| Objective:In order to know the occult downward trend of cognitive in the patients of acute phase of ischemic stroke with virtual class certificate and real class certificate,and provide a basis for imaging in the syndrome differentiation of traditional Chinese medicine(TCM).Using new imaging data processing method to estimate the degree of brain atrophy of the patients,Combined with the cognitive assessment of patients and the quantitative scoring of TCM deficiency and excess syndromes,to explore the acute phase of ischemic stroke in patients with cerebral atrophy,cognitive function and the correlation between and among the actual class certificate of TCM.Methods:From October 2018 to February 2019,patients in the acute stage of ischemic stroke in the department of neurology,Dongzhimen Hospital of Beijing University of Chinese Medicine were collected.Relevant data of patients were collected on the day of admission.And eligible patients were included in the study according to inclusion and exclusion criteria.On the day of admission,patients were diagnosed with TCM syndrome elements.And based on the diagnostic results of syndrome elements,all patients were divided into deficiency syndrome group and excess syndrome group according to whether there were deficiency syndrome(Qi deficiency and Yin deficiency).All patients were evaluated by syndrome quantification score and National Institute of Health stroke scale(NIHSS)score.The cognitive was assessed by the Beijing Version of Montreal Cognitive Assessment Scale(MoCA)and the Mini-Mental State Examination(MMSE)at 14 days after stroke onset.Meanwhile,the patients with 24 items of Hamilton Depression Scale(HAMD-24)>20 points and 14 items of Hamilton Anxiety Scale(HAMA-14)>14 points were excluded.Finally,11 cases of deficiency syndrome group and 7 cases of excess syndrome group were included.All patients were scanned by thin slice scan of MRI.Processing and calculating the MRI 3D-T1 data by using Docker Bids/Baracus Docker images and FreeSurfer software,and brain atrophy indices such as brain age,mean cortical thickness of each brain area,cortical mean curvature,volume of each brain structure were obtained.The difference between brain age and'actual physiological age was a quantitative index for comprehensive brain atrophy.For the collected effective data,SPSS 25.0 was used for statistical analysis of the macro data,and R 3.5.2 was used for statistical analysis of the micro data.Results:1.There was no significant difference in demographic data,past medical history,smoking and drinking history between the deficiency syndrome group and the excess syndrome group of ischemic stroke(p>0.05).There was no significant difference in the total scores and item scores of MoCA and total scores of MMSE between deficiency syndrome group and excess syndrome group(p>0.05).The naming and orientation of patients with cognitive impairment in acute stage of ischemic stroke were significantly lower than those without cognitive impairment(p<0.05).There was no significant difference in other cognitive fields(p>0.05).2.In the correlation analysis between TCM syndrome elements and MoCA and MMSE scores,the quantitative scores of phlegm-dampness syndrome were negatively correlated with the total scores of MoCA(r=-0.579,p=0.030),MMSE(r=-0.569,p=0.034)and the delayed recall scores of MoCA scale(r=-0.560,p=0.037);the other TCM syndrome elements had no significant difference with the total scores and item scores of MoCA and total scores of MMSE(p>0.05).3.There were significant differences in cortical thickness of 1 brain area and volume of 9 brain structures between patients with cognitive impairment and patients without cognitive impairment(p<0.05),and the degree of atrophy was more severe in the cognitive impairment group than in the non-cognitive impairment group.The total score of MoCA was positively correlated with the cortical thickness of 10 brain regions and the volume of 14 brain structures(p<0.05),negatively correlated with the mean curvature of 1 brain region(p<0.05).The total score of MMSE was positively correlated with the cortical thickness of 15 brain regions and the volume of 11 brain structures(p<0.05),negatively correlated with the mean curvature of 1 brain region(p<0.05).There was no significant correlation between the comprehensive quantitative indices of brain atrophy and the total scores of MoCA and MMSE(p>0.05).4.There were significant differences in cortical thickness of 1 brain region,brain structure volume of 1 region and mean curvature of 13 brain regions between deficiency and excess syndrome groups(p<0.05),and the differences in atrophy index of these brain regions were more serious in the excess syndrome group than in the deficiency syndrome group.5.In the correlation analysis of brain atrophy index and syndrome elements in each brain region,the endogenous wind syndrome,endogenous fire syndrome and phlegm-dampness syndrome were respectively related to brain atrophy index in different brain regions(p<0.05),and no brain atrophy index was significantly related to Qi deficiency syndrome.The sample size of blood stasis syndrome and Yin deficiency syndrome is too small to make statistical analysis.Conclusion:1.The cognitive impairment of patients with acute ischemic stroke is mainly manifested in the deficiency of naming and directivity.2.Phlegm pathogen is the main pathological factor leading to cognitive decline even mild dementia in patients with acute ischemic stroke.3.Post-stroke cognitive impairment is closely related to brain atrophy in frontal,insula,temporal and parietal lobes,which are highly coincident with the default mode network in the brain functional network.4.For the patients with acute ischemic stroke,the effect of excessive Biao is greater than that of deficiency Ben;different TCM syndromes have different effects on brain atrophy indices in different brain regions. |
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