria of NIHSS scale; symptoms of stroke,ADL,NIHSS can be explained each other by canonical correlation variable with a fair proportion between 35%-58%.Conclusion1 Syndrome Diagnostic elements are different from syndromes effect evaluation elements;2 The major aspects that Syndromes effect evaluated are the patient's feelings---symptoms and signs which belongs to "impairment" level of modern medicine.3. The relevance between the syndrome dynamic change of Stroke and modern medical evaluation scale (NIHSS, ADL, QOL-BREF) are overall not strong, but certain TCM symptoms of ischemic stroke have a strong correlation with some items of ADL scales and NIHSS, symptoms of stroke ADL, NIHSS can be explained each other by canonical correlation variable with a fair proportion.