Study On The Diagnosis Model Of Kidney Deficiency Syndrome in The Recovery Period Of Ischemic Stroke Based On Multiple Logistic Regression
Dec 06, 2022
Abstract:
Objective To establish a diagnostic model of kidney deficiency syndrome in the recovery period of ischemic stroke based on multiple Logistic regression methods.
Methods Through the prospective, multi-center, and dynamically collected four-diagnosis information survey, 181 convalescent patients with ischemic stroke who met the inclusion and exclusion criteria were included in 15 sub-centers, and a total of 970 cases of complete data information were obtained. The diagnosis model of kidney deficiency syndrome was constructed by using multivariate Logistic regression, and the efficacy was judged by ROC curve. The results screened out 12 factors such as cheekbones, backache, frequent urination, forgetfulness, weak pulse, hot flashes, soft knees, five upset fever, listlessness, cold waist, clear and long urine, and deep and thready pulse, which are the key factors for ischemic stroke recovery. Kidney deficiency
The correlative factors of the evidence were established, and a diagnostic model was constructed: P=1/[1 + Exp (11.223-2.002 × zygomatic red - 1.861 × backache - 1.738 × frequent urination - 1.494 × forgetfulness - 1.469 × weak pulse - 1.361 × hot flashes - 1.297 × soft knees - 1.181 × five upset fever - 1.028 × listlessness - 0.742 × cold waist - 0.722 × clear and long urine - 0.594 × deep and thready pulse)], the area under the ROC curve of the prediction function model is 0.946, and the Youden index is 0.766 , the sensitivity of the diagnostic model was 90.5%, the specificity was 85.4%, and the diagnostic consistency of the same sample was 84.1%.
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Conclusion Through multivariate Logistic regression analysis, a diagnostic model of kidney deficiency syndrome in the convalescent period of ischemic stroke based on the information of the four diagnoses was constructed to provide a reference tool for the identification of kidney deficiency syndrome in the convalescent period of ischemic stroke.
Keywords: recovery period of ischemic stroke; syndrome of kidney deficiency; multiple Logistic regression; ROC curve; diagnostic scale
Stroke has become the number one cause of death and disability in Chinese adults [1-2], among which ischemic stroke accounts for about 60% to 80% [3], bringing a heavy economic burden to our country. Although thrombolysis and other vascular recanalization can improve the neurological function of stroke patients, due to the narrow time window and low accessibility, most patients still have neurological deficits such as limb dysfunction and aphasia after entering the recovery period. Symptoms [4]. Chinese medicine plays an important role in the clinical diagnosis and treatment of ischemic stroke recovery period [5]. With the in-depth study of the "brain-kidney correlation" theory, it is generally believed that "collateral damage, brain insufficiency, and brain dysfunction" are the pathogenesis of neurological deficits after stroke [6]. The previously proposed diagnostic system for ischemic stroke syndrome elements of "wind, fire, phlegm, blood stasis, qi deficiency, and yin deficiency" still lacks a quantitative diagnostic tool for syndromes of ischemic stroke with kidney deficiency, which affects clinical efficacy evaluation, etc. related research work. Therefore, it is particularly necessary to construct relevant diagnostic scales by carrying out multi-regional, multi-center, and multi-time-point investigations of kidney deficiency syndromes in the convalescent period of ischemic stroke, and analyzing the data of the four diagnosis information. This study intends to screen the four diagnosis information related to the establishment of kidney deficiency syndrome by multivariate Logistic regression discriminant method, construct a diagnostic model of kidney deficiency syndrome in the recovery period of ischemic stroke, and provide a reference for quantitative diagnosis.
1 Materials and methods
1.1 General Information
This study is a prospective, multi-center, dynamic collection of four diagnosis information survey. Carried out in 15 sub-centers, including: Dongzhimen Hospital of Beijing University of Chinese Medicine, Lianyungang Hospital of Traditional Chinese Medicine, Linfen Central Hospital, Weifang Hospital of Traditional Chinese Medicine, Luohe Hospital of Traditional Chinese Medicine, Jincheng University Hospital, Fourth Affiliated Hospital of Nanchang University, Rizhao City Hospital of Traditional Chinese Medicine, Fourth Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Jiulongpo District Hospital of Traditional Chinese Medicine of Chongqing, Huaian Hospital of Traditional Chinese Medicine, Kunming Hospital of Traditional Chinese Medicine, Affiliated Hospital of Jiujiang Medical College, Second Hospital of Luoyang City of Traditional Chinese Medicine, People's Hospital of Ganzhou City. Patients recovering from ischemic stroke who were seen in their clinic or hospitalized were selected.
