| BackgroundCerebrovascular disease is a common and frequently occuring illness in nervous system with the mortality of 10% of all the disease,being one of three important causes of death, additionally,50%-70% survivors retain severe disability, such as paralysis and alalia ect.lt becomes the focuse hot spot on clinical study due to the characteristics of "high morbidity", "high mortality", "high disabilities", "high relapsement rate" and the unsustainable burden for the society and families. Cerebrovascular disease can be mainly devided into hemorrhagic stroke and ischemic stroke, and the former one includes the cerebral haemorrhage and subarachnoid hemorrhage, while the latter is called cerebral infarction (CI) including cerebral thrombosis, lacunar infarct and cerebral embolism and so on with about 70% of all the stroke. Acute phase is a critical period of stroke treatment, thus, it is significant to understand and master the stage of pathogeny and pathogenesis on the treatment of this disease.From the modern medical research, ischemic stroke large and small artery disease patient groups with different etiology, pathogenesis, neuropathology changes, changes in neural imaging, and clinical outcome. Modern medicine's classification of ischemic stroke deeper. Current international use of ischemic stroke the most important classification is still the anatomy and etiology, TOAST classification is commonly used international classification method. Hot previous research focused on comparative weight of brain artery disease lesions, and cerebral small vessel disease less severe, clinical symptoms hidden, its lack of concern. With the development of science, found a high incidence of cerebral small vessels, a ladder-like or progressive course of disease progress for several years after neurological deficit, often leading to pseudobulbar palsy and subcortical dementia. In 2008, the International Stroke Conference and the European Stroke Conference, both made "small vascular disease is the cause of the problem."This paper devides intio three parts to study as follows:the classification of syndrome in the ischemic apoplexy at acute stage and the correlation analysis of the Western medicine indicators and the related analysis on the large and small cerebral artery disease, an the study on the development rules in the traditional Chinese medicine of ischemic apoplexy at acute stage as well as the relationship between the ischemic large and small artery pathology and stroke prognosis.Study Aim1.The related anaylisis on the acute period of ischemic stroke syndromes meridian card and the size of the correlation in arterial lesions2.Find the evolution rule of traditional Chinese medicine in artery disease on Acute stage in ischemic apoplexy3.Explore the relationship between the arterial ischemic stroke lesions and the prognosis for stroke patientsResearch methodsStudied the paitents of acute stage in ischemic apoplexy within 7 days and adopted the《Diagnosis main points of all kinds of cerebrovascular disease》on the ischemic cerebrovascular disease, the diagnosis and evaluation of syndrome factor are adopted《the syndrome differentiation and diagnosis criteria of stroke》, mainly using the standard of diagnose and dividing type of ischemic cerebrovascular disease TOAST combined with imageology. The patients are divided into large cerebral artery disease group and arteriolopathy to do the collection on thesyndrome factors in 6-hour real time and dynamic state, therefore, we find that the pointoftime design is respectively 1day,2 days,3 days,7 days,14 days and 28 days after morbidity to discuss the development rule through the syndrome scale scores at each time and the dynamic analysis of syndrome.Additinally, the acquisition of dynamic state of NIHSS,improvement score and ADL rating scale are for the patients to discuss the relationship between the patholog of ischemic large and small artery and prognosis.We collect 207 cases in neurology of Dongfang Hospital in Beijing University of Chinese Medicine and of Dongzhimen Hospital with 129 of masculinity and 78 of feminality.The youngest age is 39 and the oldest is 85 and the avearge age is 66.63±11.21 with 87 Macroangiopathy and 120 Small vessel lesions.Using the Access2003 database to establish a database,two people log data in the applicatins of SPSS 17.0 software to anyalyze the data.Result1. The related study result for the classification of acute ischemic stroke and the related Western syndromes indexs and size of artery disease(1) Compared with the general information among the two groups of the artery disease patients, we can find that there are not any significant differences among the sex, age, height, weight, ethnicity, marital status and other aspects between them.(2) As for the past medical history,there are significantly differences on the coronary heart disease, atrial fibrillation, and other aspects in the two groups.There are more patients with the following diseases in the main artery lesion.