| Objective:1.Collect the general data,symptoms,pulse index,tongue index and other data of patients with MCI phlegm obstruction syndrome,screen and construct the diagnostic model suitable for MCI phlegm obstruction syndrome,and verify the diagnostic effic iency of the diagnostic model.2.To explore the relationship between serum NPY,ghrelin,ADAS cog score and intestinal flora in patients with phlegm turbidity obstruction orifices syndrome of MCI,so as to provide preliminary basis for follow-up clinical research.3.To explore the effects of invigorating the spleen,resolving phlegm and opening orifices on NPY,ghrelin and intestinal flora in patients with phlegm turbidity obstruction orifices syndrome of MCI.Methods:1.117 patients with MCI phlegm turbidity obstruction syndrome and 118 patients with MCI non phlegm turbidity obstruction syndrome were included to study the differences of general data,symptoms,pulse indexes and tongue indexes in each group.Combined with the above difference indexes,the traditional logistic regression method and machine learning method are used to establish a diagnostic model based on the training set for the rapid diagnosis of phlegm turbidity obstruction in MCI.Then the verification set is tested to evaluate its performance.The receiver operating characteristic curve(ROC curve)of the two models was analyzed and the diagnostic accuracy of the two models was compared.2.From the perspective of "brain gut axis",to study the relationship between serum NPY,ghrelin,ADAS cog score and intestinal flora in patients with phlegm turbidity obstruction orifices syndrome of MCI.30 cases of phlegm turbidity blocking orifices syndrome in MCI and 30 normal healthy controls were included.Firstly,the correlation between ADAS cog score and serum NPY and ghrelin was analyzed.Secondly,the correlation between intestinal bacteria and serum NPY and ghrelin in patients with phlegm turbidity obstruction orifices syndrome of MCI was analyzed.Finally,intermediary analysis was used to explore the potential relationship between serum NPY,ghrelin,ADAS cog score and intestinal flora in patients with phlegm turbidity obstruction orifices syndrome of MCI.3.The clinical efficacy of Xixin Decoction modified Granule on MCI patients with phlegm turbidity obstruction orifices syndrome was studied from the perspective of "brain intestinal axis".55 patients with MCI phlegm obstruction syndrome were randomly divided into Jianpi Huatan Kaiqiao group and control group.There were 28 cases in Jianpi Huatan Kaiqiao group and 27 cases in control group.The patients in the treatment group were treated with Xixin Decoction plus or minus granules,and the patients in the control group were treated with Piracetam Tablets.The treatment period of the two groups was 2 months.The changes of TCM syndrome score,ADAS cog score,MMSE score,MOCA score,GSRS score,serum NPY,ghrelin,intestinal flora and tongue pulse index were compared before and after treatment.Results:1.Clinical study on prediction model of MCI phlegm turbidity blocking orifices syndrome:(1)The relevant variables selected for constructing the diagnostic model were hyperlipidemia,dizziness and body pain,tongue tip rgb-r,tongue tip hsl-h,tongue tip hsl-1,left tongueedge rgb-g,left tongue edge lab-a and right hand pulse diagnosis H3/H1.(2)Based on the calculation of the training set,the area under the curve(AUC)of the logistic diagnostic prediction model was AUC=0.81,the standard error was 0.02,95%CI was 0.76-0.87,P<0.001,and the accuracy of the model was 78.1%.The area under the curve of xgboost machine learning prediction model AUC=0.83,standard error 0.02,95%CI:0.78-0.88,P<0.001,model accuracy=82.1%.(3)Based on the calculation of validation set,the area under the curve(AUC)of logistic diagnostic prediction model were AUC=0.70,standard error 0.05,95%CI 0.58-0.82,P<0.01.The area under the curve of xgboost machine learning prediction model AUC=0.75,standard error 0.06,95%CI:0.63-0.87,P<0.2.Relationship between serum NPY,ghrelin,ADAS cog and in testinal flora in patients with phlegm turbidity obstruction orifices syndrome of MCI:The results of correlation analysis showed that Bifidobacterium was negatively correlated with serum NPY,and Bifidobacterium was positively correlated with serum ghrelin.Bacteroides was positively correlated with serum NPY.Clostridium was positively correlated with serum NPY.Adas cog was positively correlated with serum NPY.The mediating effects of serum NPY and ghrelin in intestinal flora(Bifidobacterium,Enterococcus,Bacteroides and Clostridium) and ADAS cog were further analyzed.Finally,it was found that there was a significant indirect effect of serum NPY in Bifidobacterium and ADAS cog in