A Study On Relationship Between The TCM Treatments Based Upon The Differentiation Of Syndromes And Prognosis Of Patients With Acute Stroke

Background:Stroke is one of the third death cause of mankind,it's a disease of high incidence,mutilation rate and case fatality,and it brings about heaviest stress and grave economic burden to individuals,families and the community. Investigation on impacting factors of stroke prognosis can help to guide treat, promote patients' recovery from illness and distribute medical treatment resource.The syndromes of Traditional Chinese Medicine(TCM)and treatment based upon syndromes differentiation would affect the prognosis of stroke patients,which is the source of evidence to evaluate the treatment effects. At present,domestic report in this area has few.Then,it has great clinical significance to hunting the relationship between prognosis and syndromes of TCM,treatment based upon differentiation of symptoms and signs.Objective:To analyze the prognostic factors,which may impact the prognosis of acute stroke patients,and to analyze the relationships between the initial syndromes of TCM and prognosis of stroke,especially for the TCM treatment.The study results may redound to reduce the recurrence rate of stroke,morbidity and mortality,for the better the prognosis.Methods:By means of the stroke registry system of Guangdong Provincial Hospital of TCM,the subjects were interviewed continuously from Oct 1,2005 to Sep 30, 2007.Data including the general state on admission,pathogenetic condition, the initial syndromes of TCM and TCM treatments for the initial syndromes were collected from these patients.The follow-ups were implemented at the end of the first month,the third month,the sixth month,the first year and the second year after occurrence of stroke.Survival situation and Barthel index(BI) scores of patients were assessed at five above time points.The general situation,the initial syndromes of TCM and TCM treatments were analyzed by univariate analysis.Then the prognosis analysis was performed on the basis of application of the univariate analysis for each visit time point for the prognostic factors,multi-variate logistic regressions were applied to analysis BI and survival status related to the prognostic factors.Finally, the Cox model was used to analyze and established the survival model for the initial syndromes of TCM and the TCM treatments.Results:Of the 687 patients of acute stroke met the diagnostic,inclusion and exclusion criteria were interviewed.In analysis of the single initial syndromes of TCM,it presented highest frequency for the Wind Syndrome and the Sputum Syndrome,which were 81.4%and 64.0%respectively,and the lowest frequency for Yin-deficiency Syndrome(3.2%).Double-combined Syndromes and Triple-combined Syndrome of TCM were also frequency in the patients.The combination of the Wind Syndrome and the Sputum Syndrome in double-combined Syndromes was highest frequency(40.2%).The combi-nation of the Wind Syndrome, the Sputum Syndrome and Fire-heat Syndrome in Triple-combined Syndromes was highest frequency(54.6%).The results from logistic regression analysis showed that the significant factors for the poor prognosis(BI score<60)at the third month included age, the TCM type of stroke and the National Institutes of Health Stroke Scale (NIHSS).The prognostic factors at six month were age,NIHSS and the history of CHD.The prognostic factors at the first year were age,NIH score scale, the Qi-deficiency Syndrome score and the Fire-heat Syndrome score.And the prognostic factors at two year were age and NIH score scale.The significant factors of prognosis for death at the third month included age,NIHSS,the stagnant blood syndrome score,the Qi-deficiency syndrome score and the number of day of hospitalization.The factors of prognosis for death at six month were age,NIHSS and the number of day of hospitalization.The factors of prognosis for death at the first year and the second year were age and NIHSS. Treatments based upon differentiation of symptoms and signs,the Chinese medicine Corresponding to the Wind Syndrome,the Fire Syndrome,the Sputum Syndrome,the Stagnant Blood Syndrome,the Qi-deficiency Syndrome and the Yin-deficiency Syndrome was higher frequency.Administrations of above kinds of Chinese medicine were given as 18.2%,4.6%,16.7%,24.3%and 10.5%in all TCM prescriptions,and the proportion in all patients were 93.2%,44.8 %,87.2%,94.8%and 41.9%respectively.There was no significance relationship with the prognosis at fourth month time point.The rational using of decoction and preparations of TCM was enclosed as independent variables into logistic regression model,then the results of the analysis indicated that significant factors for the third-month point were age,the TCM type of stroke,NIHSS and Qi-deficiency Syndrome,and that for the sixth-month point were age,NIHSS,the number of day of hospitalization,diastolic blood pressure and systolic blood pressure,and that for both one and two year point were age and NIH score scale.The rational using of decoction and preparations of TCM have no significance relationship with the prognosis in this model. The results of survival analysis showed that the factors related to survival time included age(OR=1.067,95%CI:1.043～1.092),the type of TCM of stroke (OR=2.145,95%CI:1.046～4.392)and NIHSS(OR=1.042,95%CI:1.046～4.392).The survival model displayed a good predictability.The rational using of decoction and preparations of TCM was also brought into the Cox model as independent variable.The model remained the significant factors including age,the TCM type of stroke,NIHSS and the history of diabetes mellitus.The rational using of decoction and preparations of TCM were also no significant relationship with the prognosis in the model.Conclusion:At different visit points,the prognosis of acute stroke related to a varies of factors,such as age,NIHSS,days of hospitalization,Fire-heat Syndrome score,Qi-deficiency Syndrome score,the type of TCM of stroke,the history of CHD and so on.The results such as age and NIHSS factors were similar to other prognostic studies.However,there were no significant in the relationship between the rational using of decoction and preparations of TCM and the prognosis of stroke.As the limitations of this study,these results have to need to be exploratory or long-term follow-up studies to gain more evidences.