急性缺血性中风病患者痰热腑实证证候的预测  

Study on Syndrome Prediction for Phlegm-heat and Fu-viscera Excess Pattern in Acute Ischemic Stroke Patients

作　　者：陈沛[1] 耿花蕾 江澜[1] 吴爽[1] 闫如玉 王雅惠 王月 陆梦馨 杜钟名 果海姣 邹忆怀[1] CHEN Pei;GENG Hualei;JIANG Lan;WU Shuang;YAN Ruyu;WANG Yahui;WANG Yue;LU Meng-xin;DU Zhongming;GUO Haijiao;ZOU Yi-huai(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700)

机构地区：[1]北京中医药大学东直门医院,北京市东城区海运仓5号100700

出　　处：《中医杂志》2018年第22期1937-1942,共6页Journal of Traditional Chinese Medicine

基　　金："十二五"国家科技支撑计划(2013BAI13B02);北京中医药大学2018年度基本科研业务费项目(2018-JYBZZ-XS153)

摘　　要：目的探讨急性缺血性中风病痰热腑实证的临床特征。方法纳入急性缺血性中风病患者265例,辨证分为痰热腑实证组117例,非痰热腑实证组148例。调查两组人口学资料[包括性别、年龄、体重指数(BMI)、生命体征、发病时间、现病史及既往史等],进行病类诊断评分和美国国立卫生研究院卒中量表(NIHSS)评分,检测高敏C反应蛋白(hs-CRP)、白细胞介素6 (IL-6)、肿瘤坏死因子(TNF)、总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、促肾上腺皮质激素(ACTH)、皮质醇(CORT)、血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、糖化血红蛋白(HbA1c)、同型半胱氨酸(HCY)、脂蛋白a [LP (a)]、神经元特异性烯醇化酶(NSE)。采用Logistic回归分析及梯度提升决策树(GBDT)算法进行数据挖掘。结果痰热腑实证组患者BMI、收缩压、病程、病类诊断评分、NIHSS评分及TT4、FT4、LP (a)水平显著高于非痰热腑实证组(P <0. 05或P <0. 01),而FT3、ACTH、CORT、NSE水平显著低于非痰热腑实证组(P <0. 05或P <0. 01)。Logistic回归分析显示,NIHSS、FT3和CORT与痰热腑实证的偏回归系数有统计学意义(P <0. 05或P <0. 01); GBDT结果显示CORT、BMI、FT3、ACTH是痰热腑实证的重要特征。结论急性缺血性中风病患者NIHSS评分越高、FT3和CORT水平越低,痰热腑实证成立的可能性越大。Objective To explore the clinical features of acute ischemic stroke patients with the syndrome of phlegm-heat and fu-viscera excess. Methods A total of 265 acute ischemic stroke patients were selected and divided into the phlegm-heat and fu-viscera excess syndrome group（117 cases） and the non-phlegm-heat and fu-viscera excess syndrome group（148 cases）. Demographic data of 2 groups including gender,age,body mass index（BMI）,vital signs,time of onset,and current and past medical history were investigated,and disease diagnosis scores as well as National Institutes of Health Stroke Scale scores（NIHSS） were observed. The high-sensitivity C-reactive protein（hs-CRP）,interleukin-6（IL-6）,tumor necrosis factor（TNF）,total triiodothyronine（TT3）,total thyroxine（TT4）,free triiodo Thyrolysine（FT3）,free thyroxine（FT4）,thyroid stimulating hormone（TSH）,adrenocorticotropic hormone（ACTH）,cortisol（CORT）,plasma renin activity（PRA）,angiotensin Ⅱ（Ang Ⅱ）,aldosterone（ALD）,glycated hemoglobin（HbA1 c）,homocysteine（HCY）,lipoprotein a [LP（a） ],neuron-specific enolase（NSE） were detected. The logistic regression analysis and gradient lifting decision tree（GBDT） algorithm methods were used for data mining. Results Compared with the non-phlegm-heat and fu-viscera excess syndrome group,patients in the phlegm-heat and fu-viscera excess syndrome group had higher level BMI,course of disease,systolic pressure,disease diagnosis scores,NIHSS scores and TT4,FT4,LP（a）（P〈 0. 05,or P〈 0. 01）. As to laboratory indexes,the FT3,ACTH,CORT and NSE scores were lower（P 〈0. 05,or P〈 0. 01） than those of the non-phlegmheat and fu-viscera excess syndrome group. Logistic regression analysis showed that the partial regression coefficients of NIHSS,FT3 and CORT and syndrome of phlegm-heat and fu-viscera excess were statistically significant（P〈 0. 05 or P 〈0. 01）. The GBDT results showed that CORT,BMI,FT3,and ACTH were important features of phlegm-heat a

关 键 词：急性缺血性中风病 痰热腑实证 梯度提升决策树 LOGISTIC回归 

分 类 号：R255.2[医药卫生—中医内科学]