The Study On The Relationship Between Fundus Arteriosclerosis And TOAST Of Cerebral Infarction And TCM Syndrome Types

ObjectiveThrough the analysis of the degree of arteriosclerosis of the fundus in patients with acute cerebral infarction,TOAST classification and TCM syndrome type,this paper discusses the correlation between the degree of arteriosclerosis of the fundus in patients with acute cerebral infarction,TOAST classification and TCM syndrome type,so as to provide new ideas for the effective prediction of the occurrence of cerebral infarction and the treatment and prevention from the aspect of TCM.MethodsPatients who suffered from ischemic stroke within 14 days from January 2018 to November 2019 were selected to be admitted to the Department of Neurology of Shenzhen Second People’s Hospital for treatment and fundus photography.According to the results of fundus photography,acute cerebral infarction patients with fundus arteriosclerosis were selected as the case group(fundus arteriosclerosis group)and those without fundus arteriosclerosis as the control group(no fundus arteriosclerosis group).The fundus with arteriosclerosis was graded.According to the cause of cerebral infarction,acute cerebral infarction can be divided into three types according to the toast(trial of org10172 in acute stroke treatment),namely,cardio embolic(CE),large-scale atherosclerotic(LAA),occlusion sall artery occlusive(SAA),stroke of other induced competition,SOE)and stroke other unexplained rate etiology(SUE).To explore the correlation between the degree of fundus arteriosclerosis and toast in patients with acute cerebral infarction.According to the syndrome differentiation standard of TCM,acute cerebral infarction patients are divided into Qi deficiency syndrome,yin deficiency and yang hyperactivity syndrome,wind syndrome,fire heat syndrome,phlegm syndrome and blood stasis syndrome,to explore the correlation between acute cerebral infarction with fundus arteriosclerosis and various syndrome types of TCMResults1.among 203 patients with acute cerebral infarction,162(79.8%)had fundus arteriosclerosis,41(20.2%)had no fundus arteriosclerosis.Among them,65(40.12%)were grade Ⅰ,78(48.15%)grade Ⅱ,19(11.73%)grade Ⅲ,and grade Ⅳ.2.(1)The number of patients with hypertension,diabetes,hyperlipidemia and coronary heart disease in the group of arteriosclerosis of the fundus was significantly higher than that in the group without arteriosclerosis of the fundus(P=0.006,0.043,0.026),and the number of patients with arteriosclerosis of the fundus was significantly higher than that in the group without arteriosclerosis of the fundus(P=0.006,0.043,0.026),The results showed that systolic blood pressure(t=2.078,P=0.039),LDL-C(Mann Whitney U=2457.500,P=0.010),HCY(Mann Whitney U=1902.500,P=0.000),fasting blood glucose(Mann Whitney U=1639.500,P=0.000),glycosylated hemoglobin(Mann Whitney U=2421.000,P=0.007)was higher than that of the group without arteriosclerosis.3.Multivariate logistic regression analysis of ocular fundus arteriosclerosis in patients with acute cerebral infarction;hypertension,diabetes mellitus,homocysteine value and ocular fundus arteriosclerosis have significant correlation,the risk of ocular fundus arteriosclerosis in patients with hypertensive cerebral infarction is 24.4%higher than that in patients without hypertension(OR=0.244,95%CI:0.070-0.846),and that in patients with diabetic cerebral infarction is 24.4%(OR=0.244,95%CI:0.070-0.846).The relative risk increased by 19.7%(OR-0.197,95%CI:0.077-0.506)and 1.171 times(1.056-1.298)for each 1mmol/L increase of homocysteine.4.(1)According to the logistic regression analysis of TOAST classification and other influencing factors of ophthalmic arteriosclerosis,the odds ratio was calculated with the small artery occlusion as the reference variable.The relative risk of ophthalmic arteriosclerosis in patients with large atherosclerotic cerebral infarction was 5.026 times higher than that in patients with small artery occlusion(OR=5.026,95%CI:1.843-13.705);(2)TOAST classification of ophthalmic arteriosclerosis Kruskal Wallis H test showed that the difference was statistically significant(χ2=32.934,P=0.000),suggesting that there was significant difference in different subtypes of toast.By the nemenyi test,there were significant differences between small artery occlusion and large atherosclerosis(P=0.000),unknown cause and large atherosclerosis(P=0.003),and the degree of fundus arteriosclerosis was more serious in patients with large atherosclerosis.5.(1)According to the Logistic regression analysis of TCM Syndrome Types and related influencing factors,the superiority ratio was calculated with Qi deficiency syndrome as reference variable.The results showed that phlegm syndrome and blood stasis syndrome were significantly correlated with fundus arteriosclerosis.The relative risk of fundus arteriosclerosis in patients with phlegm cerebral infarction was 3.579 times higher than that in patients with Qi deficiency cerebral infarction(OR=3.579,95%CI:1.016-12.600);the patients with blood stasis cerebral infarction the relative risk of fundus arteriosclerosis was 4.245 times higher than that of cerebral infarction patients with Qi deficiency syndrome(OR=4.245,95%CI:1.130-15.947);(2)the classification of fundus arteriosclerosis in fundus arteriosclerosis group by Kruskal Wallis H test showed that the difference was statistically significant(χ2=38.625,P=0.000),showing that the degree of fundus arteriosclerosis was not the same in patients with different syndromes of traditional Chinese medicine The results showed that there were significant differences in the degree of fundus sclerosis between the patients with Yin deficiency and yang hyperactivity syndrome phlegm syndrome(P=0.001),Qi deficiency syndrome phlegm syndrome(P=0.001),wind syndrome phlegm syndrome(P=0.000).The degree of fundus arteriosclerosis in the patients with phlegm syndrome was more serious than that in the patients with Yin deficiency and yang hyperactivity syndrome,Qi deficiency syndrome and wind syndrome.Conclusion1)There is a significant correlation between the arteriosclerosis of the fundus of the patients with acute cerebral infarction and the values of hypertension,diabetes and homocysteine.Hyperlipidemia,coronary heart disease,smoking,drinking and insomnia also have some influence on the arteriosclerosis of the fundus of the patients with acute cerebral infarction.2)There is a correlation between the arteriosclerosis of the fundus in patients with acute cerebral infarction and the type of large atherosclerosis in toast,and the degree of arteriosclerosis of the fundus in patients with large atherosclerosis is more serious.3)There is a correlation between the arteriosclerosis of the fundus of the patients with acute cerebral infarction and the syndrome of phlegm and blood stasis in the syndrome type of traditional Chinese medicine,and the degree of arteriosclerosis of the fundus of the patients with phlegm syndrome is more serious.