According to the calculation of the 33 items involved in the "Information Collection Form for the Four Diagnosis of Kidney Deficiency Syndrome in the Recovery Period of Ischemic Stroke" [7], the collection cases should not be less than 660 cases. A total of 181 convalescent patients with ischemic stroke who met the inclusion and exclusion criteria were included, including 122 males and 59 females; aged 40-78 years, with an average age of (60.7±8.29) years; 111 inpatients and 111 outpatients.
70 cases; a total of 970 cases of complete collection of data information were obtained. This study was approved by the Ethics Committee of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine (approval number: DZMEC-JG-2017-79).
1.2 Diagnostic criteria
Western medicine diagnostic criteria: Western medicine diagnostic criteria for ischemic stroke are formulated with reference to the diagnostic criteria for ischemic stroke in the "Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke in China 2018" [8]: ① Acute onset; ② Focal neurological function Defects (weakness or numbness on one side of the face or limbs, language barriers, etc.), a few are comprehensive neurological deficits; ③The duration of symptoms or signs is not limited (when imaging shows responsible ischemic lesions), or lasts for more than 24 hours (When there is no imaging responsible lesion); ④ Exclude non-vascular causes; ⑤ Brain CT or MRI to exclude cerebral hemorrhage. Diagnosis by stages: The recovery period is 2 weeks to 6 months after the onset.
Diagnostic criteria for TCM syndromes: The syndrome differentiation criteria for kidney deficiency syndromes are formulated with reference to the syndrome differentiation criteria for kidney yin deficiency and kidney yang deficiency in the "Guiding Principles for Clinical Research of New Chinese Medicines" (Trial) [9]. Main symptoms: soreness or cold pain in the waist and knees, listlessness or unresponsiveness or sluggish movement, forgetfulness, urinary incontinence or frequent urination, frequent nocturia or clear and long urination. Secondary symptoms: chills and cold limbs, five upset fever or hot flashes and night sweats, dizziness or blurred vision, hair loss and tooth shaking, tinnitus and deafness. Tongue pulse: Pale tongue, thin white fur or little or no fur, weak or deep thready or slow pulse. With 1 main symptom or more than 2 secondary symptoms, combined with the tongue and pulse, the syndrome can be differentiated as the original syndrome.
1.3 Inclusion criteria
①Patients who meet the diagnostic criteria of ischemic stroke in Western medicine; ②Patients who meet the diagnostic criteria of kidney deficiency syndrome in the recovery period of ischemic stroke in traditional Chinese medicine; ③The course of disease is 2 to 6 weeks after the onset; ④Age between 40 and 80 years old; Tested and signed informed consent.
1.4 Exclusion criteria
①Patients with cerebral infarction caused by tumors, trauma, blood diseases, etc.; ②Patients with severe mental illness; ③Pregnancy, lactating women or those who have a family plan in the near future; ④Patients with cognitive impairment, aphasia or who cannot clearly describe their own diseases; ⑤Those who are suspected or have a history of alcohol or drug abuse, or are not suitable for inclusion in the researcher's judgment.
1.5 Information collection
Information collection mainly includes the following aspects: ①Basic information of patients: name, gender, age, onset time, follow-up time, personal history, past history, etc.; ②Disease diagnosis: Chinese medicine diagnosis, Western medicine diagnosis, and judgment on inclusion and exclusion criteria; ③Collection of four diagnosis information: adopt "Ischemic Stroke Convalescence Stage Kidney Deficiency Syndrome Four Diagnosis Information Collection Form", involving 33 different items in total; ④ Kidney deficiency syndrome determination; ⑤ Other information.
