Study On The Characteristics Of TCM Syndromes Before And After Deep Brain Stimulation In Middle-advanced Parkinson's Disease

Objective:To investigate the characteristics of TCM syndromes before and after deep brain stimulation surgery for Parkinson's disease in the middle and late stages.By observing the frequency of common TCM symptoms and the element distribution of TCM syndromes in patients before and after DBS surgery,summarize the characteristics of TCM syndromes,discuss the evolution characteristics of TCM syndromes and the distribution of TCM syndrome types before and after DBS surgery,provide TCM treatment basis for PD DBS patients,and provides evidence-based medical evidence for the establishment of clinically syndrome classification standards.Methods:This study adopted a cross-sectional study method and strictly followed the inclusion and exclusion criteria to select patients who were hospitalized at the Neuromodulation Center of Yuquan Hospital of Tsinghua University from October 2019 to February 2021.PD patients who meet the enrollment requirements were carried out for two time periods(1 week before the operation,2 weeks after the operation).to fill in the questionnaire,including general information and the PD TCM Syndrome Element Scale,the International Dyskinesia Association Unified Parkinson's Disease Rating Scale(UPDRS table).Enter the data in the questionnaire into the database uniformly,and check again after all the entry work is completed.Use SPSS 20.0 and R 4.0.3 for statistical processing,measurement data is represented by X±S or M(min,max),counting data is represented by frequency(composition ratio),and the frequency distribution of TCM syndrome elements is compared by chi-square test,The non-parametric Wilcoxon rank test was used for the comparison of TCM syndrome element integrals and UPDRS table integrals.The correlation between UPDRS table integrals and TCM syndrome elements uses Spearman rank Correlation analysis,and use R 4.0.3 software for systematic clustering analysis,the significance level of various tests are two-sided tests P<0.05.Research result:1.General situation:80 effective cases were collected in this study,160 cases in total.There were 34 males(42.5%)and 46 females(57.5%)before surgery,age ranged from 21 to 78 years,with a median age of 62.5 years;the disease course was 3?25 years,and the median disease course was 10 years;The H-Y grade was 2.5?5.0 stage,and the median value was 4.0 stage.There were 29 mid-stage PD patients and 51 patients with advanced PD.2.Distribution frequency of TCM syndrome elements:(1)The frequency of occurrence of each syndrome element before DBS operation from high to low is:marrow reduction(97.50%),liver wind(96.25%),yin deficiency(81.25%),qi deficiency(76.25%),Yang hyperactivity(75.00%),kidney deficiency(66.25%),blood deficiency(58.75%),internal heat(57.50%),spleen deficiency(45.00%),yang deficiency(43.75%),qi stagnation(43.75%),Blood stasis(33.75%),phlegm turbidity(6.25%);(2)The frequency of occurrence of each syndrome element after DBS is as follows:Yin deficiency(95.00%),marrow reduction(91.25%),Qi deficiency(88.75%),Blood stasis(81.25%),blood deficiency(78.75%),Yang hyperactivity(68.75%),internal heat(62.50%),kidney deficiency(61.25%),liver wind(56.25%),spleen deficiency(46.25%),qi stagnation(42.50)%),Yang deficiency(38.75%),phlegm turbidity(30.00%);(3)The frequency of the six syndrome elements of Qi deficiency,blood deficiency,yin deficiency,phlegm turbidity,blood stasis,and liver wind is significant between the two groups Difference(all P<0.05).3.TCM syndrome element scores:(1)The top three preoperative syndrome element scores are marrow reduction,hepatic wind,and yin deficiency syndrome,and the top three postoperative syndrome element points are marrow reduction,Yin deficiency and Qi deficiency syndrome;(2)The comparison of the integral values of the six syndrome elements of blood deficiency,marrow reduction,yang hyperactivity,phlegm turbidity,blood stasis,and liver wind between the two groups was statistically significant(P<0.05).There was no statistical difference in the integral value of TCM syndrome elements.4.Hierarchical cluster analysis:(1)The top 10 TCM symptoms in preoperative patients with DBS are:slow movements(91.25%),tendons(87.50%),difficulty in walking(87.50%),and inability to walk.Stability(85.00%),weakness of limbs(83.75%),tremor(82.50%),soreness of waist and knees(81.25%),ache of limbs and shin(80.00%),fatigue(78.75%),irritability(76.25%)(2)Two weeks after DBS,the top 10 TCM symptoms in patients with frequency