| Objective:To analyze the relationship between Traditional Chinese Medicine (TCM) syndrome elements as well as information obtained by four diagnostic methods with the prognosis in patients at acute stage of ischemic stroke, to explore the significance of early TCM intervention on syndrome elements and clinical symptoms of acute ischemic stroke, and to provide basis for further improving the treatment regimens of acute ischemic stroke and objectively evaluating the efficacy of TCM in the treatment of acute ischemic stroke.Methods:This study is part of the project "Study on the diagnostic criteria and therapeutic effect evaluation system of ischemic stroke based on disease-syndrome combination" of National Key Basic Research Development Program (973 Program). From February 2005 to June 2007, the "information acquisition manual" was used in four clinical research centers to continuously collect the clinical information of patients admitted to hospital within 72 hours of onset of acute ischemic stroke, and the information was recorded in a database; altogether, the clinical information of 14,880 cases from 1023 patients was collected. Software program was applied and the "stroke syndrome element diagnostic scale" developed by our research group was used to determine the elements of syndrome according to the first recorded information of the patients obtained by TCM four diagnostic methods. Data were screened according to the requirements of the study, finally the clinical information of 804 cases was selected, and then the database was locked. The patients' clinical information including syndrome elements firstly recorded after admission were used as independent variables, while Barthel Index (BI) on the 90th of onset were used as indicators for prognosis evaluation, that is, as the dependent variables. SPSS 13.0 software package was used for frequency distribution analysis on the independent variables; logistic regression and chi-square test were used to analyze the relationship between acute stage TCM syndrome elements as well as information obtained by four diagnostic methods with the prognosis, and the relationship between the clinical information excluding TCM factors with the prognosis; Spearman rank correlation analysis was used to analyze the correlation between various prognosis-related factors of the acute stage.Results:The qi deficiency syndrome elements of acute stage of ischemic stroke was significantly positively correlated with poor prognosis on the 90th day of the onset (OR= 1.595, P<0.01); urinary incontinence (OR= 3.861, P<0.01), faint low voice (OR=1.910, P<0.05), fatigued spirit (OR= 1.383, P<0.05) were positively correlated with poor prognosis on the 90th day of the onset.The age of onset (OR= 1.037), initial NIHSS score (OR= 1.237), past history of stroke (OR= 1.774), and neutrophil percentage (OR=1.019) showed significant positive correlation with poor prognosis on the 90th day of the onset (P≤0.01); past history of diabetes had a positive correlation with poor prognosis on the 90th day of the onset (OR=1.602, P<0.05); initial Glasgow score (OR= 0.783, P<0.05) was negatively correlated with poor prognosis on the 90th day of the onset. It prompted that patients who had the disease onset at an old age, with a high initial NIHSS score after the onset, or a history of stroke or diabetes may have high possibility of poor prognosis on the 90th day of the onset; the neutrophil percentage was associated with poor prognosis, and abnormal neutrophil percentage had a greater impact on poor prognosis (P<0.01); patients with high initial Glasgow score had lighter brain damage, and their activities of daily living were in a better recovery on the 90th day of the onset.There was correlation between various prognosis-related factors of the acute stage. The age of onset had a negative correlation with initial Glasgow score (P<0.05), while it had positive correlation with past history of stroke, qi deficiency syndrome elements, faint low voice, fatigued spirit, and urinary incontinence (P<0.05). Initial NIHSS score had a significant negative correlation with the initial Glasgow score (P<0.01), while it had significant positive correlation with neutrophil percentage, qi deficiency syndrome elements, urinary incontinence, and fatigued spirit (P<0.01). Initial Glasgow score had negative correlation with the neutrophil percentage, qi deficiency syndrome elements, and urinary incontinence (P<0.05). A past history of stroke had positive correlation with urinary incontinence and fatigued spirit (P<0.05). However, the correlation between the above-mentioned factors was small (rs<0.5).Conclusion:There is correlation between TCM syndrome elements as well as information obtained by four diagnostic methods of acute stage of ischemic stroke with the prognosis, while qi deficiency syndrome elements, urinary incontinence, fatigued spirit and faint low voice are positively correlated with poor prognosis; various items of clinical information of acute stage are related with prognosis, while the initial Glasgow score is negatively correlated with poor prognosis, and past history of stroke, past history of diabetes, age of onset, initial NIHSS score, neutrophil percentage are positively correlated with poor prognosis; there is lower correlation between various prognosis-related factors of the acute stage. The early intervention on the syndrome elements, information obtained by four diagnostic methods and other clinical indicators may play a positive role in improving the prognosis of patients. |
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