急性缺血性脑卒中患者中医证候及心脏代谢多发病对预后的影响  

Effects of traditional Chinese medicine syndrome and cardiometabolic multimorbidity on prognosis of patients with acute ischemic stroke

作　　者：栾慧林 谢颖桢[1] 梁笑笑 邓文珠 柳洪奎 LUAN Huilin;XIE Yingzhen;LIANG Xiaoxiao;DENG Wenzhu;LIU Hongkui(Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院,北京100700

出　　处：《现代中西医结合杂志》2025年第4期459-467,共9页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：国家重点研发计划项目(2017YFC1700101)。

摘　　要：目的探索心脏代谢多发病、中医证候与急性缺血性脑卒中患者1年后功能预后之间的关联性,帮助识别预后不良的高危人群。方法对2019年9月—2020年11月于北京中医药学东直门医院、北京中医药大学房山区中医院、北京中医药大学东方医院、太原市中心医院、广安门医院住院治疗的435例急性缺血性脑卒中患者进行为期1年的随访调查,采集患者入院时的临床资料,包括一般资料和中医诊断、中医证候分布情况、虚实证候、神经功能缺损评分量表(NIHSS)评分、日常生活能力量表(BI)评分;采用改良Rankin量表评价患者随访1年后的功能预后情况。根据基线时的心脏代谢疾病情况将患者分为无心脏代谢疾病组、单个心脏代谢疾病组及心脏代谢多发病组,按照中医证候将患者分为风痰上扰组、痰瘀阻络组、风火上扰组、痰热上扰组、气虚化风组及阴虚风动组,根据随访1年预后情况将患者分为预后良好组和预后不良组,比较各组间基线时的临床资料,单因素和多因素分析急性缺血性脑卒中患者的预后影响因素。结果单因素分析显示,年龄(P<0.001)、性别(P=0.013)、心脏代谢疾病个数(P<0.001)、心脏代谢多发病(P=0.002)、脑卒中+冠心病(P=0.012)、脑卒中+糖尿病+冠心病(P<0.001)、任何心脏代谢疾病(P=0.030)、中脏腑(P<0.001)、痰热上扰证(P=0.033)、虚实夹杂(P=0.003)、虚证为主(P<0.001)、既往卒中次数(P<0.001)、2周内感染史(P<0.001)、NIHSS评分(P<0.001)、BI评分(P<0.001)和并发症中肺部感染(P=0.003)、泌尿系感染(P=0.012)、便秘(P=0.002)、下肢深静脉血栓(P=0.002)均是预后不良的危险因素。多因素分析显示,脑卒中+糖尿病+冠心病(P<0.001)、中脏腑(P=0.008)、虚实夹杂(P<0.001)、虚证为主(P<0.001)、年龄(P<0.001)、2周内感染史(P=0.004)、NIHSS评分(P<0.001)、失眠(P=0.035)是患者预后不良的独立危险因素,阴虚风动(P=0.024)是Objective It is to explore the association between cardiometabolic multimorbidity,traditional Chinese medicine(TCM)syndrome and the prognosis of ischemic stroke patients after 1 year.Methods A total of 435 acute ischemic stroke patients hospitalized at Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine,Fangshan District Hospital of Beijing University of Traditional Chinese Medicine,Dongfang Hospital of Beijing University of Traditional Chinese Medicine,Taiyuan Central Hospital,and Guang’anmen Hospital from September 2019 to November 2020 were followed up for one year,and their Clinical data at the time of admission,including general information,TCM diagnosis,distribution of TCM syndromes,excessive and deficiency syndromes,scores of NIH stroke Scale(NIHSS)and Barthel index(BI)were collected;the functional prognosis of the patients after 1 year of follow-up was evaluated by modified Rankin Scale.The patients were divided into non-cardiometabolic disease group,single cardiometabolic disease group and multiple cardiometabolic disease group according to the cardiometabolic diseases at baseline,they were divided into group of wind-phlegm harassing the upper,group of phlegm-stasis obstructing the collaterals,group wind-fire harassing the upper,group phlegm-heat harassing the upper,group of Qi deficiency stirring wind,and group of Yin deficiency stirring wind according to the TCM syndromes,and they were divided into good prognosis group and bad prognosis group according to the prognosis after 1 year of follow-up.The clinical data at baseline were compared among the groups,and the prognostic factors of patients with acute ischemic stroke were analyzed univariately and multivariately.Results Univariate analysis showed that age(P<0.001),gender(P=0.013),number of cardiom etabolic disease(P<0.001),cardiometabolic multimorbidity(P=0.002),stroke+coronary heart disease(P=0.012),stroke+diabetes+coronary heart disease(P<0.001),presence of any cardiometabolic disease(P=0.030),apoplexy involving the Zangfu(P

关 键 词：缺血性脑卒中 心脏代谢多发病 中医证候 预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]