(3) As for the physical and chemical inspection, it is significantly different to the lymphocyte percentage, HDL, LDL in the two groups in that the levels of the patietns with large artery lesion are lower in the three indicators.There is no significant difference in the neck vascular ultrasound data results of the blood vessel.TCD data shows that the difference is significant on the proportion of vessel is higher with high velocity in the patients with large vessel disease(4)There is a significance on the difference in the NIHSS score and modified Rankin score for the patients with large artery lesions in the neurological scale.(5) Compared with groups in the syndrome judgement of the IBS QOL questionnaire in TCM syndrome,the Asthenic yin and predominant yang group show the significant differences, and this syndrome is in a high proportion of small vessel disease.Compared with the groups of the syndrome scale of the traditional Chinese medicine, we can find that the the groups of yin deficiency and yang upward syndrome shows the significant differences, and this syndrome of small vessel disease is in a high proportion.(6) Adopted with the logistic regression analysis related to the arterial lesions of the Western targets, it is of significances to the model of the results retains the previous atrial fibrillation history, other history of heart disease, LDL TCD high velocity and the size associated with vessel vascular lesions. The Chinese medicine index associated with the size of arterial lesions include the yin deficiency and yang upward syndrome and sputum score value.Using logistic regression,they are the mutual independence factors in that the increase on the sputum rating value supports the diagnosis of artery disease, and the yin deficiency and yang upward syndrome supports the small artery lesions.2. The TCM syndrome development rule of the large and small cerebral artery disease in the acute ischemic stroke lesion(1) The wind syndrome score curves show the different characteristics. Firstly, the artery curve rose,and then it declined,and the peak value was on the third day;firstly the small artery curve decreased and then went up, then went down, it has a wave trough, and the peak was the third day. The repeated variance analysis is used including the nonsignificant difference between groups P=0.295 in the time point data.The wind frequency at each time point shows a similar performance in the study population trends of dynamic score and wind dynamic score.Firstly the Artery curverose, then it declined,and the peak value was in the third day;firstly the small artery curve declined, and then it decreased, it had a wave trough through in the second day and the peak value was the third day.Compared with each time point, there was no significant difference.(2) Firstly, the hot syndrome score curve artery curve increased,then it decreased,and the peak value was in the third day; and the small artery curve first decreased and then showed up, and a wave trough was in the second day with the peak value on the third day;however, the peak curve value was in the third day and the small artery was in the 7th day.Compared with the T test for each time point, the 2th,3rd and the 28th days have the significant differences.The repeated variance analysis is used including the difference between groups P=0.295 in the time point data, which is significant on statistics.The dynamic trend is similar to the syndrome score of the appeared frequency in the study people at each time ignition proof.The artery curve firstly increased, then it decreased in the third day;small artery curves firstly decreased and then increased,and further it decreased with a wave trough of the third day.Compared with the groups for each time point, the 2th,3rd days have the significant differences.(3) Firstly,the large artery carve of the Phlegm syndrome score increased,then it decreased,and the peak value was in the third day; and the small artery curve first decreased and then showed up,and further it decreased again,and a wave trough was in the second day with the peak value on the third day; Compared with the T test for each time point,the 2th,3rd,7th,14th and the 28th days have the significant differences.The repeated variance analysis is used including the difference between groups P=0.0001 in the time point data, which is significant on statistics.The ratio of the trend curve in the Phlegm syndrome is similar to the score carve,firstly it increased,then it decreased,and the peak value was in the third day; small artery curve first decreased and then showed up,and further it decreased again,and a wave trough was in the second day with the peak value on the third day; and it was mild in the the 3rd and the 7th. Compared with each time point, the 2th,3rd,7th,14th and the 28th days have the significant differences.