Analysis Of TCM Syndrome Characteristics Of Amyotrophic Lateral Sclerosis

ObjectiveTo explore characteristics of Traditional Chinese Medicine(TCM)syndromes in patients with amyotrophic lateral sclerosis(ALS),and its influence on prognosis,so as to provide evidence for differentiation of syndromes and treatments in TCM.Methods225 ALS patients(Age:27-84;Male:Female=1.42:1)seen at Third Hospital of Peking University from November 2018 to January 2020 were included.The basic information(name,gender,age,nationality,place of residence,education level,smoking history,drinking history,tea drinking habits,past medical history,medication,etc.),medical history(diagnosis level,classification,king's ALS clinical staging scale,date of onset,date of treatment,time of important events,ALS functional rating scale,ALS functional rating scale revised,etc.)and diagnosis were collected.Researchers were trained in the same standard to collect information.The TCM syndrome score was evaluated by the 'TCM syndrome information collection table'.A database was established and statistics were analyzed by SPSS 25.0.This study uses cross-sectional investigation and cohort study.Univar ate analysis of variance and nonparametric test were used to compare the distribution characteristics of syndromes among groups.Cox multivariate regression analysis was used to screen the risk factors of disease prognosis.Results1 According to TCM syndrome score distribution,the most common one is wind syndrome(60.89%,8.34 ± 4.607),then qi deficiency syndrome(51.11%,6.88 ± 4.851),yang deficiency syndrome(37.78%,5.67±4.737),yin deficiency syndrome(35.11%,5.44 ± 3.898)and yang hyperactivity syndrome(32.89%,4.64±3.455).2 Comparison of TCM syndrome score in different onset parts shows that qi deficiency syndrome score of lower limb onset group is higher than that of upper limb onset group(8.03± 4.297 vs.6.33 ± 4.833,P=0.027),wind syndrome score of bulbar onset group is higher than that of lower limb onset group(9.40 ± 5.138 vs.7.44 ± 4.625,P=0.022).The phlegm dampness syndrome score is higher than that of upper limb(4.37 ± 3.236 vs.2.45±3.059,P=0.000)and lower limb onset group(4.37 ± 3.236 vs.1.56±2.135,P=0.000).3 Comparison of TCM syndrome score in onset site and diagnosis types shows that the common types in upper limb-onset ALS(UL-ALS)group and flail-arm syndrome(FAS)group are,in order,wind syndrome(69.84%,61.11%),qi deficiency syndrome(50.79%,30.56%),yang deficiency syndrome(42.86%,30.56%)and yang hyperactivity syndrome(41.27%,30.56%).The scores of yin deficiency syndrome(6.13 ± 4.066 vs.4.17 ± 3.376,P=0.035),blood deficiency syndrome(2.95± 2.762 vs.1.67 ± 1.927,P=0.017)and qi stagnation syndrome(5.22±4.685 vs.3.25±4.087,P=0.018)of UL-ALS group are higher than those of FAS group,and there are different trend in the scores of yin deficiency syndrome(5.20± 3.605 vs.3.58 ± 2.859,P=0.124)and qi stagnation syndrome(4.40 ± 3.654 vs.3.27 ± 4.153,P=0.101)in the early stage of the disease.The common syndromes in lower limb-onset ALS(LL-ALS)group and flail-leg syndrome(FLS)group are qi deficiency syndrome(67.44%,66.67%),wind syndrome(55.81%,41.67%)and yang deficiency syndrome(41.86%,33.33%).Yin deficiency syndrome(41.86%)is more common in LL-ALS group,while yang hyperactivity syndrome(33.33%)is more common in FLS group.The scores of heat syndrome(5.35±3.572 vs.2.75± 2.417,P=0.019)and phlegm dampness syndrome(2.33 ± 2.950 vs.0.17 ± 0.557,P=0.006)in LL-ALS group are higher than those in FLS group,and there are different trend in the scores of heat syndrome(4.23 ± 2.619 vs.2.73± 6.418,P=0.150)and