Liu Lu, Gao Ying
Department of Neurology, Beijing University of Chinese Medicine, Beijing, China.
Zhong Xi Yi Jie He Xue Bao. 2012 Sep;10(9):983-90. doi: 10.3736/jcim20120906.
To investigate the correlation between traditional Chinese medicine (TCM) syndrome and short-term prognosis of ischemic stroke.
TCM syndrome factors and the neurological deficit degree of 464 patients with ischemic stroke were assessed using the Ischemic Stroke TCM Syndrome Factor Diagnostic Scale (ISTSFDS) and National Institutes of Health Stroke Scale (NIHSS) on the 1st, 7th and 14th day from the onset of ischemic stroke. Patients were assigned to the favorable short-term prognosis group and the unfavorable short-term prognosis group, depending on the NIHSS score on the 14th day after onset of stroke. The correlation between TCM syndrome factors and the short-term prognosis of ischemic stroke was studied using the logistic regression model. Then, the receiver operating characteristic (ROC) curves were used to evaluate the predicting capacity of logistic regression mode. Lastly, according to the results of the logistic regression model, the authors investigated the correlation between blood stasis syndrome and the neurological deficit degree of stroke with application of repeated-measures analysis of variance.
Blood stasis syndrome (odds ratio=2.924, 95% confidence interval from 1.231 to 6.946, P=0.015) on the 14th day and NISSS score (odds ratio=1.956, 95% confidence interval from 1.701 to 2.250, P=0.000) on the 1st day after onset of stroke were risk factors that could predict short-term prognosis of ischemic stroke. The area under the ROC curves of the logistic regression model was 0.95. There was a tendency for stroke patients with blood stasis syndrome to have higher NIHSS scores than patients without blood stasis syndrome, and there was a decreased NIHSS score with time points delay.
Blood stasis syndrome is a risk whose diagnosis could predict short-term prognosis of ischemic stroke. Clinically, the application of treatment focusing on activating blood and resolving stasis can improve the short-term prognosis of stroke patients. This study provides an evidence base for dynamic intervention of a comprehensive integrative medical treatment program based on syndrome differentiation for ischemic stroke.
探讨缺血性中风中医证候与短期预后的相关性。
采用缺血性中风中医证候要素诊断量表（ISTSFDS）和美国国立卫生研究院卒中量表（NIHSS），于缺血性中风发病第1、7和14天评估464例缺血性中风患者的中医证候要素及神经功能缺损程度。根据中风发病后第14天的NIHSS评分，将患者分为短期预后良好组和短期预后不良组。采用logistic回归模型研究中医证候要素与缺血性中风短期预后的相关性。然后，使用受试者工作特征（ROC）曲线评估logistic回归模型的预测能力。最后，根据logistic回归模型的结果，应用重复测量方差分析研究血瘀证与中风神经功能缺损程度的相关性。
中风发病后第14天的血瘀证（比值比=2.924，95%置信区间为1.231至6.946，P=0.015）和发病后第1天的NISSS评分（比值比=1.956，95%置信区间为1.701至2.250，P=0.000）是可预测缺血性中风短期预后的危险因素。logistic回归模型的ROC曲线下面积为0.95。血瘀证中风患者的NIHSS评分往往高于无血瘀证患者，且随着时间点的延迟NIHSS评分降低。
血瘀证是一种诊断可预测缺血性中风短期预后的风险因素。临床上，应用活血化瘀为主的治疗可改善中风患者的短期预后。本研究为基于缺血性中风辨证论治的综合中西医结合治疗方案的动态干预提供了循证依据。