(4) Firstly, the large artery carve of the score carve in the blood stasis syndrome syndrome it increased,then it decreased,and the peak value was in the third day; small artery curve first decreased and then showed up,and further it decreased again,and a wave trough was in the second day with the peak value on the third day; Compared with the T test for each time point, the 2th,3rd, and the 28th days have the significant differences.The repeated variance analysis is used including the difference between groups P=0.0001 in the time point data, which is significant on statistics.The blood stasis syndrome syndrome firstly increased,then it decreased,and the peak value was in the third day; small artery curve has no wave trough Compared with each time point, the 14th day has the significant differences.(5) The score carve of qi-deficiency syndrome syndrome firstly increased,then it decreased,and the peak value of large artery carve was in the 3rd day while the small artery carve was in the 7rd day. Compared with the T test for each time point, the,3rd, and the 28th days have the significant differences.The repeated variance analysis is used including the difference between groups P=0.084 in the time point data, which is not significant on statistics.The trend curve of deficiency of vital energy syndrome ratio is similar to the score carve, firstly it increased,then it decreased,and the peak value of large artery carve was in the 3rd day while the small artery carve was in the 7rd day. Compared with each time point, the 14th day has the significant differences.(6) The two groups of the yin deficiency and yang excess syndrome showed different characteristics. Firstly it increased,then it decreased,and the peak value of large artery carve was in the 14th day while the small artery carve firstly decreased and then showed up,and further it decreased again,and a wave trough was in the second day with the peak value on the 7th day; Compared with the T test for each time point, they haveno significant differences.The repeated variance analysis is used including the difference between groups P=0.451 in the time point data, which isn't significant on statistics.The trend curve of syndrome rate is similar to the score carve. The large artery carve firstly increased, then it decreased with a peak value on the 14th day;small artery curves firstly decreased and then increased,and it had a valley value of the third day and the peak value of the 7th day. Compared with each time point, the 1st day has the significant differences.3.Discussion on the relationship between the ischemic strokel large and small artery pathology and stroke prognosis.(1) Analyzed on the non-parametric tests of the large and small artery pathology at each time point, there is significantly difference between the two groups of NIHSS in that the NIHSS of large artery pathology was so high at each time point.NIHSS score curve and the syndrome showed a similar rule curve, the small artery curve has a trough in the next day with the peak between 3-7 days.(2) It is significant to the large and small artery pathology and the improvement Rankin score after the invasion with 28 days of improvement on the non-parametric tests and analysis.(3) There is no significant difference on the large and small artery pathology and the 28 days of improvement after the invasion on the non-parametric tests and analysis.Conclusion1. The apoplexy invasion of the stroke patients attacked on the first day, and the past history of atrial fibrillation, history of other heart disease, LDL, TCD high flow vascular lesions associated with the independent factors of the size of the vessel, and the LDL level is negatively correlated with macrovascular disease,while the other factors are positive correlation. From the perspective of Chinese medicine, Chinese medicine yin deficiency and yang excess, sputum score value and the size of the independent factors related to vascular disease, in that the increased score value ofsputum supports the diagnosis of large artery disease, yin deficiency and yang excess supports the diagnosis of small artery2.There is certain regularity of the dynamic progression on the essential factors after the 1st,2nd,3rd,7th,14th and 28th, we can conclude as follows:The same score of syndrome factor and the variation curve of the occurrence rate time point change showed the similar trend; Based on the size of arterial lesions in the different arterial lesions,the patients'FHP, phlegm, blood stasis three certificates have shown a higher rate and incidence; syndrome score and incidence of dynamic evolution trend are different artery disease based on the size of the artery pathology.3.The trend development of the NIHSS scale score showed the similar regulation of the syndrome score. Firstly the large artery pathology increased,then it decreased, while the small artery carve firstly decreased and then showed up,and further it decreased again,and a wave trough appeared after the second day with the peak value between the 3th and 7th days.4.The large artery pathology is worser than the prognosis of small artery.
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