卒中后非痴呆患者5年认知功能变化与中医证候要素关系探讨
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摘要
目的:通过对卒中后非痴呆患者的5年随访,分析其认知功能变化特点及其与中医证候要素的关系。方法:2011年10月至2013年9月在北京中医药大学东方医院纳入卒中后非痴呆患者233例,5年后随访,66例完成面对面访视。根据认知水平是否较入组时下降分为认知下降组(39例)和认知无下降组(27例),分析5年认知功能变化与中医证候要素之间的关系。结果:认知下降组气虚、痰浊证候要素较基线显著增加(P<0.05,P<0.01),证候虚实夹杂、多个证候要素组合的比例明显增加(P<0.05)。下降显著的认知域为视空间与执行功能、语言、延迟回忆。视空间与执行功能下降组,5年后气虚明显增加,但差异无统计学意义;在语言、延迟回忆下降组,5年后痰浊显著增加(P<0.01)。结论:在卒中后认知功能下降的长期病程中,证候要素倾向于虚实夹杂、相兼组合,证候及病机更加复杂;气虚、痰浊与卒中后认知障碍进展相关,气虚与视空间与执行功能下降之间存在关联,痰浊与语言、记忆功能下降之间存在关联。
Objective: To analyze the characteristics of cognitive function and its relationship with TCM syndrome elements through five-year follow-up of non-dementia patients after stroke. Methods: A total of 233 post-stroke non-dementia patients were enrolled in Dongfang Hospital Affiliated to Beijing University of Chinese Medicine from October 2011 to September2013, and a total of 66 patients were face-to-face interviewed after 5 years. Patients were divided into cognitive decline group(39 cases) and non-decline group(27 cases) based on whether the cognitive level was lower than the baseline. The relationship between the changes of cognitive function in 5 years and the elements of TCM syndromes was analyzed. Results: In cognitive decline group, the syndrome elements of qi deficiency and phlegm turbidity increased significantly compared with baseline(P<0.05,P<0.01). The proportion of syndrome elements of intermingled deficiency and excess mixed with multiple syndromes elements increased significantly(P<0.05). The cognitive domains that tended to aggravation were visual space and executive function,language and delayed memory. In the visual space and executive function decline group, qi deficiency increased significantly after5 years, but there was no significant difference. In the language score decreasing group and the delayed memory score decreasing group, the proportion of phlegm turbidity increased significantly after 5 years(P<0.01). Conclusion: In the long-term course of post-stroke cognitive decline, syndrome elements tend to be intermingled deficiency and excess, and combine with each other.Syndromes and pathogenesis tend to be more complex. Qi deficiency and phlegm turbidity are correlated with the progress of cognitive impairment after stroke. qi deficiency may be correlated with the decline of visual space and executive function, and phlegm turbidity may be correlated with the decline of language and memory function.
Objective: To analyze the characteristics of cognitive function and its relationship with TCM syndrome elements through five-year follow-up of non-dementia patients after stroke. Methods: A total of 233 post-stroke non-dementia patients were enrolled in Dongfang Hospital Affiliated to Beijing University of Chinese Medicine from October 2011 to September2013, and a total of 66 patients were face-to-face interviewed after 5 years. Patients were divided into cognitive decline group(39 cases) and non-decline group(27 cases) based on whether the cognitive level was lower than the baseline. The relationship between the changes of cognitive function in 5 years and the elements of TCM syndromes was analyzed. Results: In cognitive decline group, the syndrome elements of qi deficiency and phlegm turbidity increased significantly compared with baseline(P<0.05,P<0.01). The proportion of syndrome elements of intermingled deficiency and excess mixed with multiple syndromes elements increased significantly(P<0.05). The cognitive domains that tended to aggravation were visual space and executive function,language and delayed memory. In the visual space and executive function decline group, qi deficiency increased significantly after5 years, but there was no significant difference. In the language score decreasing group and the delayed memory score decreasing group, the proportion of phlegm turbidity increased significantly after 5 years(P<0.01). Conclusion: In the long-term course of post-stroke cognitive decline, syndrome elements tend to be intermingled deficiency and excess, and combine with each other.Syndromes and pathogenesis tend to be more complex. Qi deficiency and phlegm turbidity are correlated with the progress of cognitive impairment after stroke. qi deficiency may be correlated with the decline of visual space and executive function, and phlegm turbidity may be correlated with the decline of language and memory function.
引文
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[8]史亚楠,金香兰,赵建军,等.高血压合并腔隙性脑梗死认知障碍特点及中医证候分析.中华中医药杂志,2017,32(5):2280-2284
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[11]清·沈金鳌.杂病源流犀烛.北京:人民卫生出版社,2006
[2]各类脑血管疾病诊断要点.中华神经科杂志,1996(6):60-61
[3]American Psychiatric Association Committee on Nomenclature and Statistics.Diagnostic and Statistical Manual of Mental Disorders(DSM-Ⅳ),Fourth Edition.Washington,DC:American Psychiatric Association,1994
[4]中风病辨证诊断标准(试行).北京中医药大学学报,1994(3):64-66
[5]中国卒中学会,卒中后认知障碍管理专家委员会.卒中后认知障碍管理专家共识.中国卒中杂志,2017,12(6):519-531
[6]Rodríguez García P L,Rodríguez G D.Diagnosis of vascular cognitive impairment and its main categories.Neurología,2015,30(4):223-239
[7]刘玥,金香兰,薛斐然,等.基于因子分析脑梗死后认知障碍中医证候要素研究.北京中医药,2015,34(2):83-87
[8]史亚楠,金香兰,赵建军,等.高血压合并腔隙性脑梗死认知障碍特点及中医证候分析.中华中医药杂志,2017,32(5):2280-2284
[9]张允岭,梅建勋,谢颖桢,等.老年期血管性痴呆分期分证探讨.中医杂志,2008,49(2):173-175
[10]明·方隅.医林绳墨.北京:商务印书馆出版社,1957
[11]清·沈金鳌.杂病源流犀烛.北京:人民卫生出版社,2006