| Objective:To investigate the TCM pathogenesis of AGI secondary to ischemic stroke by observing the distribution and evolution of TCM symptoms in patients with acute acute gastrointestinal injury(AGI)secondary to ischemic stroke,and to investigate the effect of plasma citrulline and intestinal fatty acid binding protein(IFABP)on the level of AGI secondary to ischemic stroke.We investigated the effect of plasma citrulline and IFABP on the pathogenesis of AGI secondary to ischemic stroke by applying the difference in the levels of plasma citrulline and intestinal fatty acid binding protein(IFABP)between patients who developed AGI after acute ischemic stroke and those who did not,and thus clarified the role of citrulline and IFABP in the pathogenesis of AGI secondary to ischemic stroke in the acute phase.Methods: Complete clinical data of patients admitted to the Department of Neurology of Qingdao Hospital of Traditional Chinese Medicine in the acute phase of ischemic stroke from December 2021 to November 2022 were selected,and patients were screened according to uniform diagnostic criteria,inclusion criteria and exclusion criteria.A total of 211 acute ischemic stroke patients admitted within 24 hours of onset were included in the prospective survey,patients were divided into 2 groups according to the occurrence of acute gastrointestinal injury,namely the symptom group and thecontrol group,including 154 patients with acute gastrointestinal injury secondary to acute ischemic stroke within 7 days of admission,and the basic information characteristics,distribution of evidence elements and pattern of evidence combination of patients with acute gastrointestinal injury secondary to acute ischemic stroke were analyzed.The basic information(including gender,age,past history,smoking and drinking history)was collected from the patients;guanine and IFABP were measured in early morning fasting blood at the time of admission and on the 7th day of onset(or on the occurrence of AGI);the National Institute of Health stroke scale(NIHSS)score was administered to each patient at the time of admission.The National Institute of Health stroke scale(NIHSS)score was administered to each patient at the time of admission;the Chinese Medicine Evidence Scale was completed at the time of admission and at day 7(or at the onset of AGI).RESULTS:1.A total of 211 patients with acute ischemic stroke were admitted in this study,of which 154 cases had acute gastrointestinal injury secondary to acute ischemic stroke within one week,with an incidence rate of 73.0%.The incidence of gastrointestinal dysfunction(AGI class I-II)in acute ischemic stroke patients was 58.8%,which was higher than the incidence of gastrointestinal failure(AGI class III-IV),which was 14.2%.2.Age and combined past history were found to be significantly correlated with the occurrence of AGI in the study,and the number of combined past medical history diseases were in descending order of hypertension,coronary heart disease,diabetes mellitus,and cerebral infarction.No correlation was found between gender,whether smoking or alcohol consumption and the occurrence of AGI in the study.3.Distribution of TCM symptoms at the time of admission:(1)The symptoms of wind,phlegm and wetness,and yin deficiency in the symptom group and the control group were statistically significant(P<0.01),and the evidence of internal fire,blood stasis and qi deficiency in the two groups was notstatistically significant(P>0.05).(2)At the time of admission,there were0 cases of single type in the symptom group,and 16 cases(10.3%)in the two-certificate group were less than those in the control group,which were statistically significant(P<0.01);80 cases(51.9%)and 15 cases(9.7%)in the symptom group were more than those in the control group,which were statistically significant(P<0.05);the combination of the two groups had no statistical significance(P>0.05).4.(1)Distribution of TCM syndrome on the 7th day of admission(or the occurrence of AGI): the symptoms of internal wind,internal fire,blood stasis,phlegm and wetness,qi deficiency and yin deficiency in the symptom group and the control group were statistically significant(P<0.01).In patients with acute ischemic stroke,the number of cases of AGI was significantly higher than that in the control group.(2)At seven days of admission(or AGI),0cases of document type,2 cases of two-certificate combination(1.2%),62 cases of three-certificate combination(40.2%),67 cases of four-certificate combination(43.5%),23 cases of five-certificate combination(14.9%)and 17cases(29.8%)of two-certificate combination,31 cases(54.3%)of two-certificate combination,7 cases of three-certificate combination(12.2%),2 cases of four-certificate combination(3.5%),and 0 cases of five-certificate combination were compared with the control group.It was statistically significant(P<0.01)and there was a significant difference.The control group accounted for more than the symptom group,and the combination of symptoms tended to be simpler.Compared with the control group,the proportion of patients in the three-certificate combination,four-certificate combination and five-certificate combination of the symptom group increased significantly,and the symptom combination tended to be more complex.5.The evolution of TCM syndrome elements:(1)It was statistically significant to compare the symptoms of internal stroke,phlegm and dampness,qi deficiency and yin deficiency at the time of admission and AGI(P<0.05).The results showed that there were significant differences in the number of occurrences of internal stroke,phlegm dampness,qi deficiency and yin deficiency before and after AGI in the symptom group,and the number of internal stroke cases decreased,and the number of sputum wet evidence,qi deficiency evidence,and yin deficiency cases increased.There was no significant significance(P>0.05)between internal fire evidence and blood stasis evidence at the