缺血性卒中体质状态与中风复发巢式病例对照研究
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摘要
目的采用巢式病例对照研究方法分析缺血性卒中患者中医体质状态与复发之间的关系。方法采用巢式病例对照研究方法,以339例缺血性卒中患者作为研究队列,进行1年随访,以随访期间复发的37例患者作为病例组,按1∶4从随访队列未发生复发事件的患者中匹配148例作为对照组,统计比较2组患者年龄、性别、高血压、高脂血症、糖尿病、高同型半胱氨酸血症、冠心病、急性卒中治疗低分子肝素试验病因分型(TOAST分型)、美国国立卫生研究院卒中量表(NIHSS)评分、是否首发、服用中药汤剂时间、康复治疗时间以及中医体质之间的差异性。将以上单因素分析中有统计学意义的变量采用Logistic回归模型进行多因素分析。结果 2组TOAST分型比较差异有统计学意义(P <0. 05),病例组大动脉粥样硬化型(LAA型)较多(P <0. 05);中医体质方面,病例组气虚质多于对照组(P <0. 05),对照组痰湿质多于病例组(P <0. 05)。Logistic回归模型分析显示,TOAST分型中LAA型及中医体质气虚质是缺血性卒中复发的危险因素。结论特定的中医体质状态与缺血性卒中的复发具有相关性。
Objective The nested case-control study was used to explore and analyze the relationship between TCM constitutional status and recurrence in patients with ischemic stroke. Methods A nested case-control study was conducted in which 339 patients with ischemic stroke were enrolled in the study cohort for 1 year follow-up. 37 patients who relapsed during the follow-up period served as the case group,148 patients without recurrence were matched as control group at the ratio of 1 ∶ 4. The age,sex,hypertension,hyperlipidemia,diabetes mellitus,hyperhomocysteinemia,coronary heart disease, acute stroke treatment with low molecular weight heparin test( TOAST),National Institutes of Health Stroke Scale( NIHSS),whether the first onset,time of taking Chinese medicine decoction,time of rehabilitation treatment and constitution of TCM between the two groups were statistically compared. Logistic regression model was used to analyze the variables with statistical significance in the above univariate analysis. Results The difference of TOAST classification between the two groups was statistically significant( P <0. 05). The LAA type in the case group was significantly higher than that in the control group( P < 0. 05). The Qi deficiency type in the case group was more than that in the control group( P < 0. 05). The phlegm-dampness type in control group was more than that in the case group( P < 0. 05). Logistic regression model analysis showed that LAA type and TCM constitutional Qi deficiency type were risk factors for recurrent ischemic stroke in TOAST classification. Conclusion The specific constitutional state of TCM is related to the recurrence of ischemic stroke.
Objective The nested case-control study was used to explore and analyze the relationship between TCM constitutional status and recurrence in patients with ischemic stroke. Methods A nested case-control study was conducted in which 339 patients with ischemic stroke were enrolled in the study cohort for 1 year follow-up. 37 patients who relapsed during the follow-up period served as the case group,148 patients without recurrence were matched as control group at the ratio of 1 ∶ 4. The age,sex,hypertension,hyperlipidemia,diabetes mellitus,hyperhomocysteinemia,coronary heart disease, acute stroke treatment with low molecular weight heparin test( TOAST),National Institutes of Health Stroke Scale( NIHSS),whether the first onset,time of taking Chinese medicine decoction,time of rehabilitation treatment and constitution of TCM between the two groups were statistically compared. Logistic regression model was used to analyze the variables with statistical significance in the above univariate analysis. Results The difference of TOAST classification between the two groups was statistically significant( P <0. 05). The LAA type in the case group was significantly higher than that in the control group( P < 0. 05). The Qi deficiency type in the case group was more than that in the control group( P < 0. 05). The phlegm-dampness type in control group was more than that in the case group( P < 0. 05). Logistic regression model analysis showed that LAA type and TCM constitutional Qi deficiency type were risk factors for recurrent ischemic stroke in TOAST classification. Conclusion The specific constitutional state of TCM is related to the recurrence of ischemic stroke.
引文
[1] Liu L,Wang D,Wong KSL,et al. Stroke and stroke care in China:huge burden,significant workload,and a national priority[J]. Stroke,2011,42(12):3651-3654.
[2] Hankey GJ,Spiesser J,Hakimi Z,et al. Time frame and predictors of recovery from disability following recurrent ischemics troke[J]. Neurology,2007,68(3):202-205.
[3]徐桂琴,谢雁鸣,邹忆怀,等.缺血性中风避免复发中医研究现状[J].辽宁中医杂志,2009,36(5):857-858.
[4] Wang Y,Xu J,Zhao X,et al. Association of Hypertension With Stroke Recurrence Depends on Ischemic Stroke Subtype[J]. Stroke,2013,44(5):1232-1237.
[5]赵红梅,刘文华,王筱萌,等.复发性脑梗死的危险因素及病因学分析[J].中华老年心脑血管病杂志,2013,15(1):42-45.