Information collection includes the following 6 time points: 2 weeks from onset, 4 weeks from onset, 6 weeks from onset, 8 weeks from onset, 12 weeks from onset, and 14 weeks from onset. 4 rounds of information collection of the four diagnostics and clinical determination of kidney deficiency syndromes resulted in a total of 970 cases of completely collected data information.
1.6 Quality Control
It is required that the researchers of each center should be above the level of senior attending TCM physicians in the Department of Encephalopathy. Before the start of the study, the physicians involved in the diagnosis of TCM syndromes should be uniformly trained and the consistency test should be carried out to ensure the treatment of ischemic stroke with kidney deficiency in the recovery period. The investigation was conducted after the clinical judgments of the syndromes were relatively consistent (consistency > 85%); the sub-centers were monitored during the research to minimize the heterogeneity of the centers. The EDC system is used to double-enter the survey results to ensure the authenticity and reliability of the data.
1.7 Statistical methods
SPSS 17.0 software was used for statistical analysis of data, including cross-tabulation chi-square test and multiple Logistic regression, and P<0.05 was considered statistically significant. Taking whether the diagnosis of clinical syndrome is established or not as the dependent variable (1 = the syndrome of kidney deficiency is established, 0 = the syndrome of kidney deficiency is not established), and the variables with statistical significance in the χ2 test are introduced into the multivariate Logistic regression equation, and the forward step method is selected, and the maximum iteration is The number of times is 100, with P<0.05 as the detection level of the stepping variable, and P>0.10 as the detection level of the elimination variable; and the individual prediction value of the regression function is generated in SPSS, and the tangent point of the model is estimated and evaluated by the ROC curve diagnostic performance.
2 results
2.1 Univariate analysis of the four diagnosis information related to kidney deficiency syndrome in the convalescent stage of ischemic stroke
Univariate analysis showed that among the 33 factors of kidney deficiency syndrome in the recovery period of ischemic stroke, chills, cold extremities, dark complexion, flaccid limbs, spontaneous sweating, listlessness, slow movement, tinnitus, forgetfulness, five upset fever, Hot flashes, flushed cheekbones, night sweats, sore back, sore knees, soft waist, soft knees, cold waist, cold knees, urinary incontinence, short urination, frequent urination, frequent urination at night, clear and long urination, little or no coating, tongue 28 factors such as obesity, weak pulse, and deep thready pulse were correlated with the establishment of kidney deficiency syndrome in the recovery period of ischemic stroke (P<0.05). See Table 1.
2.2 Multivariate logistic regression analysis of the four diagnostic information related to kidney deficiency evidence during ischemic stroke recovery The 28 variables with P<0.05 in the univariate analysis were included in the multivariate logistic regression analysis, and the stepwise model was used. Results The results showed that after excluding the influence of confounding factors, zygomatic redness, lumbar soreness, frequent urination, amnesia, weak pulse, hot flashes, knee tenderness, five heart troubles, heat The 12 factors, including mental depression, lumbar coldness, clear and long urine, and sunken pulse, were correlated with the establishment of kidney deficiency evidence in the recovery period of ischemic stroke. (P<0.05). See Table 2.
2.3 Diagnostic modeling of kidney deficiency evidence in the recovery period of ischemic stroke
Based on the results of multivariate logistic regression, a diagnostic model of kidney deficiency in ischemic stroke recovery was constructed: P=1/[1 + Exp(11.223-2.002 × red cheek - 1.861 × lumbar soreness - 1.738 × frequent urination - 1.494 × forgetfulness - 1.469 × weak pulse - 1.361 × hot flashes - 1.297 × knee weakness - 1.181 × fever in the five hearts - 1.028 × mental depression - 0.742 × lumbar coldness - 0.722 × clear and long urination - 0.594 × sunken pulse)], where each item was a dichotomous variable (1=yes, 0=no), and formed an individual predictive value variable.
The individual predictive value variables were formed. The ROC curve was further constructed to determine the diagnostic efficacy of the model by combining the results of expert experience. Based on the ROC curve, the bound value of the highest point of the model Yuden index (0.766) was 0.001 3, and the area under the curve was 0.946, p < 0.001, suggesting that the predictive function model has high predictive value. At this point, the sensitivity of this diagnostic model was 90.5%, and the specificity was 85.4%.
