醒脑开窍针法治疗脑卒中(肝肾亏虚证)临床预后危险因素分析
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摘要
目的探讨醒脑开窍针法治疗脑卒中(肝肾亏虚证)临床预后危险因素。方法回顾性分析接受醒脑开窍针法治疗的136例脑卒中(肝肾亏虚证)患者临床资料。根据临床治疗效果分为有效组112例与无效组24例;比较两组患者临床资料的差异。通过建立Logistic回归模型,分析醒脑开窍针法治疗脑卒中(肝肾亏虚证)临床预后相关危险因素。结果有效组和无效组患者血糖、发病-就诊时间、糖尿病史有显著差异(P <0.05);多因素Logistic回归模型显示血糖(OR=2.777,95%CI=1.270～6.070)、发病-就诊时间(OR=1.087,95%CI=1.049～1.127)、糖尿病史(OR=0.122,95%CI=0.031～0.469);模型整体显著性(P <0.05),伪R~2=0.527,模型预测准确率=93.38%,灵敏度75.00%,特异度97.32%;拟合ROC曲线下面积AUC=0.9308,最佳拟合cutoff=0.2。结论血糖、发病-就诊时间、糖尿病史是疗效不佳的独立危险因素;当回归模型Logistic P> 0.02时,提示醒脑开窍针法治疗脑卒中(肝肾亏虚证)疗效不佳,为节约医疗资源以及医疗成本,可建议患者选择其他有效的综合治疗方式。
Objective: To explore the clinical prognostic risk factors of Xingnao Kaiqiao Acupuncture on stroke of liver and kidney deficiency type. Methods: 136 patients′ data was divided into the effective group(112 cases)and the ineffective group(24 cases) according to the clinical therapeutic effect. The difference of clinical data between the two groups was compared. By establishing logistic regression model,the risk factors related to clinical prognosis of stroke with deficiency of liver and kidney treated by Xingnao Kaiqiao Acupuncture Method were analyzed. Results: There were significant differences in blood sugar,time of onset-visit and history of diabetes between groups(P < 0.05). Multivariate logistic regression model showed blood sugar(OR=2.777,95%CI=1.270-6.070),onset-visit time(OR=1.087,95%CI=1.049-1.127),history of diabetes(OR=0.122,95%CI=0.031-0.469).The overall significance of the model was P < 0.05,pseudo R~2=0.527,the prediction accuracy of the model 93.38%,the sensitivity 75.00%,and the specificity 97.32%. The area under the ROC curve was AUC=0.9308,and the best fit was cutoff = 0.2. Conclusion: Blood sugar,time of onset-visit and history of diabetes mellitus are independent risk factors for poor curative effect. When logistic P > 0.02 is regression model,it is suggested that Xingnao Kaiqiao Acupuncture is ineffective in treating stroke of deficiency of liver and kidney. In order to save medical resources and cost,other effective comprehensive treatment methods can be recommended for patients.
Objective: To explore the clinical prognostic risk factors of Xingnao Kaiqiao Acupuncture on stroke of liver and kidney deficiency type. Methods: 136 patients′ data was divided into the effective group(112 cases)and the ineffective group(24 cases) according to the clinical therapeutic effect. The difference of clinical data between the two groups was compared. By establishing logistic regression model,the risk factors related to clinical prognosis of stroke with deficiency of liver and kidney treated by Xingnao Kaiqiao Acupuncture Method were analyzed. Results: There were significant differences in blood sugar,time of onset-visit and history of diabetes between groups(P < 0.05). Multivariate logistic regression model showed blood sugar(OR=2.777,95%CI=1.270-6.070),onset-visit time(OR=1.087,95%CI=1.049-1.127),history of diabetes(OR=0.122,95%CI=0.031-0.469).The overall significance of the model was P < 0.05,pseudo R~2=0.527,the prediction accuracy of the model 93.38%,the sensitivity 75.00%,and the specificity 97.32%. The area under the ROC curve was AUC=0.9308,and the best fit was cutoff = 0.2. Conclusion: Blood sugar,time of onset-visit and history of diabetes mellitus are independent risk factors for poor curative effect. When logistic P > 0.02 is regression model,it is suggested that Xingnao Kaiqiao Acupuncture is ineffective in treating stroke of deficiency of liver and kidney. In order to save medical resources and cost,other effective comprehensive treatment methods can be recommended for patients.
