中风病气虚证与神经功能缺损程度及远期预后的关系研究

作者	单位
辛喜艳	北京中医药大学东直门医院神经内科
马斌	北京中医药大学东直门医院神经内科
高颖	北京中医药大学东直门医院神经内科
曹克刚	北京中医药大学东直门医院神经内科

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中文摘要:

目的探讨中风病气虚证与神经功能缺损程度及远期预后的关系。方法选取发病72 h内、发病第7、14、28、90天中风病证候要素(风、火、痰、血瘀、气虚、阴虚)诊断量表评分、美国国立卫生研究院卒中量表(The National Institutes of Health Stroke Scale,NIHSS)评分及发病第90天日常生活能力量表(Barthel in-dex,BI)评分的临床信息俱全的中风病患者706例,分为气虚证组(330例)及非气虚证组(376例)。采用两样本重复测量数据方差分析比较气虚证组与非气虚证组不同时点NIHSS评分;应用Logistic回归分析探讨中风病不同时点各证候要素与远期预后的关系。结果各时点气虚证组患者NIHSS评分均高于非气虚证组患者(P<0.01);两组组内各时点NIHSS评分比较,差异均有统计学意义(P<0.01,P<0.05),且随时间的延后,NIHSS评分逐渐降低。血瘀证与痰证在各时点出现频次均较高。发病第90天,BI≥95分者427例(60%),预后良好;BI<95分者279例(40%),预后不良。各时点气虚证均与发病第90天BI指数呈负相关,B值依次为-0.496、-0.714、-0.867、-0.567、-0.764。结论中风病气虚证患者神经功能缺损程度较非气虚证患者更重;中风病急性期气虚证与发病第90天预后不良有密切关系,早期积极扶助正气治疗对改善中风病远期预后具有重要作用。

英文摘要:

Objective To explore the correlation between stroke of qi deficiency syndrome(QDS) and the neurological impairment degree,and to study its correlation between QDS and its long-term prognosis.Methods Recruited were 706 stroke patients with complete clinical information including diagnostic scale scoring of elements such as wind,fire,phlegm,blood stasis,qi deficiency,and yin deficiency,scoring of The National Institutes of Health Stroke Scale(NIHSS) within 72 h from attack,on the 7th,14th,28th,and 90th day after attack,and Barthel index(BI) scoring on the 90th day.They were assigned to the QDS group(330 cases) and the non-QDS group(376 cases).The NIHSS scores at different time points were compared between the two groups using analysis of variance of repeated measure data.The correlation between each syndrome element and the long-term prognosis of stroke was studied using Logistic regression analysis.Results Higher NIHSS score was found in patients of QDS than those of non-QDS at each time point(P<0.01).Statistical difference existed in NIHSS score between the two groups at each time point(P<0.01,P<0.05).Besides,NIHSS score decreased gradually as time went by.The occurrence frequencies of blood stasis syndrome and phlegm syndrome were higher at each time point.On the 90th day after attack,427 patients with BI≥95(accounting for 60%) had favorable prognosis,while 279 with BI<95(accounting for 40%) had unfavorable prognosis.QDS at each time point was negatively correlated with the 90th-day BI,with the B value being-0.496,-0.714,-0.867,-0.567,and-0.764,respectively.Conclusions Stroke patients of QDS had more severe neurological impairment than those of non-QDS.Stroke patients of acute-stage QDS was closely correlated with unfavorable prognosis on the 90th day after attack.Early actively invigorating healthy qi plays an important role in improving the long-term prognosis of stroke patients.

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