基于中医证候特征的缺血性中风复发风险的横断面分析

目的:探讨缺血性中风复发风险的中医学证候学特征。方法:以长春中医药大学附属医院中风病及冠心病慢病防治管理信息协作平台为依托,调取2014年1月1日至2015年12月31日期间录入的中风病患者人群为研究对象并开展横断面研究。应用广义Boosted模型,Wilcoxon秩和检验及Logistic多元回归探讨多因素条件下证候及证候要素对中风病复发的影响情况。结果:本次研究共纳入病例3 322例,其中新发缺血性中风病例1 542例,复发缺血性中风病例1 780例。通过广义Boosted模型分析发现,证候学特征成为了影响缺血性中风复发的重要因素;采用Wilcoxon秩和检验进行对新发及复发缺血性中风的证候诊断比较,发现气虚血瘀、阴虚风动、风火上扰、痰热腑实证候构成比有统计学差异(P0.05,P0.01);复发缺血性中风病的证候要素痰、瘀、气虚的构成比高于新发缺血性中风病同样的证候要素的构成比(P0.01)。应用Logistic多元回归分析后发现风痰阻络、气虚血瘀、痰热腑实、痰蒙清窍、痰热内闭证候类型表现可能是缺血性中风复发的危险因素(P0.05,P0.01);全部的风、火、痰、瘀、气虚、阴虚证候要素表现也可能是缺血性中风复发的危险因素(P0.05,P0.01)。结论:缺血性中风复发人群显示出了特定的中医证候特征,提示在开展中风病二级预防的研究中应重视证候学特征的因素,有必要通过更多的循证医学手段和临床实践加以验证。

Cross-sectional Analysis of Risk of Ischemic Stroke Recurrence Based on Traditional Chinese Medicine Syndrome Characteristics

Objective: To explore the characteristics of traditional Chinese medicine(TCM) syndromes of the risk of the recurrent ischemic stroke. Method: The cases were selected from January 1^st,2014 to December 31^th,2015 in the chronic disease prevention and treatment information coordinate platform of the affiliated hospital to Changchun University of Chinese Medicine to start a cross-sectional study.Logistic multiple regression,generalized Boosted model and Wilcoxon rank sum test were used to discuss the influence of TCM syndromes and the syndrome factors on the recurrence of stroke. Result: In this study,3 322 cases were selected,including 1 542 cases of the new ischemic stroke and 1 780 cases of recurrent ischemic stroke.Characteristics of TCM syndromes manifested an important factor affecting the recurrence of ischemic stroke through generalized Boosted model.The result from Wilcoxon rank sum test showed that constituent rates of Qi deficiency and blood stasis syndrome,Yin deficiency and wind formation syndrome,upward disturbance of wind-fire syndrome and phlegm-heat and excessive Fu-viscera syndrome had statistical differences both in new and recurrence group(P<0.05,P<0.01);the constituent rates of phlegm,stasis and Qi deficiency in recurrence ischemic stroke were higher than the first ischemic stroke(P<0.01).Furthermore,Logistic multiple regression analysis was used to find that the performance of obstruction of collateral caused by windphlegm syndrome,Qi deficiency and blood stasis syndrome,phlegm-heat and excessive Fu-viscera syndrome,orifices confused by phlegm syndrome and phlegm-heat internal block syndrome may be the risk factor for the recurrence of ischemic stroke(P<0.05,P<0.01).All wind,fire,phlegm,stasis,Qi deficiency and Yin deficiency may also be a risk factor for the recurrence of ischemic stroke(P<0.05,P<0.01). Conclusion: Recurrence group of ischemic stroke manifests the characteristics of TCM syndromes.It indicates that the factors of the characteristics of TCM syndromes should be paid attention to in the stroke secondary prevention.It''s necessary to be verified by means of evidence-based medicine and clinical practice.