patients with phlegm turbidity obstruction orifices syndrome of MCI(P<0.05).3.Effect of invigorating the spleen,resolving phlegm and opening orifices on NPY,ghrelin and intestinal flora in patients with MCI phlegm turbidity blocking orifices syndrome:(1)Compared with before treatment,there were statistical differences in the total scores of ADAS cog,MMSE,MOCA between the two groups(P;After treatment,there was no statistical difference between the two groups in the total scores of ADAS cog,MMSE and MOCA(P>0.05).There was statistical difference between the two groups in the total score of GSRS(P<0.05).There was statistical difference between the two groups in the scores of head weight such as wrapping,abdominal distension,excessive phlegm and salivation,and limb sleepiness(P<0.05).(2)Among the scores of ADAS cog,compared with those before treatment,the scores of "word recall" and "word recognition"in the Jianpi Huatan Kaiqiao group were statistically significant(P<0.05),and the scores of "word recognition" in the control group were statistically significant(P<0.05).Among the MMSE scores,compared with those before treatment,the difference of "time orientation","immediate memory" and "delayed memory"scores in the Jianpi Huatan Kaiqiao group was statistically significant(P<0.05),and the difference of "delayed memory" scores in the control group was statistically significant(P<0.05).Among the scores of Moca,the difference of "language" score in Jianpi Huatan Kaiqiao group was statistically significant compared with that before treatment(P<0.05).Among the scores of GSRS,compared with those before treatment,the scores of "abdominal distension","belching","increased exhaust" and "end less defecation" in the Jianpi Huatan Kaiqiao group were statistically significant(P<0.05),while the scores of GSRS in the control group were not statistically significant(P>0.05).(3)In the indexes of tongue diagnosis,after treatment,there were significant differences in rgb-rand lab-a at the tip of the tongue(P values were 0.01 and 0.01 respectively)and rgb-g,lab-1 and lab-b at the left edge of the tongue(P values were 0.01,0.01 and<0.01 respectively)between the Jianpi Huatan Kaiqiao group and the control group.There were significant differences in rgb-r,rgb-g,rgb-b,lab-l,lab-a and lab-b at the tip of tongue,left tongue and right tongue before and after treatment in Jianpi Huatan Kaiqiao group(P<0.05).After treatment,there were significant differences in rgb-r,rgb-g,rgb-b,lab-1 and lab-b between Jianpi Huatan Kaiqiao group and control group(P values were 0.03,<0.01,0.02,<0.01 and<0.01 respectively).There were significant differences in rgb-r,rgb-g,lab-l and lab-b of tongue coating before and after treatment in Jianpi Huatan Kaiqiao group(P<0.05),but there was no significant difference in rgb-b of tongue coating before and after treatment in Jianpi Huatan Kaiqiao group(P=0.80).In addition,in the pulse diagnosis indexes,after treatment,there were significant differences in the frequency domain indexes H3 and H4/H1 of right hand pulse diagnosis between the two groups(P values<0.001 and 0.01 respectively).(4)Compared with before treatment,the expression level of NPY decreased,the expression level of ghrelin increased,the content of Bifidobacterium increased,the content of Lactobacillus increased and the content of Enterococcus decreased in Jianpi Huatan Kaiqiao group(P<0.05);There was no statistical difference in the expression levels of NPY and ghrelin,the contents of Bifidobacterium,Enterococcus,Bacteroides,Lactobacillus and Clostridium in the control group(P>0.05).After treatment,there were statistical differences in the expression levels of NPY and ghrelin,the contents of bifidobacteria,enterococci and Lactobacillus between the two groups(P<0.05).Conclusion:1.Xgboost machine learning prediction model and logistic diagnosis prediction model can be used to identify MCI cases of phlegm turbidity obstruction.In the diagnosis of the disease,the accuracy of xgboost machine learning prediction model is equivalent to that of logistic diagnosis prediction model.2.There is a significant indirect effect of serum NPY in bifid obacteria and ADAS cog score in patients with MCI phlegm obstruction syndrome,that is,bifidobacteria may affect ADAS cog score in patients with MCI phlegm obstruction syndrome through serum NPY.3.Jianpi Huatan Kaiqiao method can improve the TCM symptom score,ADAS cog,MMSE and MOCA score of patients with MCI phlegm obstruction syndrome.Its mechanism may be to increase the content of Bifidobacterium in patients with MCI phlegm obstruction syndrome,reduce serum NPY and finally affect the ADAS cog score of patients. |
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