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Journal of Chinese Integrative Medicine ›› 2012, Vol. 10 ›› Issue (9): 983-990.doi: 10.3736/jcim20120906

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Study on the correlation between traditional Chinese medicine syndrome and short-term prognosis of ischemic stroke using logistic regression model and repeated-measures analysis of variance

Lu Liu, Ying Gao()   

  1. Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
  • Received:2012-03-12 Accepted:2012-06-05 Online:2012-09-20 Published:2018-09-15
  • Contact: Ying Gao E-mail:gaoying973@126.com

Objective: To investigate the correlation between traditional Chinese medicine (TCM) syndrome and short-term prognosis of ischemic stroke.

Methods: TCM syndrome factors and the neurological deficit degree of 464 patients with ischemic stroke were assessed using the Ischemic Stroke TCM Syndrome Factor Diagnostic Scale (ISTSFDS) and National Institutes of Health Stroke Scale (NIHSS) on the 1st, 7th and 14th day from the onset of ischemic stroke. Patients were assigned to the favorable short-term prognosis group and the unfavorable short-term prognosis group, depending on the NIHSS score on the 14th day after onset of stroke. The correlation between TCM syndrome factors and the short-term prognosis of ischemic stroke was studied using the logistic regression model. Then, the receiver operating characteristic (ROC) curves were used to evaluate the predicting capacity of logistic regression mode. Lastly, according to the results of the logistic regression model, the authors investigated the correlation between blood stasis syndrome and the neurological deficit degree of stroke with application of repeated-measures analysis of variance.

Results: Blood stasis syndrome (odds ratio=2.924, 95% confidence interval from 1.231 to 6.946, P=0.015) on the 14th day and NISSS score (odds ratio=1.956, 95% confidence interval from 1.701 to 2.250, P=0.000) on the 1st day after onset of stroke were risk factors that could predict short-term prognosis of ischemic stroke. The area under the ROC curves of the logistic regression model was 0.95. There was a tendency for stroke patients with blood stasis syndrome to have higher NIHSS scores than patients without blood stasis syndrome, and there was a decreased NIHSS score with time points delay.

Conclusion: Blood stasis syndrome is a risk whose diagnosis could predict short-term prognosis of ischemic stroke. Clinically, the application of treatment focusing on activating blood and resolving stasis can improve the short-term prognosis of stroke patients. This study provides an evidence base for dynamic intervention of a comprehensive integrative medical treatment program based on syndrome differentiation for ischemic stroke.

Key words: stroke, brain ischemia, symptom complex, neurologic manifestations, prognosis, clinical trial

Table 1

Baseline clinical characteristics of the two group study subjects"

Item Past medical history Short-term prognosis
Favorable (n=374) Poor (n=90) P value
Age (Median (P25, P75), years) 63 (55~73) 72 (57.75~78.25) 0.000
Gender (male/female) 270/104 55/35 0.039
Atrial fibrillation (n, %) Yes 10 (2.7%) 10 (11.1%) 0.001
No 364 (97.3%) 80 (88.9%)
Hypertension (n, %) Yes 266 (71.1%) 60 (66.7%) 0.406
No 108 (28.9%) 30 (33.3%)
Hyperlipidemia (n, %) Yes 53 (14.2%) 10 (11.1%) 0.447
No 321 (85.8%) 80 (88.9%)
Coronary heart disease (n, %) Yes 69 (18.4%) 18 (20.0%) 0.735
No 305 (81.6%) 72 (80.0%)
Diabetes mellitus (n, %) Yes 110 (29.4%) 26 (28.9%) 0.992
No 264 (70.6%) 64 (71.1%)
NIHSS1 (Median (P25, P75), scores) 3 (2, 5) 11 (9, 14.25) 0.000

Table 2

Logistic regression models of syndrome factors and short-term prognosis"

Variable β Standard error Wald df P value OR 95% Confidence interval
Lower Upper
NIHSS_1 0.671 0.071 88.302 1 0.000 1.956 1.701 2.250
BBS_14 1.073 1.073 5.909 1 0.015 2.924 1.231 6.946
Constant –6.756 0.714 89.514 1 0.000 0.001

Figure 1

Receiver operating characteristic curve"

Figure 2

NIHSS score of two groups on the 1st, 7th and 14th day after stroke onsetNIHSS: National Institutes of Health Stroke Scole. "

"

Group n NIHSS score
T1 T2 T3
BBS 309 4 (2, 7) 3 (1, 7) 3 (1, 6)*
Not BBS 155 4 (2, 6) 3 (2, 5) 2 (1, 5)
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