DOI QR코드

DOI QR Code

Development of Standardized Predictive Models for Traditional Korean Medical Diagnostic Pattern Identification in Stroke Subjects: A Hospital-based Multi-center Trial

  • Jung, Woo-Sang (Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University) ;
  • Cho, Seung-Yeon (Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University) ;
  • Park, Seong-Uk (Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University) ;
  • Moon, Sang-Kwan (Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University) ;
  • Park, Jung-Mi (Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University) ;
  • Ko, Chang-Nam (Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University) ;
  • Cho, Ki-Ho (Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University) ;
  • Kwon, Seungwon (Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University)
  • Received : 2019.10.26
  • Accepted : 2019.11.22
  • Published : 2019.12.01

Abstract

Objectives: To develop a standardized diagnostic pattern identification equation for stroke patients, our group conducted a study to derive the predictive logistic equations. However, the sample size was relatively small. In the current study, we aimed to derive new predictive logistic equations for each diagnostic pattern using an expanded number of subjects. Methods: This study was a hospital-based multi-center trial recruited stroke patients within 30 days of symptom onset. Patients' general information, and the variables related to diagnostic pattern identification were measured. The diagnostic pattern of each patient was identified independently by two Korean Medicine Doctors. To derive a predictive model for pattern identification, binary logistic regression analysis was applied. Results: Among the 1,251 patients, 385 patients (30.8%) had the Fire Heat Pattern, 460 patients (36.8%) the Phlegm Dampness Pattern, 212 patients (16.9%) the Qi Deficiency Pattern, and 194 patients (15.5%) the Yin Deficiency Pattern. After the regression analysis, the predictive logistic equations for each pattern were determined. Conclusion: The predictive equations for Fire Heat, Phlegm Dampness, Qi Deficiency, and Yin Deficiency would be useful to determine individual stroke patients' pattern identification in the clinical setting. However, further studies using objective measurements are necessary to validate these data.

