| ObjectivePrevious studies have shown that low hemoglobin level was closely related to the morbidity, mortality and the complication rate among patients with ischemic stroke. Cerebral oxygen delivery is determined by the cerebral blood flow and arterial oxygen content, which depends mainly on hemoglobin levels. Reduced levels of hemoglobin may lead to reduced brain oxygen delivery, increased the brain ischemia and hypoxia in patients with ischemic stroke, and aggravate symptoms of neurological deficit, increase the incidence of progressive stroke. Progressive stroke have a higher incidence in ischemic cerebrovascular disease, associated with a poor prognosis, increase long-term mortality and morbidity. We hypothesized that there was close relationship between the low hemoglobin level and progressive stroke and further investigated its relationship have a more profound effect to the patients with intracranial arterial stenosis/occlusion or relatively large cerebral infarction. The purpose of this paper is by using a retrospective method, the cases included in the study, demonstrate these hypotheses, and to investigate and analysis the TCM syndrome distribution of studies, and explore the correlation between low hemoglobin level and progressive stroke in the "yin and yang type certificate".MethodsConsecutive patients with acute ischemic stroke were retrospectively enrolled from Encephalopathy Center of Guangdong Provincial Hospital of Chinese Medicine between August 1,2005 and July 31,2008. The demographic information, NIHSS, hemoglobin (Hb) concentration, brain imaging data, other risk factors of the patients as well as TCM syndrome types were collected from the electronic medical record system. All the patients were classified as major stroke and minor stroke based on BASIS. If the continuous variables with normal distribution were analyzed using t-test, it does not comply with the Wilcoxon rank sum test; categorical variables were analyzed using the chi-square test. Logistic regression model for multivariate analysis. A P value of 0.05 was used to demarcate statistical significance.Results1337 patients were enrolled in this study. After excluding 771 without MRA and 126 without hemoglobin,440 patients were in the final analysis. Among these 440 patients,157(35.7%) were major stroke while 283(64.3%) were minor stroke. The multivariate analysis showed that in the total population, the elevation of hemoglobin (per 1g/1) could reduce the risk of progressive stroke by 3%(95% CI:0.94-0.99); in patients with hemoglobin≥100g, the risk of progressive stroke could reduce 91%(95% CI:0.02-0.44); the incidence of progressive stroke in patients with anemia was 2.53 as high as those without anemia, but there was no statistical significance.Furthermore, the stratified analysis showed that:In patients with major stroke, the elevation of hemoglobin (per 1g/1) could reduce the risk of progressive stroke by 4%(OR:0.96; 95%CI:0.92-0.99), in patients with minor stroke(OR:0.99; 95%CI:0.94-1.04)was no statistical significance; in patients with major stroke when the hemoglobin≥100g/l, the risk of progressive stroke could reduce 97%(OR:0.03; 95%CI:0.002-0.43), in patients with minor stroke (OR:0.23; 95% CI:0.02-2.89) was no statistical significance; In patients with major stroke, the incidence of progressive stroke in patients with anemia was 2.04 as high as those without anemia, but there was no statistical significance (p=0.27).In 440 cases of subjects, distribution characteristics of TCM syndrome types as follows:The proportion of "yin type certificate" is 68.4%, the proportion of "yang type certificate" is 31.6%. In patients with "yin type certificate", the elevation of hemoglobin (per 1g/1) could reduce the risk of progressive stroke by 7%(OR:0.93; 95% CI:0.88-0.97), the difference was statistically significant (p＜0.01); in patients with "yin type certificate" when the hemoglobin≥ 100g/l, the risk of progressive stroke could reduce 96% (OR:0.04; 95% CI:0.004-0.33), the difference was statistically significant (p ＜0.01).ConclusionOur results show that support for the hypothesis:low hemoglobin level was closely associated with progressive stroke among acute ischemic stroke population, especially among patients suffered from major stroke. The distribution characteristics of TCM syndrome types of acute ischemic stroke patients showed "yin type certificate" is more common. For "yin type certificate" patients, hemoglobin levels decrease closely related to the incidence of stroke progression. But related pathogenesis of low hemoglobin levels on how to influence the progress of stroke requires further prospective cohort study in the future to confirm. |
PDF Full Text Request