Study On The Correlation Between Sublingual Collaterals And TCM Syndromes And Clinical Symptoms In Patients With Cerebral Small Vessel Disease

ObjectiveThis study aimed to analyse the relationship between sublingual collaterals scores and traditional Chinese medical(TCM)syndromes which concluded by cluster analysis as well as the scores of each clinical symptom of patients with cerebral small vessel disease(CSVD)by collecting the image of these patients’ sublingual collaterals which were analyzed and scored,in order to explore the role of sublingual collaterals in the TCM diagnosis of CSVD.MethodsPatients with CSVD treated in Traditional Chinese Medicine of Zhongshan Hospital from July 2020 to January 2021 were brought into this study.Sublingual collaterals images of patients were taken and analyzed.Sublingual collaterals score scales were filled out and quantified firstly after taking and analyzing the images of the sublingual collaterals.Secondly,the data of the four TCM diagnoses of the patients were collected and the information table of the four TCM diagnoses was filled in,after which the TCM syndromes of the patients were summarized through cluster analysis and the differences of the sublingual collaterals of the patients’ TCM syndromes were analyzed.Finally,the correlation analysis was conducted between the sublingual collaterals scores and CSVD symptoms related scale scores or questionnaire survey.ResultsIn terms of basic information,this study accepted 214 patients with CSVD,among which there were 126 men and 88 women.The maximum age was 87 years old,the minimum age was 33 years old,and the average age was 66.5 years old.Sublingual collaterals scores were positively correlated with age(P<0.05).Sublingual collaterals score was correlated with smoking and drinking(P<0.05).Sublingual collateral score was correlated with the risk factors CSVD such as hypertension,diabetes,hyperlipidemia,hyperuricemia and hyperhomocysteinemia(P<0.05).But there was no statistical correlation with gender(P>0.05).In this study,the most common abnormalities of sublingual collaterals in CSVD patients were mild purplish dark color of sublingual collaterals,mild main branch,mild filling of main trunk,mild sublingual spots,and mild abnormality of length,width and diameter as well as those without varices and finules(accounted for 77.1%,91.1%,65.9%.46.7%.63.1%.42.5%,44.9%respectively).In terms of sublingual collaterals scores segment,the proportion of sublingual collaterals scores segment 10-19 was the highest(64%),followed by less than 10 scores segment(22.4%)and 20-29 integral segment(12.6%),and the proportion of sublingual collaterals scores segment more than 30 was the lowest(0.9%).Through systematic cluster analysis of the collected data of four diagnoses,TCM syndromes of patients in this study included blood stasis and collaterals blocking,qi stagnation and blood stasis,Yin and Yang deficiency,kidney essence deficiency,qi deficiency and blood stasis,Yin and blood deficiency,and phlegm blocking collaterals,among which the patients with phlegm blocking collaterals accounted for the most(25.7%),and the patients with deficiency of kidney essence accounted for the least(1.9%).The scores of sublingual collaterals in patients with CSVD of each syndromes were listed from high to low as blood stasis and collaterals blocking syndrome,qi deficiency and blood stasis syndrome,qi stagnation and blood stasis syndrome.phlegm blocking collaterals syndrome,Yin and blood deficiency syndrome.Yin and Yang deficiency syndrome.and kidney essence deficiency syndrome.There was statistical significance in the scores of sublingual collaterals among different syndrome types of CSVD(P<0.05).In terms of excess syndrome or deficiency syndrome,there was no significant difference in the proportion of them and sublingual collaterals scores among them(P>0.05).The seven syndromes could be summarized as stasis syndrome,phlegm syndrome and deficiency syndrome,among which the sublingual collaterals scores were the highest in the stasis group and the lowest in the deficiency group,and the difference of the sublingual collaterals scores among the three groups were statistically significant(P<0.05),and besides,sublingual collaterals scores were positively correlated with three groups(P<0.05).In terms of sublingual collaterals scores and overall imaging load in patients with CSVD,the sublingual collaterals scores were the highest in patients with overall load score 4,while the sublingual collaterals scores were the lowest in patients with overall load score 1,and sublingual collaterals scores were positively correlated with overall load scores(P<0.01).In terms of scores related to cognitive function,there was no significant difference in the score of all levels of cognitive dysfunction(P>0.05).but sublingual collaterals scores were negatively correlated with Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment Scale(MoCA)scores(P<0.05).In terms of the emotion-related scores,there was no significant difference in sublingual collaterals scores among patients with different depression levels and different anxiety levels(P>0.05),and there was also no significant correlation between the scores of sublingual collaterals and the scores of Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)(P>0.05).In terms of the gait-related scores,the sublingual collaterals scores were negatively correlated with Tinetti Performance Oriented Mobility Assessment(Tinetti POMA)scores(P<0.05).In terms of defecation,there was significant difference in the sublingual collaterals scores between constipation and non-constipation patients(P<0.01),and there was a significant positive correlation between the Patient Assessment of Constipation symptom(PAC-SYM)scores and the sublingual collaterals scores(P<0.01).There was also statistically significant difference in the sublingual collaterals scores between patients with or without urination abnormality(P<0.05).ConclusionSublingual collaterals scores of CSVD patients are correlated with the risk factors of CSVD.According to the cluster analysis,there are 7 TCM syndromes of patients with CSVD,and they can be further summarized as the syndrome of blood stasis,phlegm and deficiency,and mainly the syndrome of blood stasis.Sublingual collaterals score has certain correlation with TCM syndrome of patients,and observing the sublingual collaterals can assist in judging the TCM syndromes of patients with CSVD.Sublingual collaterals are correlated with clinical symptoms of patients with CSVD.That is,the sublingual collaterals scores are positively correlated with overall imaging load,PAC-SYM scores,and negatively correlated with cognitive function scores,balance and gait function scores.Sublingual collation scores are also different in patients with or without urination abnormality.To some extent,the abnormality of the sublingual collaterals can assist in judging the severity of clinical condition of patients with CSVD,and provide a certain auxiliary basis for TCM diagnosis of CSVD.