Keywords

References

  1. Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet. 2008;371(9624):1612-1623. https://doi.org/10.1016/S0140-6736(08)60694-7
  2. Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet. 2012;379(9834):2364-2372. https://doi.org/10.1016/S0140-6736(12)60738-7
  3. DeMers G, Meurer WJ, Shih R, Rosenbaum S, Vilke GM.. Tissue plasminogen activator and stroke: review of the literature for the clinician. J Emerg Med. 2012;43(6):1149-54. https://doi.org/10.1016/j.jemermed.2012.05.005
  4. ESPS Group. European Stroke Prevention Study. Stroke. 1990;21(8):1122-1130. https://doi.org/10.1161/01.str.21.8.1122
  5. Gong S, Lin C, Zhang D, Kong X, Chen J, Wang C, et al. Effects of Intensive Blood Pressure Reduction on Acute Intracerebral Hemorrhage: A Systematic Review and Meta-analysis. Neurology. Sci Rep. 2017 Sep 6;7(1):10694.
  6. Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032-2060. https://doi.org/10.1161/STR.0000000000000069
  7. Kim JS, Yoon SS. Perspectives of stroke in persons living in Seoul, South Korea: a survey of 1000 subjects. Stroke. 1997;28(6):1165-1169. https://doi.org/10.1161/01.str.28.6.1165
  8. Jung WS, Choi DJ, Cho KH, Lee KS, Moon SK, Kim YS, et al. Safety and efficacy assessment of chungpyesagan-tang for acute ischemic stroke. Am J Chin Med. 2003;31(2):181-190. https://doi.org/10.1142/S0192415X03000898
  9. Park SU, Jung WS, Moon SK, Ko CN, Cho KH, Kim YS, et al. Chunghyul-dan (Qingxie-dan) improves arterial stiffness in patients with increased baPWV. Am J Chin Med. 2006;34(4):553-563. https://doi.org/10.1142/S0192415X06004090
  10. Yun SP, Jung WS, Park SU, Moon SK, Ko CN, Cho KH, et al. Anti-hypertensive effect of chunghyul-dan (qingxue-dan) on stroke patients with essential hypertension. Am J Chin Med. 2005;33(3):357-364. https://doi.org/10.1142/S0192415X05002977
  11. Cho K, Noh K, Jung W, Park S, Moon S, Park J, et al. A preliminary study on the inhibitory effect of Chunghyul-dan on stroke recurrence in patients with small vessel disease. Neurol Res. 2008;30(6):655-658. https://doi.org/10.1179/174313208X305382
  12. Jung WS, Kwon S, Cho SY, Park SU, Moon SK, Park JM, et al. The Effects of Chunghyul-Dan (A Korean Medicine Herbal Complex) on Cardiovascular and Cerebrovascular Diseases: A Narrative Review. Evid Based Complement Alternat Med. 2016;2016:2601740.
  13. Moon SK, Whang YK, Park SU, Ko CN, Kim YS, Bae HS, et al. Antispastic effect of electroacupuncture and moxibustion in stroke patients. Am J Chin Med. 2003;31(3):467-474. https://doi.org/10.1142/S0192415X03001077
  14. Kim YS, Hong JW, Na BJ, Park SU, Jung WS, Moon SK, et al. The effect of low versus high frequency electrical acupoint stimulation on motor recovery after ischemic stroke by motor evoked potentials study. Am J Chin Med. 2008;36(1):45-54. https://doi.org/10.1142/S0192415X08005576
  15. Goto H, Satoh N, Hayashi Y, Hikiami H, Nagata Y, Obi R, et al. A chinese herbal medicine, tokishakuyakusan, reduces the worsening of impairments and independence after stroke: a 1-year randomized, controlled trial. Evid Based Complement Alternat Med. 2011;2011:194046.
  16. Venketasubramanian N, Young SH, Tay SS, Umapathi T, Lao AY, Gan HH, et al. CHInese Medicine NeuroAiD Efficacy on Stroke Recovery - Extension Study (CHIMES-E): A Multicenter Study of Long-Term Efficacy. Cerebrovasc Dis. 2015;39(5-6):309-318. https://doi.org/10.1159/000382082
  17. Jung W, Kwon S, Park S, Moon S. Can combination therapy of conventional and oriental medicine improve poststroke aphasia? Comparative, observational, pragmatic study. Evid Based Complement Alternat Med. 2012;2012:654604.
  18. Seo YR, Jung WS, Park SU, Moon SK, Park JM, Park JY.. The effect of ouhyul herbal acupuncture point injections on shoulder pain after stroke. Evid Based Complement Alternat Med. 2013;2013:504686.
  19. Wu HZ, Fang ZQ, Cheng PJ. Introduction to Diagnosis in Traditional Chinese Medicine. World Century Publishing Corporation, Hackensack, NJ, USA, 2013;69.
  20. Terasawa K, Shinoda H, Imadaya A, Tosa H, Bandoh M, Satoh N. The presentation of diagnostic criteria for Oketsu syndrome. Japanese. Kampo Med. 1983;34(1):1-17. https://doi.org/10.3937/kampomed.34.1
  21. State Administration of Traditional Chinese Medicine of the People's Republic of China. A standard diagnosis for stroke in TCM. J Beijing University Trad Chin Med. 1994;17:64-66.
  22. Kim SK, Park YB. Development of questionnaires for cold-heat patternization. J Korean Inst Oriental Med Diag. 2003;7(1):64-75.
  23. Yang DH, Park YJ, Park YB, Lee SC. Development of questionnaires for blood stasis pattern. J Korean Inst Oriental Med Diag. 2006;10(1):141-152.
  24. Bae NS, Yang DH, Park YJ, Park YB, Lee SC, Oh HS. Development of questionnaires for Yol patternization. J Korean Inst Oriental Med Diag. 2006(1);10:98-108.
  25. Park JS, Yang DH, Kim MY, Lee SC, Park YJ, Park YB. Development of questionnaire for Damum patternization. J Korean Inst Oriental Med Diag. 2006;10(1):64-77.
  26. Lee JA, Park TY, Lee J, Moon TW, Choi J, Kang BK, et al. Developing indicators of pattern identification in patients with stroke using traditional Korean medicine. BMC Res Notes. 2012;5:136. https://doi.org/10.1186/1756-0500-5-136
  27. Okitsu R, Iwasaki K, Monma Y, Takayama S, Kaneko S, Shen G, et al. Development of a questionnaire for the diagnosis of Qi stagnation. Complement Ther Med. 2012;20(4): 207-217. https://doi.org/10.1016/j.ctim.2011.12.005
  28. Kim JK, Seol IC, Lee I, Jo HK, Yu BC, Choi SM. Report on the Korean standard differentiation of the symptoms and signs for the stroke-1. Korean J Oriental Physiology & Pathology. 2006;20(1):229-234.
  29. Go HY, Kim YK, Kang BK, Kim BY, Ko MM, Kang KW, et al. Report on the Korean standard differentiation of the symptoms and signs for the stroke-2. Korean J Oriental Physiology & Pathology. 2006;20(6):1789-1791.
  30. Lee JA, Lee JS, Kang BK, Ko MM, Mun TU, Cho KH, et al. Report on the Korean Standard Pattern Identifications for Stroke-III. Korean J Orient Int Med. 2011;32(2):232-242.
  31. Kim HJ, Bae HS, Park SU, Moon SK, Park JM, Jung WS. Clinical approach to the standardization of oriental medical diagnostic pattern identification in stroke patients. Evid Based Complement Alternat Med. 2011;2011.
  32. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35-41. https://doi.org/10.1161/01.str.24.1.35
  33. Gordon DL, Bendixen BH, Adams HP Jr, Clarke W, Kappelle LJ, Woolson RF. Interphysician agreement in the diagnosis of subtypes of acute ischemic stroke: implications for clinical trials. The TOAST Investigators. Neurology. 1993;43(5):1021-1027. https://doi.org/10.1212/WNL.43.5.1021
  34. WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region. WHO Western Pacific Regional Office, 2007.
  35. Lee MG, Kang BK, Kim BY, Ko HY, Choi SM, Seol IC, et al. Improvement of tentative Korean standard differentiation of the symptoms and signs for stroke for clinical application. Korean J Oriental Physiology & Pathology. 2007;21(1):347-351.
  36. Ko SG, Jun CY, Park JH, Han CH, Ko HY, Yoon Y, et al. Development of CRF and SOPs for the identification of risk factors of the cerebrovascular diseases in the east and west medicine. J Korean Oriental Med. 2006;27(1):204-219.
  37. Lee JS, Kim SY, Kang BK, Ko MM, Kim JC, Oh DS, et al. A Review of Static Blood Pattern in Stroke Pattern Diagnosis. Korean J Orient Int Med. 2009;30(4):813-820.

Cited by

  1. A Systematic Review and Meta-Analysis of the Effects of Herbal Medicine Buyang Huanwu Tang in Patients with Poststroke Fatigue vol.2021, 2019, https://doi.org/10.1155/2021/4835488
  2. An Analysis of Characteristics of Post-Stroke Fatigue in Patients without Depression: A Retrospective Chart Review vol.11, pp.12, 2019, https://doi.org/10.3390/brainsci11121642