基于决策树分析探索缺血性中风早期各时段证候特征与近期预后的关系

Investigation on the relationship between each period of syndrome characteristics and short-term prognosis in early ischemic stroke based on decision tree analysis

目的:研究缺血性中风急性期各时段证候特征与近期预后的关系。方法:对313例发病72h内入组的缺血性中风急性期患者进行动态临床信息采集。应用《缺血性中风证候要素诊断量表》判断各时段证候要素,应用日常生活能力量表(BI)评价患者发病第21天预后状态(BI 21d≥95或BI 21d<95)。以发病21d的BI分级作为目标变量,3个时段(发病第1-2天、3-5天和6-8天)6个证候要素诊断与否(1=诊断成立,0=诊断不成立)作为输入变量,应用决策树(DT)分析方法构建模型,获得分类规则、正确率、误分率及增益曲线,研究缺血性中风急性期各时段证候要素对患者近期预后的影响。结果:缺血性中风发病第3-5天内火证、第6-8天内风证、痰湿证诊断成立与否与发病第21天的BI有关,缺血性中风病急性期发病第6-8天存在内风证、痰热证的患者近期预后较差。结论:中风病急性期发病1周左右是中医证候变化的重要拐点,其中内风证、内火证及痰湿证是与患者近期预后相关的重要证候特征,临床医生应密切关注其证候演变特征,积极采取干预措施。

Objective： To explore the relationship between each period of syndrome characteristics and short-term prognosis. Methods： Clinical information of 313 patients with acute ischemic stroke （AIS） within 72 hours of onset were incrementally included and dynamically collected. ＂Ischemic Stroke TCM Syndrome Factor Diagnostic Scale＂ was used to evaluate the syndrome characteristics of different time periods, and activity of Dally Living Scale （ADL） was used to evaluate the Barthel Index （BI, BI 21d≥95 or BI 21d〈95） at day 21. The BI at day 21 as the target variable, and six elements syndrome diagnosis （l=diagnosis was established, 0=diagnosis was not established） of three time periods （onset of 1-2d, 3-5d, 6-8d） as the input variables. Decision Tree analysis was used to build the model and get the classification rules, correct rate, error rate and the gain curve. Then to research on the effect of each period of syndrome elements on short-term prognosis of patients. Results： The incidence of ischemic stroke had a relationship between syndrome elements （3-5d endogenous heat syndrome, and 6-8d endogenous wind and phlegm dampness syndrome） with BI at day 21. The short-term prognosis of patients were not good at the first 6-8 days of endogenous wind syndrome and phlegm-heat syndrome in the incidence of acute ischemic stroke. Conclusion： The onset of the first week is the important turning point of syndromes at the acute stage of stroke, the endogenous wind and endogenous heat syndromes, and phlegm dampness syndrome are important syndromes elements associated with the short-term prognosis, so clinicians would better to pay attention to the syndrome evolution and make positive intervention .