Analysis of clinical characteristics and diagnostic prediction of Qi deficiency and blood stasis syndrome in acute ischemic stroke  

急性缺血性脑卒中气虚血瘀证临床特征分析及辨证预测的研究

作　　者：Hao XU Xu ZHU Bo LI Xiaodan LIU Xihui PAN Changqing DENG 徐昊;朱旭;李波;刘晓丹;潘曦辉;邓常清(湖南中医药大学中西医结合学院,湖南长沙410208;湖南中医药大学第一附属医院影像科,湖南长沙410007)

机构地区：[1]School of Integrated Chinese and Western Medicine,Hunan University of Chinese Medicine,Changsha,Hunan 410208,China [2]The Medical Imaging Department,The First Hospital of Hunan University of Chinese Medicine,Changsha,Hunan 410007,China

出　　处：《Digital Chinese Medicine》2025年第1期111-122,共12页数字中医药(英文)

基　　金：National Natural Science Foundation of China(U22A20377);Natural Science Foundation of Hunan Province of China(23C0168).

摘　　要：Objective To explore the clinical characteristics and methods for syndrome differentiation prediction,as well as to construct a predictive model for Qi deficiency and blood stasis syndrome in patients with acute ischemic stroke(AIS).Methods This study employed a retrospective case-control design to analyze patients with AIS who received inpatient treatment at the Neurology Department of The First Hospital of Hunan University of Chinese Medicine from January 1,2013 to December 31,2022.AIS patients meeting the diagnostic criteria for Qi deficiency and blood stasis syndrome were stratified into case group,while those without Qi deficiency and blood stasis syndrome were stratified into control group.The demographic characteristics(age and gender),clinical parameters[time from onset to admission,National Institutes of Health Stroke Scale(NIHSS)score,and blood pressure],past medical history,traditional Chinese medicine(TCM)diagnostic characteristics(tongue and pulse),neurological symptoms and signs,imaging findings[magnetic resonance imaging-diffusion weighted imaging(MRI-DWI)],and biochemical indicators of the two groups were collected and compared.The indicators with statistical difference(P<0.05)in univariate analysis were included in multivariate logistic regression analysis to evaluate their predictive value for the diagnosis of Qi deficiency and blood stasis syndrome,and the predictive model was constructed by receiver operating characteristic(ROC)curve analysis.Results The study included 1035 AIS patients,with 404 cases in case group and 631 cases in control group.Compared with control group,patients in case group were significantly older,had extended onset-to-admission time,lower diastolic blood pressure,and lower NIHSS scores(P<0.05).Case group showed lower incidence of hypertension history(P<0.05).Regarding tongue and pulse characteristics,pale and dark tongue colors,white tongue coating,fine pulse,astringent pulse,and sinking pulse were more common in case group.Imaging examinations demonstrated higher propo目的探讨急性缺血性脑卒中(AIS)的临床特点及辨证预测方法,构建AIS气虚血瘀证的预测模型。方法本研究采用回顾性病例对照设计,分析2013年1月1日至2022年12月31日期间在湖南中医药大学第一附属医院神经内科接受住院治疗的AIS患者。将符合气虚血瘀证诊断标准的AIS患者纳入病例组,将非气虚血瘀证AIS患者纳入对照组。收集并比较两组患者的人口学特征(年龄、性别)、临床参数[发病至入院时间、美国国立卫生研究院卒中量表(NIHSS)评分、血压]、既往病史、中医诊断特征(舌象、脉象)、神经系统症状体征、影像学表现[磁共振弥散加权成像(MRI-DWI)]以及生化指标。将单因素分析中具有统计学差异(P<0.05)的指标纳入多因素逻辑回归分析,评估其对气虚血瘀证诊断的预测价值,并通过受试者工作特征(ROC)曲线分析构建预测模型。结果研究共纳入1035例AIS患者,其中病例组404例,对照组631例。与对照组相比,病例组患者年龄显著较大,发病至入院时间延长,舒张压较低,NIHSS评分较低(P<0.05)。病例组患者高血压史发生率较低(P<0.05)。在舌脉特征方面,病例组更常见舌淡、舌暗、苔白、细脉、涩脉和沉脉。在影像学检查中,病例组半卵圆中心梗死、脑萎缩和椎动脉狭窄比例更高(P<0.05)。在生化指标方面,病例组升高的空腹血糖和糖化血红蛋白(HbA1c)比例更高,而白细胞计数升高、血红蛋白降低和高密度脂蛋白胆固醇(HDL-C)降低的比例更低(P<0.05)。多因素逻辑回归分析确定气虚血瘀证的显著预测因素包括:细脉[比值比(OR)=4.38]、涩脉(OR=3.67)、浅感觉异常(OR=1.86)、半卵圆中心梗死(OR=1.57)、脑萎缩(OR=1.55)、椎动脉狭窄(OR=1.62)和HbA1c升高(OR=3.52)。综合预测模型的ROC曲线分析显示曲线下面积(AUC)为0.878[95%置信区间(CI)=0.855-0.900]。结论本研究发现气虚血瘀证是AIS的主要类型之一。细脉、涩�

关 键 词：Acute ischemic stroke(AIS) Case-control study Qi deficiency and blood stasis syndrome Prediction model of syndrome differentiation Logistic regression analysis 

分 类 号：R743.3[医药卫生—神经病学与精神病学]