[6]贾淑娟,吴红海.缺血性脑卒中再发危险因素临床分析[J].疾病监测与控制,2014,8(7):453-454.
[7] Matsumoto K,Sera Y,Nakamura H,et al. Correlation between common carotid arterial wall thickness and ischemic stroke in patients with type 2 diabetes mellitus[J]. Metabolism-clinical&Experimental,2002,51(2):244-247.
[8] Del Ser T,Barba R,Herranz AS,et al. Hyperhomocyst(e)inemia is a risk factor of secondary vascular events in stroke patients[J]. Cerebrovasc Dis,2001,12(2):91-98.
[9]曾倩,龙秀英,宋春江.复发性脑梗死相关危险因素分析[J].中国实用神经疾病杂志,2018,21(1):37-39.
[10]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[11]国家食品药品监督管理总局.中药新药治疗中风临床研究技术指导原则[S]. 2015.
[12]中华中医药学会.中医体质分类与判定(ZYYXH/T1 57—2009)[J].世界中西医结合杂志,2009,4(4):303-304.
[13]童福易,赖仁胜,薛博瑜.试论中医体质与疾病的发生[J].现代中西医结合杂志,2012,21(10):1128-1130.
[14]贾妮,文颖娟.从中医体质学说试论中风病的预防[J].中国中医基础医学杂志,2010,16(11):1058-1059.
[15]武彦伶,王琦,陈禹,等.气虚体质相关分型及方药应用探析[J].吉林中医药,2017,37(4):332-335.
[16]王晓红,王振华,程涛,等.浅谈中医气虚体质与疾病的关系[J].中医临床研究,2018,10(23):24-25.
[17]张桂睿,游佳华,邢亚静,等.调畅中焦防治缺血性卒中复发随机对照临床研究[J].江西中医药,2013,44(2):22-23.
[18] Adams HP Jr,Bendixen BH,Kappelle LJ,et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST.Trial of Org 10172 in Acute Stroke Treatment[J].Stroke,1993,24(1):35-41.
[19]宋丽,李婉婷,韩杰.缺血性脑卒中TOAST分型及其危险因素、复发分析[J].中国医药科学,2013,3(5):17-19.
[2] Hankey GJ,Spiesser J,Hakimi Z,et al. Time frame and predictors of recovery from disability following recurrent ischemics troke[J]. Neurology,2007,68(3):202-205.
[3]徐桂琴,谢雁鸣,邹忆怀,等.缺血性中风避免复发中医研究现状[J].辽宁中医杂志,2009,36(5):857-858.
[4] Wang Y,Xu J,Zhao X,et al. Association of Hypertension With Stroke Recurrence Depends on Ischemic Stroke Subtype[J]. Stroke,2013,44(5):1232-1237.
[5]赵红梅,刘文华,王筱萌,等.复发性脑梗死的危险因素及病因学分析[J].中华老年心脑血管病杂志,2013,15(1):42-45.
[6]贾淑娟,吴红海.缺血性脑卒中再发危险因素临床分析[J].疾病监测与控制,2014,8(7):453-454.
[7] Matsumoto K,Sera Y,Nakamura H,et al. Correlation between common carotid arterial wall thickness and ischemic stroke in patients with type 2 diabetes mellitus[J]. Metabolism-clinical&Experimental,2002,51(2):244-247.
[8] Del Ser T,Barba R,Herranz AS,et al. Hyperhomocyst(e)inemia is a risk factor of secondary vascular events in stroke patients[J]. Cerebrovasc Dis,2001,12(2):91-98.
[9]曾倩,龙秀英,宋春江.复发性脑梗死相关危险因素分析[J].中国实用神经疾病杂志,2018,21(1):37-39.
[10]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[11]国家食品药品监督管理总局.中药新药治疗中风临床研究技术指导原则[S]. 2015.
[12]中华中医药学会.中医体质分类与判定(ZYYXH/T1 57—2009)[J].世界中西医结合杂志,2009,4(4):303-304.
[13]童福易,赖仁胜,薛博瑜.试论中医体质与疾病的发生[J].现代中西医结合杂志,2012,21(10):1128-1130.
[14]贾妮,文颖娟.从中医体质学说试论中风病的预防[J].中国中医基础医学杂志,2010,16(11):1058-1059.
[15]武彦伶,王琦,陈禹,等.气虚体质相关分型及方药应用探析[J].吉林中医药,2017,37(4):332-335.
[16]王晓红,王振华,程涛,等.浅谈中医气虚体质与疾病的关系[J].中医临床研究,2018,10(23):24-25.
[17]张桂睿,游佳华,邢亚静,等.调畅中焦防治缺血性卒中复发随机对照临床研究[J].江西中医药,2013,44(2):22-23.
[18] Adams HP Jr,Bendixen BH,Kappelle LJ,et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST.Trial of Org 10172 in Acute Stroke Treatment[J].Stroke,1993,24(1):35-41.
[19]宋丽,李婉婷,韩杰.缺血性脑卒中TOAST分型及其危险因素、复发分析[J].中国医药科学,2013,3(5):17-19.