| Objective:Based on the research of ancient stroke classification system,our team proposed"Construction of Clinical Diagnostic Framework of Stroke”.The objective of this study is to probe the differences in TCM syndrome characteristics,magnetic resonance imaging(MRI)characteristics,and TOAST classifications between different diagnostic classifications in patients with acute ischemic stroke under this new clinical diagnostic framework.To provide a basis for understanding the underlying etiology.Method:A total of 456 inpatients who were diagnosed as acute ischemic stroke in the Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine were collected from January 2017 to December 2018.According to the stroke diagnostic classifications standard proposed in "Construction of Clinical Diagnostic Framework of Stroke",the clinical phenotype with hemiplegia as the core symptom was diagnosed as typical stroke.Conversely,the clinical phenotype that is not centered on hemiplegia was diagnosed as atypical stroke.The distribution of different diagnostic classifications was observed.TCM syndrome factors were evaluated in accordance with the "Stroke Disease Differential Diagnosis Standards(Trial)”,and the distribution of TCM syndrome factors between the different diagnostic classifications was compared.Collect magnetic resonance imaging data,measure the diameter of infarcts in all patients on the diffusion weighted imaging(DWI)sequence,record the number,ocation and type of DWI lesions.Fazekas score was used to the T2 fluid attenuated inversion recovery(T2FLAIR)sequence to assess the degree of white matter lesions(WMLs)in all patients.Compare the imaging features of different diagnostic classifications.Collect general demographic data,medical history data,laboratory tests,cervical vascular ultrasound and brain magnetic resonance imaging data of all patients for TOAST classifications,and compare the etiology differences between different diagnostic classifications.Results:1.Within the 456 patients diagnosed as acute ischemic stroke,244 patients determined as typical stroke and 212 patients determined as atypical stroke.The typical stroke group included 233 meridian stroke patients and 11 visceral stroke patients.212 patients with atypical stroke were composed of 120 patients who were judged as single subtype and 92 patients who were judged as two or more subtypes.In single subtype,ranked from the highest proportion to the lowest,in this order:58 patients with wind vertigo,23 patients with migratory arthralgia,19 patients with apoplectoid hysteria,18 patients with wind myasthenia.2 patients with apolectic dementia2.Compared with the typical stroke group,the atypical stroke group had a lower age of onset and shorter hospital stays,higher admission Bathel index and discharged Bathel index,the difference was statistically significant between the two groups(P<0.05).There was no statistically significant difference in terms of risk factors such as gender,smoking,drinking,hyperhomocysteinemia,hypertension,diabetes,coronary heart disease and atrial fibrillation between the two groups(P>0.05).Compared with the typical stroke group,the atypical stroke group had a higher proportion of hyperlipidemia,the difference was statistically significant(63.21%vs49.18%,P=0.003).3.Patients in both groups are mainly based on the excess syndrome factors such as sputum,fire and wind.Compared with the atypical stroke group,the typical stroke group had a higher proportion of qi deficiency syndrome,the difference was statistically significant between the two groups(11.79%vs 19.26%,P=0.029)4.There was no statistically significant difference in the number of infarctions between the two groups(P>0.05).The average maximum diameter of single lesion and multiple lesions in the typical stroke group was significant higher than those in the atypical stroke group(P<0.05).Both groups were more common in previous circulation infarction,but compared with the typical stroke group,the proportion of anterior circulation infarction in the atypical stroke group was lower(59.02%vs45.75%,P=0.005),the proportion of posterior circulation infarction in the atypical stroke group was higher(24.59%vs38.68%,P=0.001),the difference was statistically significant.Basal ganglia and/or periventricular infarction were more common in both groups,but compared with the typical stroke group,the proportion of patients with basal ganglia and/or periventricular infarction,frontal lobe infarction in atypical stroke group was lower(50.82%vs39.15%,P=0.013;31.97%vs23.11%,P=0.035),the proportion of patients with cerebellar infarction in atypical stroke group was higher(2.05%vs8.02%,P=0.003),and the differences were statistically significant.5.Compared with the typical stroke group,the incidence of WMLs in the atypical stroke group was lower(91.16%vs 83.96%,P=0.047),and the incidence of severe WMLs in the atypical stroke group was lower(37.29%vs 28.30%,P=0.042),the difference was statistically significant.6.As far as DWI classification,the small perforating branch infarction was more common in both groups of single lesions.Compared with the typical stroke group,the proportion of small perforating branch infarction in the atypical stroke group was higher(39.75%vs49.06%,P=0.046),the proportion of big perforating branch infarction in the atypical stroke group was lower(7.79%vs2.83%,P=0.020),the differences were statistically significant.Among the multiple cerebral infarction,the proportion of posterior circulation in the atypical stroke group was higher than those in the typical stroke group(10.38%vs3.69%,P=0.005),the difference was statistically significant.7.The TOAST classifications of the two groups were mainly small arterial occlusion(SAO).Compared with the typical stroke group,the incidence of small arterial occlusion in the atypical group was higher,and the difference was statistically significant(70.28%vs 54.92%,P=0.001).Conclusion:1.In this study,the incidence of typical stroke was slightly higher than that of atypical stroke.The typical stroke was dominated by meridian stroke,and the atypical stroke was dominated by single subtype.In single subtype,ranked from the highest proportion to the lowest,in this order:wind vertigo,migratory arthralgia,apoplectoid hysteria,wind myasthenia,apolectic dementia.2.Both typical stroke and atypical stroke were mainly based on the excess syndrome factors such as sputum,fire and wind.But patients with typical stroke may be more prone to qi deficiency syndrome.3.MRI showed that patients with anterior circulation infarction,the big penetrating branch infarction,large infarction and severe WMLs mostly manifest as typical stroke.Posterior circulation infarction,the small perforating branch,lacunar infarction and mild WMLs mostly manifest as atypical stroke. |
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