Clinical Observation On The Diagnostic Criteria Of Phlegm Syndrome In Different Stages Of Ischemic Stroke

ObjectiveTo evaluate the reliability and validity of the Standards of Syndrome Differentiated Diagnosis in Apoplexy(1994)for Ischemic Stroke TCM Syndrome diagnosis(Criterion 1994),the Ischemic Stroke TCM Syndrome Factor Diagnosis Scale(Criterion 2011),the Diagnostic Criteria of TCM Phlegm Syndrome(Criterion 2016)with the Phlegm-Syndrome patients during the acute phase of stroke or the convalescent phase.And to provide objective basis for clinical applicationMethodsTaking patients with ischemic stroke during the acute phase or the convalescent phase in our hospital as subjects,collect their general information(including TCM clinical signs and symptoms)and diagnosis each patient with all the three criteria when they were on admission.Divided all the patients into two groups,the Phlegm-syndrome group and the non-Phlegm-syndrome group,according to Criterion 1994.Using diagnostic test method to compare the Sensitivity,Specificity,Positive likelihood Ratio and Diagnostic Odds Ratio of each criteria.Results1.384 patients with ischemic stroke were recruited,including 264 in acute phase and 120 in convalescent phase.There were 255 men(66.4%)and 129 women(33.6%),and among them the oldest is 90 year-old and the youngest is 32 year-old.223 of the patients were diagnosed with Phlegm-syndrome,including 159(60.2%)in the acute phase,while 161 were non-Phlegm-syndrome.2.Diagnostic test results indicated that Criterion 1994,2011 and 2016 have a high consistency in diagnosis of phlegm-syndrome,with Kappa were 0.706,0.645,0.656 respectively.During the ac ute phase of stroke,the sensitivity and specificity of Criterion 2011 were 0.943 and 0.667,the positive likelihood ratio was 2.832,diagnostic odds ratio was 33.317,while the sensitivity and specificity of Criterion 2016 were 0.893 and 0.676,the positive likelihood ratio was 2.756,diagnostic odds ratio was 17.443.In the convalescent phase,Criterion 2011's sensitivity and specificity were 0.891 and 0.946,the positive likelihood ratio was 16.493,diagnostic odds ratio was 143.417.And the sensitivity and specificity of Criterion 2016 were 0.938 and 0.821,positive likelihood ratio was 5.240,diagnostic odds ratio was 69.867.3.Among 23 kinds of phlegm related symptoms studied,the symptoms with the highest frequency are greasy coating(51.8%),slippery pulse(51.8%),dizziness(48.4%),TG>1.70mmol/L(31.0%),obesity(23.4%),top-heavy(17.2%),sticky and greasy in mouth(17.2%),expectoratio n or phlegm in larynx(15.3%),loss of appetite(13.8%),dullness of mind or drowsiness(13.8%),headache(13.5%),LDL>3.64mmol/L(13.0%),BMI>28(13.0%),thick fur(9.4%),dull expression(6.7%),teeth-marked tongue(5.9%),TC>5.72mmol/L(5.9%),plump tongue(4.2%),thirsty but not eager for drinking(3.4%),diarrhea(3.1%),choking sensation in the chest and abdomen(1.6%),slipper fur(1.0%),snoring(0%).Further analysis suggests that greasy coating,slippery pulse,plump tongue,teeth-marked tongue,expectoration or phlegm in larynx,dullness of mind or drowsiness,thick fur,BMI>28,LDL>3.64mmol/L,obesity have a statistical difference between phlegm-syndrome group and non-phlegm-syndrome group.As for different phases of stoke,dizziness,top-heavy,sticky and greasy in mouth,LDL>3.64 mmol/L,headache,teeth-marked tongue,TC>5.72mmol/L,thirsty but not eager for drinking,diarrhea,slipper fur also show a differe nc e.Conclusion1.Phlegm-syndrome do play an important role in Ischemic stroke Syndrome Differentiation.2.The Ischemic Stroke TCM Syndrome Factor Diagnosis Scale may serve as the diagnosis criteria in Ischemic stroke TCM Syndrome differentiation research and clinical practice.The Diagnostic Criteria of TCM Phlegm Syndrome,as a generalized phlegm-syndrome differentiation standard,is better to be used with other Ischemic Stroke TCM Syndrome diagnosis standards.