| Vascular dementia(VD)is a group of clinical syndromes mainly caused by advanced neurocognitive dysfunction which caused by ischemic,acute and chronic ischemic hypoxia and hemorrhagic cerebrovascular diseases.Due to the acceleration of the aging process of the population,the prevalence rate of VD is increasing year by year,but such patients have insufficient awareness of the disease and low outpatient treatment rate,which causes a serious burden on families and society.Up to now,the pathogenesis of VD is not clear,there is no reasonable,applicable and unified diagnostic criteria,the treatment methods are limited,and the clinical benefits are not significant.VD,however,is the only type of dementia that can be prevented,and early intervention can be reversible.Traditional Chinese medicine considers VD as the syndrome of intrinsic deficiency,the investigation and study of TCM syndrome showed that VD was mainly manifested in deficiency of kidney and blood stasis,and often occur in combination.Therefore,it is of great practical significance to study the risk factors of VD(syndrome of virtual blood stasis)and its clinical manifestations in traditional Chinese medicine,as well as establish a clinical diagnosis prediction model.Objective:to explore the risk factors of VD(deficiency and stasis syndrome),analyze its clinical manifestations in traditional Chinese medicine,and establish a predictive model for clinical diagnosis,so as to provide a new way of thinking for VD TCM syndrome diagnosis,and provide a basis for the early prevention and treatment of this disease.Materials and methods:1.Data source:the data based on questionnaires that collected in jingzhuang town and shenjialing town,yanqing district,Beijing from June to November 2018.This study screened 170 cases of VD(deficiency of blood stasis)patients and 170 cases of non-vd(deficiency of blood stasis)patients according to inclusion and exclusion criteria,and defined them as VD group and ND group respectively.Demographic data,living data,concomitant diseases,family history,TCM characterization information,as well as the simple intelligent mental state scale,Hachinski ischemia scale and other information were collected.2.Research methods2.1 Study on risk factors of VD(deficiency and stasis syndrome)and analysis of clinical manifestations of traditional Chinese medicine:in this study,the data of VD group and ND group were analyzed retrospectively.The descriptive analysis of measurement data was represented by mean±standard deviation(x±s).Those with normal distribution and homogeneous variance were tested by t test of two independent samples,while those with non-normal distribution or heterogeneous variance were tested by non-parametric test.The counting data were tested by chi-square test.Finally,the risk factors and main clinical manifestations of VD(deficiency and stasis)were screened.2.2 Establish and verify the clinical prediction model of VD(deficiency and stasis syndrome):all the above samples were randomly divided into the modeling group and the validation group in a ratio of 2:1.Univariate logistic regression analysis and multivariate logistic regression analysis were carried out on the data of the modeling group to screen the predictors and establish the model.The model was verified from three aspects of differentiation degree,consistency and DCA decision curve analysis by using the verification group data,and VD(virtual stasis syndrome)nomogram was finally drawn.Research results:1.The risk factors of VD(deficiency of blood stasis syndrome)were obtained based on the difference analysisThis study found statistical differences in age,gender,occupation,education,sleep duration,hypertension,coronary heart disease,diabetes,hyperlipidemia,history of cerebrovascular disease,and family history of stroke between the two groups(P<0.05),there were statistically significant differences in the characteristics of Chinese medicine including intelligence decrease,lumbar acid weakness,mechanical silence,cyanosis,nocturia,tinnitus,tongue quality,tongue coating color(P<0.05),the specific results are as follows:1.1 Demographic dataThe mean age of VD group was 67.65±7.01 years,and that of ND group was 66.00±9.29 years,with statistically significant differences(P<0.05).Compared with the ND group,the proportion of men in the VD group(48.82%)and the proportion of people with less than high school education(100.00%)was higher than that in the ND group(31.18%and 98.82%),with statistically significant differences(P<0.05).The mean BMI was 34.89±7.01 in VD group and 24.20±3.55 in ND group,with no statistically significant difference(P>0.05).Compared with ND group,the proportion of heavy manual workers in VD group(100.00%)was higher than that in ND group(90.59%),and the difference was statistically significant(P<0.05).1.2 Living materialsCompared with ND group,the VD group's sleeping hours of 7h/day(51.76%)was higher than that of ND group(40.59%),and the difference was statistically significant(P<0.05).There was no significant difference in smoking history,drinking history and exercise habits between the two groups(P>0.05)1.3 Associated diseasesCompared with the ND group,the VD group had a higher proportion of hypertension(77.65%),history of cerebrovascular disease(78.82%),coronary heart disease(13.53%),diabetes(30.00%),and hyperlipidemia(18.82%)than the ND group(45.88%,7.65%,5.29%,17.65%,6.47%),with statistically significant differences(P>0.05).1.4 Family historyCompared with ND group,the proportion of VD group patients with a family history of stroke was higher(10.00%)than that of ND group(2.94%),and the difference was statistically significant(P<0.05)There was no statistically significant difference between the two groups in family history of hypertension,family history of diabetes,family history of coronary heart disease,and family history of hyperlipidemia(P>0.05).2.TCM characterization analysisCompared with the ND group,the VD group showed more significant signs of intelligence decrease,lumbar acid weakness,mechanical silence,cyanosis,nocturia,and tinnitus,with statistically significant differences(P<0.05).However,there was no statistical difference between the two groups(P>0.05)Compared with ND group,the proportion of tongue red(39.41%)and dark(31.18%)in VD group was higher than that in ND group(28.24%and 9.41%).The tongue coating color of VD group was 35.29%,ND group 24.71%.The difference was statistically significant(P<0.05).Tongue coating thickness and pulse diagnosis were no statistically different between the two groups(P>0.05).3.Establish and verify the clinical prediction model of VDThe clinical prediction model of VD(deficiency and stasis syndrome)was established,and the formula was as follows:P=1/(1+exp(-(history of cerebrovascular disease*1.123009+family history of stroke*1.701957+hypertension*1.247617+hyperlipidemia*1.079337+lumbar acid fatigue*0.7704542-sex*1.407806-sleep duration*1.121451+0.5259097))The model was verified with the validation group data,and the results of the discrimination verification showed that the area under the ROC curve of the model in the modeling group and the validation group was 0.9061 and 0.8902 respectively.In consistency verification,Unreliability test P=0.756>0.05.The clinical decision curve analyze is in the region above the range enclosed by the extreme dashed line.All three verifications passed.Conclusion:according to the statistical results,age,gender,occupation,educational background,sleep duration,history of cerebrovascular disease,hypertension,coronary heart disease,diabetes,hyperlipidemia and family history of stroke are all risk factors for VD.Intelligence decrease,lumbar acid weakness,mechanical silence,cyanosis,nocturia,tinnitus,tongue quality,tongue coating color are its main TCM characteristics.According to the test results of the three models,it can be considered that a clinical diagnosis prediction model with good differentiation,good consistency and certain clinical practical value has been established.This study is an exploratory study,and the established prediction model has a good net clinical benefit through examination,which provides a new research idea and method for studying VD syndrome diagnosis of traditional Chinese medicine.Through continuous improvement in the future,it will provide simple and effective means for prevention and screening of different syndrome types of VD TCM,and achieve "accurate diagnosis and treatment". |
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