phlegm dampness syndrome(1.54±2.332 vs.0.18±0.603,P=0.186)in the early stage of the disease.The common syndromes in bulbar-onset ALS(B-ALS)group and isolated bulbar phenotype ALS(IB-ALS)group are wind syndrome(69.70%,55.56%)and qi deficiency syndrome(45.45%,38.89%),but yang hyperactivity syndrome(39.39%)and qi stagnation syndrome(39.39%)are more common in B-ALS group,while yang deficiency syndrome(44.44%)and yin deficiency syndrome(38.89%)are more common in IB-ALS group.The score of phlegm dampness syndrome(4.12±3.542 vs.5.06±2.461,P=0.184)in B-ALS group is lower than that in IB-ALS group,which is more obvious in the early stage(3.57 ±2.793 vs.5.50±2.312,P=0.094)of disease.At the same time,the score of yang hyperactivity syndrome(6.36 ± 2.437 vs.4.57 ± 2.027,P=0.077)in B-ALS group is higher than that in IB-ALS group.4 Comparison of TCM syndrome score in different disease degrees shows that the most common syndrome in King's ALS clinical staging scale(KCSS)1 is wind syndrome(8.16 ±4.651),then yang deficiency syndrome(5.65 ± 4.500),qi deficiency syndrome(5.58 ± 4.435),yang hyperactivity syndrome(4.66±3.629)and yin deficiency syndrome(4.70 ± 3.740).The most common syndrome in KCSS2 is wind syndrome(9.16 ± 4.454),then qi deficiency syndrome(7.89±4.502),yang deficiency syndrome(6.15±5.024),heat syndrome(5.81±3.929)and yin deficiency syndrome(5.56 ± 3.509).The most common syndrome in KCSS3 is wind syndrome(8.26 ± 5.110),then qi deficiency syndrome(8.17 ± 4.877),yin deficiency syndrome(7.61 ± 4.131),yang deficiency syndrome(5.52 ± 5.017)and heat syndrome(5.35± 3.550).The most common syndromes in KCSS4 is qi deficiency syndrome(9.78 ± 5.681),then wind syndrome(7.39 ± 4.131),yin deficiency syndrome(6.65±4.569),heat syndrome(5.83 ± 3.798)and qi stagnation syndrome(5.83 ± 4.960).The score of qi deficiency syndrome in KCSS1 group is lower than that in other groups(KCSS1 P=0.002,KCSS2 P=0.015,KCSS3 P=0.000),the score of heat syndrome is lower than that in KCSS2(P=0.001)and KCSS4(P=0.019)groups,the score of yin deficiency syndrome and phlegm dampness syndrome are lower than that in KCSS3(4.70±3.740 vs.7.61 ± 4.131,P=0.001,2.14 ± 2.709 vs.3.87 ± 3.900,P=0.013)and KCSS4(4.70± 3.740 vs.6.65 ± 4.569,P=0.026,2.14 ± 2.709 vs.4.43± 3.462,P=0.001)groups,and the score of qi stagnation syndrome is lower than that in KCSS4 group(3.85 ± 3.677 vs.5.83 ± 4.960,P=0.030).The score of yin deficiency syndrome in KCSS2 group is lower than that in KCSS3 group(P=0.029),and the score of qi deficiency syndrome is lower than that in KCSS4 group(2.60 ± 3.049 vs.4.43 ±3.462,P=0.013).The score of qi stagnation syndrome in KCSS 3 group is lower than that in KCSS4 group(3.35 ± 3.984 vs.5.83 ± 4.960,P=0.035).5 Cox multivariate regression analysis shows that yin deficiency syndrome is a risk factor of ALS,and the relative risk value is 1.071.ConclusionsThe onset and course of disease of ALS patients are related to TCM syndromes.The patients with upper limb onset mainly have wind syndrome and qi deficiency syndrome.The patients with lower limb onset mainly have qi deficiency syndrome and wind syndrome.The patients with bulbar-onset mainly have wind syndrome and qi deficiency syndrome,with phlegm dampness syndrome in specific.Wind syndrome,qi deficiency syndrome,yang deficiency syndrome and heat syndrome usually exist through the whole process.Qi deficiency gradually aggravates through the progression of the disease.At the same time,development from heat syndrome to yin deficiency also presents.The appearance of yin deficiency syndrome usually indicates poor prognosis.