数字中医药（英文）2025，Vol.8Issue(1)：111-122,12.DOI:10.1016/j.dcmed.2025.03.010
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
Analysis of clinical characteristics and diagnostic prediction of Qi deficiency and blood stasis syndrome in acute ischemic stroke
摘要
Abstract
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 syn-drome 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 pa-tients meeting the diagnostic criteria for Qi deficiency and blood stasis syndrome were strati-fied into case group,while those without Qi deficiency and blood stasis syndrome were strati-fied into control group.The demographic characteristics(age and gender),clinical parame-ters[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[mag-netic resonance imaging-diffusion weighted imaging(MRI-DWI)],and biochemical indica-tors 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 1 035 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).Re-garding 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 ex-aminations demonstrated higher proportions of centrum semiovale infarction,cerebral atro-phy,and vertebral artery stenosis in case group(P＜0.05).Among biochemical indicators,case group showed higher proportions of elevated fasting blood glucose and glycated hemoglobin(HbA1c),while lower proportions of elevated white blood cell count,reduced hemoglobin,and reduced high-density lipoprotein cholesterol(HDL-C)(P＜0.05).Multivari-ate logistic regression analysis identified significant predictors for Qi deficiency and blood sta-sis syndrome including:fine pulse[odds ratio(OR)=4.38],astringent pulse(OR=3.67),su-perficial sensory abnormalities(OR=1.86),centrum semiovale infarction(OR=1.57),cerebral atrophy(OR=1.55),vertebral artery stenosis(OR=1.62),and elevated HbA1c(OR=3.52).The ROC curve analysis of the comprehensive prediction model yielded an area under the curve(AUC)of 0.878[95%confidence interval(CI)=0.855-0.900]. Conclusion This study finds out that Qi deficiency and blood stasis syndrome represents one of the primary types of AIS.Fine pulse,astringent pulse,superficial sensory abnormalities,centrum semiovale infarction,cerebral atrophy,vertebral artery stenosis,elevated blood glu-cose,elevated HbA1c,pale and dark tongue colors,and white tongue coating are key objec-tive diagnostic indicators for the syndrome differentiation of AIS with Qi deficiency and blood stasis syndrome.Based on these indicators,a syndrome differentiation prediction model has been developed,offering a more objective basis for clinical diagnosis,and help to rapidly identify this syndrome in clinical practice and reduce misdiagnosis and missed diagnosis.关键词
缺血性脑卒中/病例对照研究/气虚血瘀证/辨证预测模型/逻辑回归分析Key words
Acute ischemic stroke(AIS)/Case-control study/Qi deficiency and blood stasis syndrome/Prediction model of syndrome differen-tiation/Logistic regression analysis引用本文复制引用
徐昊,朱旭,李波,刘晓丹,潘曦辉,邓常清..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[J].数字中医药（英文）,2025,8(1):111-122,12.基金项目
National Natural Science Foundation of China(U22A20377),and Natural Science Foundation of Hunan Province of China(23C0168). （U22A20377）
