Correlation Between Phlegm-heat And Non-phlegm-heat Secondary Depression And Intestinal Flora Changes In Patients With Acute Cerebral Infarctio

Background:Post-stroke depression is a result of stroke and is characterized by a range of depressive symptoms,such as emotional indifference,fatigue,poor sleep,and a decrease in self-worth,with a prevalence of 30-60%in stroke patients.The development of depression has been shown to have an impact.Clinical observations have revealed that those suffering from phlegm-heat syndrome in the acute stage of stroke,accompanied by mental and consciousness issues,have seen a better mental state after the treatment of diarrhoea with the technique of eliminating phlegm and emptying the bowels.We therefore hypothesise that if patients in the acute phase of stroke disease are treated in a discriminatory manner,it may have promising applications for the prevention of secondary depression and early diagnosis.Objective:To investigate the differences in secondary depression in the acute phase of cerebral infarction in patients with different TCM evidence types,to clarify whether there is a higher risk of PSD in phlegm-heat and internal organs evidence,and to contrast the abundance of intestinal flora in post-stroke patients with and without secondary depression,to identify new indicators that can predict and reflect post-stroke depression,and to clarify the scientific connotation of TCM evidence types and the biological mechanisms that predict secondary depression.Methods:1.Chinese medicine evidence and depression difference study:In this study,patients with acute cerebral infarction were evaluated on the Chinese medicine evidence scale,baseline information collection and depression scale.2.Intestinal flora study:An analysis of intestinal flora was conducted using 16S rDNA amplicon sequencing technology,utilizing stool samples taken from both those with acute cerebral infarction and phlegm-heat syndrome,as well as those who fulfilled the inclusion criteria.Results:1.Significantly more potential depressive states were detected in the Phlegm-Heat group than in the non-Phlegm-Heat group,and the HAMD score was notably higher in the Phlegm-Heat group than in the non-Phlegm-Heat group,implying that those with the acute phase of cerebral infarction,as identified by TCM,have a higher probability of depression.2.Study of intestinal flora:①No distinction in alpha and beta diversity was observed between acute cerebral infarction with Phlegm-Heat and non-Phlegm-heat syndrome in the examination of intestinal flora.②Characteristic flora:Non-sputum fever group:Enterobacteriaceae;sputum fever depression group:Trichosporon spp.of the Trichosporon family,GCA₉00066755 spp.,Coprococcus₂ spp.,Clostridiales DTU089 spp.,Ralstonia spp.;sputum fever non-depression group:Tenericutes phylum,Clostridiales_vadinBB60_group,family Eggerthellaceae,genus Eggerthella;genus Hungatella,genus Epulopiscium,genus Dielma,genus Prevotella,genus Papillibacter;in the non-phlegm fever depression group:genus Sellimonas,non-phlegm fever non-depression group:red spirochete Purpose unclassified bacteria.（ⅲ）TCM evidence scores correlated with enterobacteria:Agathobacter,Coprococcus₂,DTU089,Bacteria_Unknown,Acidobacteriia_Unknown correlated positively with phlegm-heat scores;Prevotellaceae_NK3B31 group,Aminoacoccus spp.Clostridium tumefaciens₉,Moricella spp.,Co-prostaglandinum spp.,Clostridium tumefaciens spp.,Escherichia coli spp.,Trichosporaceae_NK4A136group spp.,Alistipes,Bacteroides polymorphicus,Verrucomicrobiales_UCG,Hodmanella bimorphica,Heterokaryon spp.,Escherichia spp.,Christensenaceae_R-7group spp.,positively correlated with the Qi deficiency score;Weak Bifidobacteria,Bifidobacterium spp.,Clostridium pullulans,Opitutus,Lactobacillus,Lactobacillus spp.,Enteromonas,ZOR0006,Agathobacter,Tyzzerella,Vibrio vermicularis spp.and Eubacterium faecalis spp.The correlation between the blood stasis score and these groups was positive,and it is anticipated that they will be indicative of phlegm-heat,qi deficiency and blood stasis,thus demonstrating the microecological connection between TCM and these symptoms.These organisms are expected to be markers of phlegm-heat,qi deficiency,and blood stasis,and serve as a foundation for investigating the micro-ecological relationship between TCM symptoms and translational research on specific TCM symptoms.Conclusion:①Patients with acute cerebral infarction of the phlegm-heated type are at higher risk of depression;②the characteristic flora of secondary depression in the phlegmheat and non-phlegm-heat groups are different,suggesting that different TCM evidence types lead to different mechanisms of depression;③the characteristic flora detected in the qi-deficiency,blood-stasis and phlegm-heat groups are expected to be an intrinsic basis for TCM evidence typing and promote the study of micro-ecological transformation of TCM evidence.