The Prognostic Value of Traditional Chinese Medicine Symptoms in Acute Ischemic Stroke: A Pilot Study

Jia Xu, Jian Pei, Qin-Hui Fu, Yi-Jun Zhan, Jia Xu, Jian Pei, Qin-Hui Fu, Yi-Jun Zhan

Abstract

Background: Stroke scales of traditional Chinese medicine (SSTCM) are promoted for use in the early prognosis. The current lines of evidence to support their performance evaluation are uneven. This pilot study aimed to investigate the correlation between traditional Chinese medicine (TCM) symptoms in the early stages of acute ischemic stroke and the prognosis of motor dysfunction through one-year of follow-up.

Methods: Three hundred and fifteen patients were retrospected at Longhua Hospital from January 2016 to December 2017. All patients had received standard treatments combined with acupuncture therapy, including both electroacupuncture and scalp acupuncture for a median course of five months. The observed outcomes were the Fugl-Meyer assessment (FMA), the modified Barthel index (MBI), and the modified Rankin scale (mRS) at one-year follow-up after stroke onset by multiple linear regression analysis combined with ROC curves.

Results: The favorable outcome rate was 74.3%, with the recurrence rate of 20.3% in the follow-up. In multiple linear regression, 10 TCM symptoms (MBI regression model) were related to the prognosis of MBI (DW 1.409, Ad. R 2 0.654) and 10 TCM symptoms (FMA regression model) were related to the FMA outcome (DW 1.446, Ad R 2 0.620). The two models were selected to have nine repeated symptoms (repeated model). In the ROC curves, the three models were compared with the NIHSS score, and the MBI regression model reflected the highest efficiency.

Conclusions: The combination of 10 TCM symptoms, once onset occurred, including hemiplegia, restlessness, hemianesthesia, short breath, headache, constipation, night sweat, tinnitus, thirsty, and gurgling with sputum, may affect the recovery of motor dysfunction. Furthermore, the improvements of TCM symptoms dynamically after treatment would be observed in a large prospective cohort. This trial is registered with NCT01806233.

Conflict of interest statement

The authors declare that they have no competing interests.

Copyright © 2020 Jia Xu et al.

Figures

Figure 1
Figure 1
Flowchart of the study recruitment.
Figure 2
Figure 2
Regression standardized residual histogram (MBI).
Figure 3
Figure 3
Regression plot (measured value vs. predicted value) (MBI). R2 = 0.682.
Figure 4
Figure 4
Regression standardized residual histogram (FMA).
Figure 5
Figure 5
Regression plot (measured value vs. predicted value) (FMA). R2 = 0.650.
Figure 6
Figure 6
ROC curve on four scales.

References

    1. Wu S., Wu B., Liu M., et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. The Lancet Neurology. 2019;18(4):394–405. doi: 10.1016/s1474-4422(18)30500-3.
    1. Feigin V. L., Nguyen G., Cercy K., et al. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. New England Journal of Medicine. 2018;379(25):2429–2437. doi: 10.1056/nejmoa1804492.
    1. Feigin V. L., Norrving B., Mensah G. A. Global burden of stroke. Circulation Research. 2017;120(3):439–448. doi: 10.1161/circresaha.116.308413.
    1. Wang L. D., Liu J. M., Yang Y., Wang Y. L. Chinese prevention and treatment of stroke 2017. Chinese Journal of Cerebrovascular Diseases. 2018;15(11):611–617.
    1. Yu C. H., Sun Y. N., He L. Y., Bai W. J., Liu B. Y. Traditional Chinese medicine generic questionnaire for life quality: a systematic review. Chinese Journal of Traditional Chinese Medicine and Pharmacy. 2016;31(02):432–437.
    1. Wu D. R., Lai S. L., Guo X. F., Wen Z. H., Liang W. X. Reliability and validity of Health Scale of Traditional Chinese Medicine. Journal of Chinese Integrative Medicine. 2008;6(7):682–689. doi: 10.3736/jcim20080705.
    1. Cao K. G., Fu C. H., Li H. Q., Xin X. Y., Gao Y. A new prognostic scale for the early prediction of ischemic stroke recovery mainly based on traditional Chinese medicine symptoms and NIHSS score: a retrospective cohort study. BMC Complementary and Alternative Medicine. 2015;15:p. 407. doi: 10.1186/s12906-015-0903-1.
    1. Sherman R. E., Anderson S. A., Dal Pan G. J., et al. Real-world evidence—what is it and what can it tell us? New England Journal of Medicine. 2016;375(23):2293–2297. doi: 10.1056/nejmsb1609216.
    1. Chinese Society of Neurology. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2014. Chinese Journal of Neurology. 2015;4(48)
    1. Yi Z., Da Y., Bao X. The Encephalopaty Accident and Emergency Collaborative Collaborativ Group of State Administration of TCM. Criteria of diagnosis and therapeutic effect evaluation for apoplexy (trial version). Beijing. 1996;19:55–56.
    1. Powers W. J., Rabinstein A. A., Ackerson T., et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2018;49(3):e46–e110.
    1. Wang J., Pei J., Khiati D., et al. Acupuncture treatment on the motor area of the scalp for motor dysfunction in patients with ischemic stroke: study protocol for a randomized controlled trial. Trials. 2017;18(1):p. 287. doi: 10.1186/s13063-017-2000-x.
    1. See J., Dodakian L., Chou C., et al. A standardized approach to the fugl-meyer assessment and its implications for clinical trials. Neurorehabilitation and Neural Repair. 2013;27(8):732–741. doi: 10.1177/1545968313491000.
    1. Leung S. O. C., Chan C. C. H., Shah S. Development of a Chinese version of the modified Barthel index - validity and reliability. Clinical Rehabilitation. 2007;21(10):912–922. doi: 10.1177/0269215507077286.
    1. Saver J. L., Filip B., Hamilton S., et al. Improving the reliability of stroke disability grading in clinical trials and clinical practice. Stroke. 2010;41(5):992–995. doi: 10.1161/strokeaha.109.571364.
    1. Prasad K., Dash D., Kumar A. Validation of the Hindi version of national institute of health stroke scale. Neurology India. 2012;60(1):40–44. doi: 10.4103/0028-3886.93587.
    1. Brott T., Adams H. P., Jr., Olinger C. P., et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864–870. doi: 10.1161/01.str.20.7.864.
    1. Craig L. E., Wu O., Bernhardt J., Langhorne P. Predictors of poststroke mobility: systematic review. International Journal of Stroke. 2011;6(4):321–327. doi: 10.1111/j.1747-4949.2011.00621.x.
    1. Jongbloed L. Prediction of function after stroke: a critical review. Stroke. 1986;17(4):765–776. doi: 10.1161/01.str.17.4.765.
    1. Kwakkel G., Kollen B. J. Predicting activities after stroke: what is clinically relevant? International Journal of Stroke. 2012;8(1):25–32. doi: 10.1111/j.1747-4949.2012.00967.x.
    1. Song Y., Pei J., Liu Z. D., et al. Dynamic changes in traditional Chinese medicine syndromes in patients with ischemic stroke treated by acupuncture. Journal of Chinese Integrative Medicine. 2009;7(4):334–341. doi: 10.3736/jcim20090407.
    1. Pei J., Sun L. J., Chen R. X., Zhu T. M., Qian Y. Z., Yuan D. J. The effect of electro-acupuncture on motor function recovery in patients with acute cerebral infarction: a randomly controlled trial. Journal of Traditional Chinese Medicine. 2001;21(4):270–272.

Source: PubMed

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