脑出血中医分型与良好预后影响因素的Logistic回归分析

摘要

Objective] To observe the traditional Chinese medicine(TCM) syndrome differentiation and prognosis in intracerebral hemorrhages(ICH) .To analyse the probable relationship between different symptom-complex and prognosis and search for other factors which can affect the prognosis in order to guild the clinical therapy and prevent the dangerous factors to ICH. [Methods]In June 2010 to December 2012 in the neurological wards of the Zhejiang Zhoushan Hospital,standard 128 patients with spontaneous supratentorial intracerebral hemorrhage were registered. Good outcome was defined as modified Rankin score ≤2 at three months. Chi-square,Independent-Samples T Test and multiple logistic regression were used respectively to analyze the correlations of 32 factors to predict good outcome,which was defined as modified Rankin score ≤2 at three months. [Results] Ggood prognosis(mRS 2 or less),93 cases(75%).Factors that may affect the prognosis of 32 line the trend χ2 test,independent sample group t test and the multi-factor Logistic regression analysis,the results showed that age,TCM syndrome differentiation,intraventricular hemorrhage,OR broken into the ventricle,the three factors to assess were independent predictors of prognosis of spontaneous supratentorial intracerebral hemorrhage(age: OR=1.110 ,95% CI 1.051 to 1.173;syndrome differentiation of traditional Chinese medicine:the OR=0.076 ,95%CI from 0.024 to 0.244;ventricular hemorrhage or broken into the ventricle OR=0.094,95% CI 0.023 to 0.384.Prediction model was composed of these three factors,its specific degrees=94.6%,predicting rate=87.1%. 1. We studied 128 patients who were included in the study. Among them 93 patients(75%) had good outcome. After Chi-square ,Independent-Samples T test and multiple logistic regression with 32 factors,the independent predictors of outcome were Age(OR=1.110,95%CI 1.051~1.173),symptom-complex(OR=0.076,95%CI 0.024~0.244),intraventricular hemorrhage or breaking into ventricle(OR=0.094,95%Cl 0.023~0.384),These three factors correctly classified 87.1%of patients. The specificity was 94.6%. [Conclusions](1). TCM types of hemorrhagic stroke in the distribution of certain differences ,tip of hemorrhagic stroke in the pathogenesis of the possible existence of different points,including fengtanyuzu,tanshimenbixingsheng,tanreneibixingqiao for three months prognosis was statistically significant.(2)Younger age(62.32 ±11.47 years), as in TCM fengtanyuzu persons better prognosis; older(72.32 ±9.92 years);TCM for the organs by:tanshimenbixingsheng,tanreneibixingqiao;intraventricular hemorrhage or broken into ventricles with poor prognosis.%[目的]了解急性幕上脑出血中医辨证分型及预后情况，分析研究不同证型与预后的可能关系，寻找可能预测预后的因素。[方法]选取2010年6月至2012年12月在我院神经内科住院的符合纳入标准的自发性幕上脑出血患者128例。将中医辨证等32个指标作为自变量，预后情况（mRS≤2分代表预后好，发病后3个月死亡和mRS>2分代表预后差）作为应变量，行趋势χ2检验，独立样本成组t检验及多因素Logistic回归分析。[结果]预后良好（mRS≤2）93例(75%)。将可能影响预后的32个因素行趋势χ2检验，独立样本成组t检验及多因素Logistic回归分析，结果显示年龄、中医辨证、脑室出血或破入脑室，这3个因素是评估自发性幕上脑出血预后的独立预测因素，年龄：OR=1．110，95%CI [1．051～1．173]；中医辨证：OR=0．076，95%CI [0．024～0．244]；脑室出血或破入脑室：OR=0．094，95%Cl [0．023～0．384]。由这3个因素组成的预测模型，其特异度为94．6%，预测率为87．1%。[结论]中医分型在出血性卒中的分布存在一定的差异性，其中风痰瘀阻、痰湿蒙闭心神、痰热内闭心窍对3个月时预后判断有统计学意义。年龄偏小（62．32±11．47）岁、中医辨证为中经络（风痰瘀阻）者预后较好；年龄偏大（72．32±9．92）岁、中医辨证为中脏腑（痰湿蒙闭心神、痰热内闭心窍）者、脑室出血或破入脑室的预后较差。