are:fatigue(92.50%),slow movement(88.75%),weakness of limbs(83.75%),and lack of breath(82.50%),fixed pain(76.25%),sore waist and knees(75.00%),dry stool(72.50%),sore limbs(72.50%),skin nail(71.25%),irritability(76.25%);(3)Distribution of TCM syndrome types before DBS operation:liver and kidney deficiency combined with deficiency of heart and spleen,deficiency of both yin and yang,decreased marrow of kidney with deficiency of yin and wind,syndrome of stagnation of liver and fire,internal accumulation of damp-heat,syndrome of qi deficiency and blood stasis(4)Distribution of TCM syndrome types of patients after DBS:blood stagnation syndrome,yin deficiency and internal heat with liver depression and spleen deficiency syndrome,qi and yin deficiency with kidney deficiency and marrow reduction syndrome,blood deficiency and wind movement syndrome,yin and yang deficiency syndrome,Internal accumulation of phlegm.5.The UPDRS ? scores were(21.30±6.47)and(12.12±5.77)points before and after DBS operation during the drug-off period,and the average improvement rate was(43.3 8± 19.12)%;the UPDRS ? scores were(13.48±5.64)points and(8.36±4.37)points before and after DBS operation when the drug was prescribed,and the average improvement rate was(37.48±18.85)%;the UPDRS ? scores were(42.69±12.71)and(19.1 8±9.40)points before and after DBS operation during the drug off period with an average improvement rate of(53.99± 18.91)%;the UPDRS ? scores were(23.31±10.82)and(14.33±7.56)points before and after DBS operation during the drug prescribing period,the average improvement rate is(35.74±22.58)%.In patients after DBS,UPDRS? and UPDRS-? were significantly lower than before operation,both in the drug off phase and in the drug prescribing phase,with statistical significance(all P=0.000)6.During the drug-off period of DBS patients,the UPDRS ? score was positively and weakly correlated with internal heat syndrome(r=0.312,p=0.005);in the drug-off period of DBS patients,the UPDRS ? score was correlated with Internal heat and liver wind syndrome were positively and weakly correlated(r=0.297,r=0.321,all P<0.05);During the drug-off phase of DBS patients,the UPDRS ? score was negatively correlated with yang hyperactivity syndrome(r=-0.243,P=0.03),and positively correlated with liver wind syndrome(r=0.230,P=0.04);the UPDRS ? score was positively correlated with kidney deficiency and qi deficiency.Correlation(r=0.262,r=0.290,all P<0.05).Conclusions:1.The preoperative TCM syndrome elements of patients with middle and late stage PD are mainly marrow reduction,liver wind,yin deficiency,qi deficiency,yang hyperactivity,kidney deficiency,blood deficiency,and internal heat.,Marrow reduction,qi deficiency,blood stasis,blood deficiency,yang hyperactivity,internal heat,and kidney deficiency are the main ones;2.The evolution law of TCM syndrome factors before and after DBS operation:the three types of syndromes of Qi deficiency,Yin deficiency,and blood deficiency increased significantly after operation,and the two types of syndromes of blood stasis and phlegm turbidity increased significantly;although liver wind syndrome decreased Still exist.3.The preoperative symptoms of DBS are mostly dyskinesia symptoms,the frequency of postoperative motor symptoms decreases,and the frequency of non-motor symptoms such as fatigue and constipation increases;the distribution of TCM syndrome types in patients with advanced PD before surgery:both liver and kidney deficiency Heart and Spleen Deficiency Syndrome,Yin and Yang Deficiency Syndrome,Kidney Deficiency and Marrow Reduction and Yin Deficiency Wind Movement Syndrome,Liver Stagnation and Fire Prosperity Syndrome,Damp-heat Internal Accumulation Syndrome,Qi Deficiency and Blood Stasis Syndrome;TCM Syndrome Type Distribution of Patients After DBS:Blood Stasis Blocking Collateral,Yin deficiency and internal heat with liver stagnation and spleen deficiency syndrome,Qi and Yin deficiency with kidney deficiency and marrow reduction syndrome,blood deficiency and wind movement syndrome,Yin and Yang deficiency syndrome,phlegm turbid internal accumulation syndrome.4.Correlation analysis suggests that the level of daily life before DBS operation may be related to the manifestations of internal heat syndrome,the preoperative exercise function may be related to the manifestations of internal heat and liver wind syndrome,and the postoperative daily life level may be related to the manifestations of Yang hyperactivity and liver wind syndrome.Motor function may be related to the manifestations of kidney deficiency and qi deficiency.