引文
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[10]王舒,张春红,郭琳.脑卒中与醒脑开窍针刺法[J].中华针灸电子杂志,2016,5(2):45-47.
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[13]颜建胜,张光茹,孙巧,等.针刺对脑缺血再灌注模型大鼠的保护作用及其时效性观察[J].兰州大学学报:医学版,2015,41(2):25-31.
[14]娄元俊,刘阳,单海军,等.针灸对脑性瘫痪幼鼠模型行为学的影响及其机制[J].中国组织工程研究,2016,20(49):7314-7319.
[15]肖娟娟,杨期明,肖雨晴.血糖与急性缺血性脑卒中患者预后相关性分析[J].国际神经病学神经外科学杂志,2014,41(5):415-418.
[16]张鑫鑫,刘丹,于涛.基于临床科研信息共享系统研究空腹血糖水平对针刺治疗中风偏瘫疗效的影响[J].中华针灸电子杂志,2015,4(6):252-254.
[17]Chen H,Wu B,Liu N,et al.Using standard first-pass perfusion computed tomographic data to evaluate collateral flow in acute ischemic stroke[J].Stroke,2015,46(4):961.
[18]柳青.针灸对老年脑卒中肢体功能障碍患者生活质量的影响[J].四川中医,2016,34(7):200-202.
[2]Shih CC,Liao CC,Sun MF,et al.A retrospective cohort study comparing stroke recurrence rate in ischemic stroke patients with and without acupuncture treatment[J].Medicine,2015,94(39):e1572.
[3]但昭君,熊玉倩,李海峰.醒脑开窍针法对脑卒中后认知功能障碍的疗效[J].中国康复理论与实践,2016,22(7):827-829.
[4]赵亚伟.醒脑开窍针刺法治疗中风病研究进展[J].现代中西医结合杂志,2016,25(8):907-910.
[5]Wang HQ,Bao CL,Jiao ZH,et al.Efficacy and safety of penetration acupuncture on head for acute intracerebral hemorrhage:A randomized controlled study[J].Medicine,2016,95(48):e5562.
[6]李雅洁,田浩,安丽,等.醒脑开窍针刺法治疗丘脑痛:随机对照研究[J].中国针灸,2017,37(1):14-18.
[7]中华人民共和国卫生部.中药新药临床研究指导原则[M]北京:中国医药科技出版社,2002:99-104.
[8]常玉莹.谈石学敏院士醒脑开窍学术思想在临床工作中的应用[J].内蒙古中医药,2014,33(28):44.
[9]李夏珍,高新新,马芬,等.浅探“醒脑开窍”针刺法之“小醒脑”[J].中国针灸,2016,36(7):779-780.
[10]王舒,张春红,郭琳.脑卒中与醒脑开窍针刺法[J].中华针灸电子杂志,2016,5(2):45-47.
[11]Schuchardt F,Hennemuth A,Schroeder L,et al.Acute cerebral venous thrombosis:three-dimensional visualization and quantification of hemodynamic alterations using 4-dimensional flow magnetic resonance imaging[J].Stroke,2017,48(3):671.
[12]Aries M.Cerebral hemodynamics in stroke and traumatic brain injury[J].Food Control,2015,30(2):549-555.
[13]颜建胜,张光茹,孙巧,等.针刺对脑缺血再灌注模型大鼠的保护作用及其时效性观察[J].兰州大学学报:医学版,2015,41(2):25-31.
[14]娄元俊,刘阳,单海军,等.针灸对脑性瘫痪幼鼠模型行为学的影响及其机制[J].中国组织工程研究,2016,20(49):7314-7319.
[15]肖娟娟,杨期明,肖雨晴.血糖与急性缺血性脑卒中患者预后相关性分析[J].国际神经病学神经外科学杂志,2014,41(5):415-418.
[16]张鑫鑫,刘丹,于涛.基于临床科研信息共享系统研究空腹血糖水平对针刺治疗中风偏瘫疗效的影响[J].中华针灸电子杂志,2015,4(6):252-254.
[17]Chen H,Wu B,Liu N,et al.Using standard first-pass perfusion computed tomographic data to evaluate collateral flow in acute ischemic stroke[J].Stroke,2015,46(4):961.
[18]柳青.针灸对老年脑卒中肢体功能障碍患者生活质量的影响[J].四川中医,2016,34(7):200-202.