Study On Distribution Of TCM Syndromes And Prediction Model Of Carotid Arteriosclerosis

Objective: To explore and summarize the composition and distribution characteristics of traditional Chinese medicine syndrome of carotid atherosclerosis,screen the risk factors of carotid atherosclerosis,establish a clinical prediction model and verify it.Methods: 1.Study on the distribution characteristics of TCM syndromes: 303 patients with carotid atherosclerosis were included,and clinical data including general data,associated diseases,relevant blood indicators,carotid color ultrasound,TCM syndromes and other clinical data were collected.The subjects were differentiated into different syndromes,the distribution characteristics of syndromes were analyzed,and the correlation be tween different syndromes and clinical data was discussed.2.Establishment and validation of a predictive model of carotid atherosclerosis: 547 inpatients were included and divided into 303 cases of carotid atherosclerosis group and 243 cases of non-carotid atherosclerosis group according to the results of Doppler ultrasound.Related data were collected in the form of questionnaire.Variables with differences between the two groups were selected and included in univariate and multivariate logistic regression analysis to obtain the clinical prediction model of carotid atherosclerosis and draw the receiver operating characteristic(ROC)curve.A Nomogram model was established and the calibration curve was drawn to evaluate the effectiveness of the model.Seventy-five cases were included to validate the prediction model.Results: 1.The highest frequency of single syndrome of carotid atherosclerosis was phlegm turbidity syndrome(157cases,51.8%).The other top five syndromes were qi deficiency syndrome(121 cases,39.9%),Yin deficiency syndrome(112 cases,37.0%),blood stasis syndrome(96 cases,31.7%),and qi stagnation syndrome(61 cases,20.1%).The combination of the two syn DROmes accounted for the largest proportion(236 cases,77.8%),and the top five were qi defic iency and phlegm obstruction syndrome(40 cases,16.9%),qi and Yin deficiency syndrome(36 cases,15.3%),phlegm heat accumulation syndrome(31 cases,13.1%),qi stagnation and blood stasis syndrome(26cases,11%),and phlegm and blood stasis syndrome(2 4 cases,10.2%).2.There was a significant difference in the proportion of each syndrome type complicated with cerebral infarction between the two syndromes(P < 0.05),and the proportion of cerebral infarction was the highest in patients with the syndrome of mutual association of phlegm and blood stasis.3.The syndrome of Qi stagnation and phlegm obstruction was correlated with triglyceride(TG)(correlation coefficient=0.179,P < 0.05),and the syndrome of phlegm heat was correlated with apolipoprotein B(Apo-B)and lipoprotein(α)(LP(α)(correlation coefficient =0.13,0.149,P < 0.05).4.There were significant differences in the maximum plaque length among various syndromes(P < 0.05),and the maximum plaque length in patients with the syndrome of mutu al association of phlegm and blood stasis was longer than that in patients wit h other syndromes.5.The final model based on logistic regression was constructed by Age,high blood pressure,smoking and low density lipoprotein:Logit P=11.884+0.189Age+1.707 Sm oke+0.667HTN+0.526 LDL.Hosmer-Lemeshow test was calculated to be 0.894,and AUC(area unde r curve)was 0.924(95%CI:0.902,0.945).The critical sensitivity and specificity were 82.8% and 87.3%,indicating that the model had good predictive performance.6.The model verification results show that the sensitivity is 78.6%,the specificity is81.8%,and the accuracy is 80.0%.Conclusion: 1.Deficiency and deficiency should be considered in the syndrome differentiation of carotid sclerosis.Qi,phlegm,blood stasis and deficiency are the important pathologi cal factors of its occurrence and development.2.The increase of blood lipid index in patients with carotid atherosclerosis is closely related to phlegm and evil spirits,the maximum plaque length of carotid artery is related to phlegm turbidity and blood stasis,and the probability of cerebral infarction complicated by phlegm and blood stasis is increased;3.The final model based on logistic regression was constructed by age,hypertension,smoking and low density lipoprotein.4.The prediction efficiency o f the established model is good,which is helpful to predict the risk of carotid atherosclerosis in newly diagnosed patients in clinical work and evaluate the necessity of further examination.