Similarly the validated diagnostic agreement of this book was 84.1%. The predictive ROC curves of the diagnostic model for kidney deficiency evidence in the recovery period of ischemic stroke are shown in Figure 1.
3 Discussion
As the core of clinical diagnosis and treatment in TCM, how to achieve accurate and consistent identification of evidence is the key to clinical and scientific research in TCM. Ischemic stroke, as a major health problem, has long been the focus of TCM standardization work. After the completion of the national "8th Five-Year Plan" scientific and technological research project on the diagnosis of stroke and the publication of the "Diagnostic Criteria for Ischemic Stroke" in 1994 [10], our team developed the "Diagnostic Criteria for Ischemic Stroke" based on the information of 14,880 cases and the results of the collection of the symptoms, which consists of 6 subscales of wind, fire, phlegm, stasis, qi deficiency and yin deficiency. The Diagnostic Scale of Ischemic Stroke Symptom Elements [11] was developed based on the information collected from 14,880 cases and the results of symptom information collection.
Due to the complexity of multidimensional information, the diagnostic scale for ischemic stroke was developed by removing the categories of symptoms related to kidney deficiency such as yang deficiency and yin deficiency and hyperactivity based on clinical information. With the in-depth study of brain and kidney-related theories, the kidney-based treatment has gradually been emphasized in the prevention and improvement of sequelae of ischemic stroke, and the clinical and basic research on the evidence of kidney deficiency in the recovery period of ischemic stroke has been intensified [12], which has also generated the demand for quantitative identification of symptoms. To address this need, the present study was conducted on the basis of the development of the "Diagnostic Scale of Ischemic Stroke Evidence Elements", and a quantitative diagnosis model of renal deficiency evidence in ischemic stroke recovery was constructed by selecting a multivariate Logistic regression algorithm to filter and calculate the strength of the four clinical diagnostic information affecting the establishment of renal deficiency evidence. The algorithm is based on the magnitude of similarity between clinical samples to group patients with common symptom characteristics and is applicable to information where the dependent variable is a dichotomous variable [13-14].
In this study, we initially derived four diagnostic information related to kidney deficiency evidence in ischemic stroke recovery, including 12 items including zygomatic redness, lumbar soreness, frequent urination, amnesia, weak pulse, hot flashes, knee weakness, irritable heat in the five hearts, mental depression, lumbar coldness, clear and long urination, and sunken pulse, and gave the corresponding assigned parameters, of which zygomatic redness, lumbar soreness, frequent urination, and amnesia were the four most important items. The kidney is the organ of water and fire, the root of yin and yang, the master of bone and marrow, the brain and the two bowels, and its capital is the waist. If the kidney is deficient in yin and yang floats upward, then the cheek is red; if the kidney is deficient in essence and the waist is empty, then the waist is sore; if the kidney is not solid and cannot master water, then the urine is frequent; if the kidney marrow is not nourished and the brain is empty, then the mind is not functioning, then the memory is forgetful. These four symptoms reflect the characteristics of different aspects of kidney deficiency, such as kidney yin deficiency and yang hyperactivity, kidney essence deficiency, kidney qi deficiency, and kidney marrow deficiency, which are consistent with the evolution of the pathogenesis of ischemic stroke disease caused by kidney deficiency, including "yin deficiency and internal wind" and "essence deficiency and marrow damage" [15]. Clinical manifestations [15]. It was found that kidney deficiency is an important symptomatic element of cognitive impairment in the recovery period of ischemic stroke, and the method of tonifying the kidney and benefiting the marrow can effectively improve the patients' daily living ability and cognitive ability, which is beneficial to their prognosis [16-17]. Therefore, it is important to establish a diagnostic model for the evidence elements of kidney deficiency in ischemic stroke recovery, and to improve the objectivity and accuracy of evidence-based treatment to guide the clinical treatment of ischemic stroke recovery patients in Chinese medicine.
In this study, a quantitative diagnostic tool consisting of 12 easy-to-collect and easy-to-recognize clinical four diagnostic information was constructed by multivariate logistic regression modeling and ROC curve screening of boundary values.
The model constructed in this study has good diagnostic performance and can provide a reference tool for the identification of kidney deficiency evidence in the recovery period of ischemic stroke.
