Study On The Correlation Between Carotid Plaque Of Ischemic Stroke And TCM Syndrome And Pathogenesis Characteristics Based On CCA

Research purpose1.To analyze the distribution of carotid plaque in patients with ischemic stroke.2.To explore the correlation between carotid plaque of ischemic stroke patients and TCM syndrome and pathogenesis characteristics.Research methods1.Research designThis study is a registry study.2.Research objectThis study was based on the Chinese Medicine Industry Special Project of 2015.The subjects of this study were patients with ischemic stroke who were diagnosed as ischemic stroke in 7 branches of the national encephalopathy department from July 2016 to November 2019.The project was approved by the Ethics Committee prior to commencement(No.08,2016).3.Inclusion and exclusion criteriaInclusion criteria:According to the history and MRI or CT imaging examination to make a clear diagnosis of ischemic stroke;age between 30 and 90 years;all patients had carotid plaque examination results,the collection of information on disease characteristics and the determination of TCM syndrome;and signed the informed consent form.Exclusion criteria:Patients with hemorrhagic or mixed stroke were excluded.Western medicine for the diagnosis of TOAST for CE type,OD type or UD type;Those who show consciousness disorder;Unable to gather information.4.Clinical data acquisitionBaseline demographic information,stroke characteristics,TCM syndrome characteristics,and carotid artery plaque characteristics of the 2558 patients with ischemic stroke were collected and recorded.The data were collected and saved by a combination of a paper case report form and an electronic data acquisition system.5.Statistical analysisDescriptive statistical analysis:According to the different characteristics of the counting data and measurement data,the frequency table,percentage,component ratio,mean standard deviation,percentile,etc.Difference test:According to the different characteristics of counting data and measurement data,as well as whether they conform to normal distribution and homogeneity of variance,the t-test and non-parametric test methods,such as the chi-square test,were adopted.CCA analysis:Carotid plaques were analyzed with CCA in relation to different syndromes and pathogenesis characteristics.The statistical analysis of this study used a two-sided hypothesis test with a significance level of 0.05;that is,a P value less than 0.05 will be considered to test statistically significant differences.Statistical and canonical correlation analyses were performed using SPSS(version 25.0),and the remaining analyses were performed using R(version 3.6.1).Research results1.Distribution of carotid plaques in patients with ischemic strokeRegarding the degree of intracranial vascular stenosis,most cases(1703,66.58%)had no stenosis.The others were occlusive stenosis(334 cases,13.04%),mild stenosis(266 cases,10.40%),severe stenosis(189 cases,7.39%),and moderate stenosis(66 cases,2.58%).In terms of the degree of carotid artery stenosis,patients without stenosis were the most common(2080 cases,81.31%,followed by mild to moderate stenosis(280 cases,10.95%),severe stenosis(105 cases,4.10%),occlusion(93 cases,3.64%),and heterogeneous and unstable plaques(1221 cases,47.73%;505 cases(19.74%);483 cases(18.33%)and 349 cases(13.64%).There were 1725 cases(67.44%)with intimal thickening and 833 cases(32.56%)without intimal thickening.The minimum and maximum plaque thicknesses were 0 mm and the maximum was 9.3 mm.2.Distribution of carotid plaques with different demographic characteristicsOf the 2,558 strokes in seven centers nationwide in 2015-2019,there were more males(1,681,65.72%)than females(877,34.28%).The results of the chi-square test analysis showed that,based on the existing data and methods,the degree of carotid stenosis,plaque nature,intimal thickening and plaque thickness in male patients were significantly higher than that in female patients.The median age of the patients was 64 years,and the mean age was 63.33±9.45 years,with a maximum of 60-69 years(1049 patients,41.01%).With the increase of age,the degree of carotid artery stenosis,plaque nature,intimal thickening and plaque thickness increased;There were significant differences in plaque thickness among patients with different BMI.3.Distribution of carotid plaques with different characteristicsTOAST classification of small artery(including lacunar)type of 1595 cases,accounting for 62.35%of the total sample size,961 cases of large artery type of TOAST(37.57%of total samples).The degree of intracranial vessel stenosis,carotid artery stenosis,plaque nature,intimal thickening in the TOAST classification there were significant differences.In the NIHSS scale score,the number of patients with mild stroke was the most,followed by moderate stroke.There was a significant difference between the total score and the degree of intracranial vascular stenosis.There were significant differences in the scores of mRS and the degree of intracranial vessel stenosis,the nature of plaque and intimal thickening.The higher the score of mRS scale,the thicker the plaque thickness,there is a significant difference.4.Distribution of carotid plaques in different TCM syndromesThe number of TCM syndrome characterized by deficiency of qi and blood stasis was the most,1506 cases,accounting for 58.87%,followed by wind-phlegm and stasis syndrome.The plaque thickness of different syndromes was 2.41±1.69 mm in patients with wind-phlegm fire hyperactivity,the highest severity,followed by wind-fire disturbance,wind-phlegm stasis syndrome.5.Correlation between carotid plaques and pathogenesis characteristics in patients with ischemic strokeThe TOAST classification was positively correlated with the degree of intracranial vessel stenosis and intimal thickening.The NIHSS score was positively correlated with the degree of intracranial vascular stenosis,the nature of plaque and intimal thickening.The mRS scale was positively correlated with the degree of intracranial vessel stenosis and intimal thickening.6.Correlation between carotid plaque and TCM syndromes in patients with ischemic strokeThere was a positive correlation between wind-phlegm and fire hyperactivity syndrome and plaque thickness,and between wind phlegm and blood stasis syndrome and thickness of plaque and stenosis degree of carotid plaque.Qi deficiency and blood stasis syndrome was positively correlated with the degree of intracranial vascular stenosis,and phlegm dampness clouding Shen syndrome and carotid artery stenosis were positively correlated.ConclusionBased on data from this study,among 2558 patients with ischemic stroke,the severity of carotid plaque characteristics was higher in males than in females as a whole,and increased with age.Plaque thickness also showed an increasing trend.TOAST,NIHSS and mRS were positively correlated with the degree of intracranial vessel stenosis and intimal thickening.The NIHSS scale was positively correlated with the nature of the plaque,which was statistically significant,indicating that the severity of carotid plaque was related to the characteristics of the disease.Qi deficiency and blood stasis syndrome was positively correlated with the degree of intracranial vascular stenosis,and phlegm dampness clouding the spirit syndrome with carotid artery stenosis.Wind-phlegm and fire-hyperactivity syndrome was positively correlated with plaque thickness,wind-phlegm and blood stasis syndrome had a positive correlation with carotid artery stenosis and plaque thickness.The results showed that carotid plaque was related to phlegm,blood stasis,dampness and deficiency.