| Objective:To investigate the incidence of Post-Stroke Spasticity(PSS)at 3months after the onset of cerebral infarction,to screen the related risk factors of PSS,and to provide a basis for early screening of patients with high risk of spticity after cerebral infarction.To explore the correlation between traditional Chinese medicine(TCM)syndrome elements in the acute stage of cerebral infarction and PSS,and to provide objective basis for TCM syndrome differentiation treatment of patients with high risk of spastic paralysis after cerebral infarction.Methods: A prospective nested case-control study was conducted.Patients with acute cerebral infarction who were hospitalized in the Department of Encephalopathy and the Department of Acupuncture and Rehabilitation of the Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine and Changsha Sanzhen Hospital from December 2021 to November 2022 were collected.Relevant biological,imaging,past medical history and other data were collected within 24 hours after admission,and TCM syndrome elements and related scales were evaluated.After 3 months,limb Spasticity was evaluated in outpatient follow-up.Patients without spastic paralysis were included in the NPSS group,and the information of the two groups was compared.Univariate analysis was used to analyze the differences of variables between the two groups,and Logistic regression analysis was used to analyze the factors with significant differences to explore the risk factors of PSS in patients with cerebral infarction.The distribution of TCM syndrome elements in patients with PSS in the acute stage of cerebral infarction and its correlation with the occurrence of PSS were analyzed,and the characteristics of PSS were analyzed.Results:Research Data: According to the inclusion and exclusion criteria,a total of 243 patients were enrolled,12 cases dropped out(9 cases were lost to follow-up,3 cases recurs during the observation period),103 patients in PSS group(PSS group)and 128 patients in NPSS group(non-pss group)were finally includedRelationship between the incidence of PSS and general data: There were statistically significant differences between the two groups in the history of hyperlipidemia,hypertension,and abstinence from alcohol(P < 0.05),including hypertension(OR 1.307,95%CI 1.163-3.156,P=0.041),no abstinence from alcohol(OR 4.598,95%CI 1.948-12.618,P=0.041),and no abstinence from alcohol(OR 4.598,95%CI 1.948-12.618,P=0.041).P=0.001)were independent risk factors by multivariate analysis.There were no significant differences in gender,age,BMI,diabetes history,coronary heart disease history,and smoking history between the two groups(P > 0.05).The relationship between the incidence of PSS and clinical symptoms and signs: There were significant differences in limb pain,hypoesthesia and limb muscle strength between the two groups(P < 0.05).Limb pain(OR 2.333,95%CI 1.948-12.618,P=0.001),muscle strength < grade 3(OR 2.973,95%CI1.948-12.618,P=0.001),and muscle strength < grade 3(OR 2.973,95%CI1.948-12.618,P=0.001)were significantly different between the two groups.95%CI 1.088-6.359,P=0.001)were independent risk factorsRelationship between the incidence of PSS and stroke history,related functional deficits,and interventions: There were significant differences in the history of stroke,degree of neurological deficit,ability of daily living and physical activity between the two groups(P < 0.05).The history of stroke(OR9.769,95%CI 11.432-125.466,P=0.001),NIHSS score > 15(OR 2.071,95%CI11.432-125.466;95%CI 1.259-3.834,P=0.036),MBI score ≤40(OR 3.598,95%CI 1.414-9.154,P=0.007),S-FM score < 50(OR 4.135,95%CI0.074-0.244,P=0.007),P=0.001)were independent risk factors by multivariate analysis.There was no significant difference in intervention and treatment measures between the two groups(P > 0.05).The relationship between the incidence of PSS and imaging data: there were significant differences in the location and size of cerebral infarction between the two groups(P < 0.05),and basal ganglia infarction(OR 3.381,95%CI 2.239-5.755,P=0.004)was an independent risk factor by multivariate analysisAnalysis of the incidence of PSS: in the PSS group,68 cases(66.1%)had spasticity in the upper limbs,24 cases(23.3%)had spasticity in the lower limbs,and 11 cases(10.6%)had spasticity in both upper and lower limbs.In PSS group,there were 53 cases(51.5%)with mild spasticity(MAS score 1-2),37 cases(35.9%)with moderate spasticity(MAS score 3),and 13 cases(12.9%)with severe spasticity(MAS score 4).The proportion of mild spasms in all parts was higher,while the proportion of moderate spasms(39.7%)and severe spasms(14.7%)in patients with upper limb spasms was higher than that in the other two groups,and the proportion of mild spasms in patients with lower limb spasms was higher(62.5%)The frequency of TCM syndrome elements in the acute stage of cerebral infarction in PSS group was blood stasis syndrome > internal wind syndrome > phone-dampness syndrome > internal fire syndrome > qi deficiency syndrome > Yin deficiency syndrome.The frequency of TCM syndrome elements in the acute stage of cerebral infarction in NPSS group was internal wind syndrome > blood stasis syndrome > phone-dampness syndrome > internal fire syndrome > qi deficiency syndrome > Yin deficiency syndrome.No five-factor combination syndrome was found,and the incidence of single syndrome in the two groups was low.The comprehensive rate was4.9% in PSS group and 9.3% in NPSS group,respectively.The proportion of patients with two-factor syndrome in PSS group was 41.7%,and 39.1% in NPSS group.The distribution of syndrome combination in PSS group in acute stage was as following: internal wind + phlegm dampness > phlegm dampness+ blood stasis > internal wind + phlegm dampness + blood stasis > qi deficiency + phlegm dampness > internal wind + blood stasis + qi deficiency.The distribution of syndrome combination in NPSS group in acute stage was as following: Internal wind + phlegm dampness syndrome > phlegm dampness+ blood stasis syndrome > internal wind + phlegm dampness + blood stasis syndrome > qi deficiency + phlegm dampness syndrome = internal wind +blood stasis + qi deficiency syndrome.The proportion of TCM blood-stasis syndrome in PSS group was significantly higher than that in NPSS group(P <0.05).95%CI 1.061-3.991,P=0.045)Conclusions:Non-abstinence,hypertension,MBI≤40 points,S-FM < 50 points,NIHSS > 15 points,muscle strength < 3 grade,stroke history,basal ganglia infarction,limb pain,acute TCM syndrome elements of blood stasis syndrome are independent risk factors for PSS in patients with cerebral infarction at 3months after onset,which can significantly affect the occurrence of PSS.At the baseline of cerebral infarction patients with PSS in the acute stage of cerebral infarction,the TCM syndromes of blood stasis syndrome,internal wind syndrome and phlegm dampness syndrome are more common.The syndrome combination of internal wind + phlegm dampness syndrome,phlegm dampness syndrome,internal wind + phlegm dampness + blood stasis syndrome is more common in the acute stage of cerebral infarction in PSS patients.Its pathogenesis is the result of the interaction of multiple syndrome elements.The incidence of PSS is high at 3 months after the onset of cerebral infarction,and active early treatment and intervention should be taken for patients with cerebral infarction. |
