At Different Time Points Of Ischemic Stroke Neurologic Impairment Syndrome Characteristics And Prognosis

Accepted western scales are usually used to evaluate the curative effect of patients with stroke in term of "disease" itself. However, with a long therapeutic history and definitely curative effect, the Chinese traditional medicine focuses on the "syndrome" to treat patients and improve their symptoms. It can not be comprehensive, objective and effective to evaluate the curative effect of Chinese medicine to treat stroke only based on "disease" itself. Therefore, combinating of disease and syndrome would be a comprehensive, scientific, objective and accurate method to evaluate the outcomes of patients with stroke.ObjectiveIn the present study, by comparing the predictive abilities of scales to evaluate the outcomes of patients with ischemic stroke in term of only the "disease" and the combination of "disease and syndrome", to evaluate the effect of syndrome on the outcomes of stroke, and to provide the evidence for evaluation of curative effect in term of combination of disease and syndrome.MethodsThis study is one part of the project "the study of the key technologies in the therapeutic effect evaluation of Chinese herb showing the advantages of the therapeutic effect" (project number:2009ZX09502-028). According to the purpose of the study, NIHSS scale was chosen to evaluate the disease, syndrome factor of ischemic stroke diagnosis scale to evaluate the syndrome and Barthel Index (BI) to evaluate the outcomes(disabled or not). By using the retrospective data analysis method,755 patients were extracted from the data of former project 973 by screening and transforming the data. The variables of patients included general information(18 items), the scores of neurological evaluation scales at different time points (NIHSS, BI) (6 items), TCM four diagnostic factors (196 items) and syndrome factors (6 items).Results1 Optimization of statistical methods at different time pointsThe binary classifier in Clementine 12.0 software was used to evaluate the modeling capability of different statistic methodsbased on the maximum used of fields and the largest area under the curve and the results showed that Logistic regression analysis method was superior to Bayesian networks, decision trees, discriminant analysis. 2 Preliminary screening factors associated with poor outcome 90 days after onset of stroke70% of cases from the database were extracted randomly as the training subset to screen the factors associated with poor outcome 90 days after onset of stroke by using logistic regression analysis. The results showed that these factors included age, history of stroke, OCSP type, NIHSS score and grading and syndrome factors. Different syndrome factors became preliminary screening factors at different time points. At day 3, it was qi deficiency, day 7 phlegm and damp syndrome and qi deficiency, day 14 qi deficiency, day 28 fire syndrome and qi deficiency, and day 90 wind syndrome, fire syndrome, phlegm and damp syndrome, blood stasis syndrome, qi deficiency, which indicating that different syndrome factors at different time points contribute to the prodiction of prognosis. We also found that qi deficiency has significant relationship with the prognosis.3 The correlation of disease and disease-syndrome combination with prognosisThe disability model equations based on NIHSS scores at different time points showed that NIHSS scores at all time points were closely relevant to disability, and could be as an independent risk factor to predict disability, suggesting that the concept that used the "disease" to determine the changes and outcome of disease showed important clinical significance to some degree.The disability model equations based on NIHSS scores and syndrome factors at different time points showed that qi deficiency entered into the disease-syndrome combination' equations at day 3, day 7, and day 14 and the fire syndrome and yin deficiency into the equation model as independent risk factors at day 90, suggesting that some syndromes could serve as independent risk factors to predict disability and the model of efficacy assessment should be based on the model of disease-syndrome combination.By using databaseâ…¡, we validated the two disability model equations based on only NIHSS scores or both NIHSS scores and syndrome factors at different time points. By comparaing the two models longitudinally we found that both of them can predict disability with AUC>0.7, and this predictive ability was more powerful with the longer course of disease. By comparising the two models horizontally, we found that there were no statistically significant difference in AUC, sensitivity, specificity and Youden index.4 The evolutionchange of single syndrome factorat different time points means different prognosis The results showed that at day 3 and day 14, the fire syndrome and phlegm and damp syndrome in group syndrome disappearing displayed better outcome than these in group syndrome non-change and sydrome plus, suggesting that at the acute phase of stroke, the condition of stroke and short-term prognosis were mainly influenced by the core syndrome of fire syndrome and phlegm and damp syndrome. At dayl4 and day 28, yin deficiency in group of sydrome plus showed poor prognosis than that in the group of syndrome disappearing, indicating that yin deficiency syndrome had more impact on short-term prognosis than other syndrome. At day 28 and day 90, the wind syndrome in group of sydrome plus showed poor prognosis than that in the group of non-change, and the fire syndrome and qi deficiency in group of sydrome disappearing had better outcome than these in group syndrome non-change; blood stasis syndrome in group of sydrome plus had poor prognosis than in the group non-change and disappearing. These findings suggested that during the late recovery of stroke, the wind syndrome meaned bad prognosis, and we should pay much attention to the treatment of fire syndrome, qi deficiency and blood stasis syndrome. So the state of syndrome should be the core of evaluation of traditional Chinese medicines, and we should pay attention to these dynamic features of syndormes.ConclusionsStroke is an acute disease with diverse clinical manifestation, and the conditions in different periods have different characteristics and syndrome features. Current evaluation methods usually focus on "disease" itself and ignore "syndrome", by using such methods it is difficult to make use of the efficacy of unique advantages of Chinese medicine. The results in this study suggest that during the process of evaluation of curative effect, except disease itself, we should pay much more attention to "syndrome" and their dynamic change characteristics in time and space. The system for clinical evaluation of stroke should be mainly based on syndromes and their dynamically spatial and temporal characteristics and combine the disease and the state of syndrome closely.