急性脑梗死中医证素与危险因素的相关性分析

Correlation Analysis on TCM Syndromes and Risk Factors in Acute Cerebral Ischemic Stroke

目的:探讨急性脑梗死患者中医证素与危险因素的相关性。方法:回顾性分析298例急性脑梗死患者的病历资料,统计中医证素分布,分析不同证素与年龄、性别及职业等的相关性,通过Logistic回归建立模型,采用Hosmer-Lemeshow检验评价模型的校准能力。结果:主要证型有风痰阻络证159例,阴虚风动证73例,气滞血瘀证20例,厥证13例,阴虚阳亢证12例,肝阳上亢证6例,气虚络阻证5例,风火上扰证4例,阴虚气滞证2例,气虚血瘀证1例,寒凝肝脉证1例,单中经络2例。涉及病性证素有风79.19%(236/298),痰53.36%(159/298),阴虚29.19%(87/298),气滞7.38%(22/298),血瘀7.05%(21/298),阳亢6.04%(18/298),厥4.36%(13/298),气虚2.01%(6/298),火1.34%(4/298),寒0.34%(1/298);病位证素有经络68.46%(204/298),肝2.35%(7/298)等。男性患者多于女性患者。<50岁,16例;51~60岁,47例;61~70岁,83例;71~80岁,101例;>80岁,51例。证素与危险因素Logistic回归显示,在急性脑梗死患者中,吸烟与气滞、血瘀正相关,职业与气虚正相关。动脉粥样硬化与病性证素风、痰、阴虚,以及病位证素中经络正相关;高尿酸与阴虚正相关;住院时间与气滞、血瘀正相关。Hosmer-Lemeshow检验均P>0.05,说明模型有较好的校准能力。结论:急性脑梗死的危险因素有年龄、吸烟、动脉粥样硬化和高尿酸血症;中医证素主要包括风、痰、阴虚、血瘀、气滞和气虚等。

Objective:To explore the correlation between risk factors and TCM syndrome factors in patients with acute cerebral ischemic stroke.Methods:Totally 298 patients were analyzed retrospectively.The distribution of TCM syndrome factors and the correlation between different syndrome factors and age,sex and occupation were analyzed.The model was established by Logistic regression and the calibration ability was evaluated by Hosmer-Lemeshow test.Rresults:The main syndromes were wind-phlegm obstruction of collaterals(159 cases),Yin deficiency and wind moving syndrome(73 cases),Qi stagnation and blood stasis syndrome(20 cases),Jue syndrome(13 cases),Yin deficiency and Yang hyperactivity syndrome(12 cases),liver Yang hyperactivity syndrome(6 cases),Qi deficiency and collaterals obstruction syndrome(5 cases),wind-fire disturbance syndrome(4 cases),Yin deficiency and Qi stagnation syndrome(2 cases),Qi deficiency and blood stasis syndrome(1 case),cold coagulated liver vessels syndrome(1 case),single meridian syndrome(2 cases).The disease nature syndrome factors were wind 79.19%(236/298),phlegm 53.36%(159/298),Yin deficiency 29.19%(87/298),Qi stagnation 7.38%(22/298),blood stasis 7.05%(21/298),Yang hyperactivity 6.04%(18/298),Jue 4.36%(13/298),Qi deficiency 2.01%(6/298),fire 1.34%(4/298)and cold 0.34%(1/298).The disease location syndrome factors include meridians and collaterals 68.46%(204/298),liver 2.35%(7/298),etc..In general,there were more males than females.There were 16 patients less than 50 years old,47 patients ranged from 51 to 60 years old,83 patients ranged from61 to 70 years old,101 patients ranged from 71 to 80 years old,and 51 patients more than 80 years old.Logistic regression analysis showed that smoking was positively correlated with Qi stagnation and blood stasis in stroke patients and that occupation was positively correlated with Qi deficiency.Atherosclerosis was positively correlated with disease nature syndrome factors,wind,phlegm and Yin deficiency,as well as disease location syndrome factors,meridians and collaterals.High uric acid was positively correlated with Yin deficiency.Hospital stay was positively correlated with Qi stagnation and blood stasis.The Hosmer-Lemeshow test showed P>0.05,which indicated that the model showed good calibration ability.Conclusion:The risk factors of acute stroke include age,smoking,arteriosclerosis and Hyperuricemia,and the syndrome factors of TCM mainly include wind,phlegm,Yin deficiency,blood stasis,Qi stagnation and Qi deficiency.