time of admission and AGI in the symptom group,indicating that there was no significant difference between the number of internal fire evidence and blood stasis evidence in the symptom group when admitting and the 7th day of onset.The comparison of internal stroke,internal fire,blood stasis and yin deficiency at the time of admission and 7 days of onset in the control group was statistically significant(P<0.01),indicating that there was a significant difference between the number of occurrences of internal stroke,internal fire and blood stasis at the time of admission of the control group and the 7th day of onset,and the number of occurrences of yin deficiency evidence,and the number of internal wind evidence,internal fire certificate and blood stasis certificate decreased,and the number of negative deficiency evidence increased.There was no significant significance in the control group at admission and 7 days of onset(P>0.05),indicating that there was no significant difference between the number of sputum wetness and qi deficiency in the control group at admission and on the 7th day of onset.(2)There were 16 cases(10.3%)of two-certificate combination and 43 cases(27.9%)of three-certificate combination at the time of admission in the symptom group,2 cases(1.3%)of two-certificate combination and 62 cases(40.3%)of three-certificate combination at the time of AGI,which were statistically significant(P<0.05),indicating that there were significant differences between the combination of two and three certificates before and after AGI in the symptom group,and showed a downward trend.There was nostatistically significant(P>0.05)between 80 cases(51.9%)and 15 cases(9.7%)in the symptom group at the time of admission with 67(43.5%)and 23(14.9%)combinations of four evidence at the time of AGI,indicating that there was no significant difference between the combination of four and five symptoms before and after AGI in the symptom group.Compared with 4 cases(7.0%),19cases(33.3%),9 cases(15.7%)of four-certificate combination and 17 cases(29.8%),7 cases(12.3%)and 2 cases(3.5%)of four-certificate combination at the time of admission of the control group,there were statistical significance(P<0.05),indicating that there were significant differences between the control group at the time of admission and the combination of three certificates on the 7th day of onset,and showed an upward trend,while the combination of four certificates was different and showed a downward trend.There was no significant significance in comparing 25 cases(43.8%)in the control group with 31(54.3%)on the 7th day of admission(P>0.05).The composition tends to be more complex.6.Early morning fasting plasma citrulline levels were significantly lower in patients with acute ischemic stroke secondary to acute gastrointestinal injury compared with the control group(P < 0.01),where the higher the grading between subgroups,the more significant the decrease in citrulline levels(P< 0.01 or P < 0.05).There was a negative correlation between citrulline level and the severity of AGI.7.The serum IFABP level was significantly higher in the symptomatic group than in the control group at the time of admission and at the 7th day of admission(or occurrence of AGI),which was statistically significant(P <0.01);and the gastrointestinal failure group was significantly lower than the gastrointestinal dysfunction group(P < 0.01),and its index gradually increased with the deepening of the severity of AGI,and the difference was statistically significant(both P < 0.01).Cross-sectional comparison between the control group and the gastrointestinal impairment group at the time ofadmission and at the 7th day of admission(or the occurrence of AGI)showed an increase in IFABP concentration but the difference was not significant,but the gastrointestinal failure group showed a significant difference.8.This study showed that patients with severe stroke(NIHSS > 15)had a higher probability of AGI.The incidence of gastrointestinal failure was significantly higher in patients with severe stroke than in the mild to moderate stroke group,suggesting a correlation between the level of AGI classification and stroke severity.Conclusions: 1.The etiology of acute ischemic stroke patients at the onset of the disease is dominated by actual evidence of wind,fire,phlegm,and stasis,and with the change of the disease,the main deficiency is dominated by actual evidence of symptoms;internal wind,phlegm and dampness,stasis of blood,and yin deficiency are the precipitating factors of AGI.Patients with acute ischemic stroke are more likely to have AGI with multiple evidence combinations,and the frequency of each evidence element increases significantly when AGI occurs,and the combination of evidence elements tends to be more complex,while patients with acute ischemic stroke who do not have AGI within 7 days of onset have a simpler combination of evidence elements,and the frequency and severity of evidence elements are reduced.Patients with acute ischemic stroke should be actively involved in secondary prevention of AGI in order to reduce the occurrence of AGI in patients with significant manifestations of internal wind,phlegm and dampness,stasis of blood,and yin deficiency after acute ischemic stroke.2.There was a significant negative correlation between the change of plasma citrulline level and the severity of AGI;there was a significant positive correlation between the change of serum IFABP level and the severity of AGI.The lower the level of citrulline and the higher the level of IFABP,the higher the grade of AGI.3.The degree of neurological deficits and the occurrence and degree of AGIwere mutually influential,and the more severe the neurological impairment,the more likely it was to occur and the more severe it was.Patients with NIHSS score >15 at the time of admission should be treated aggressively to prevent the occurrence of gastrointestinal failure. |
