The Relationship between Stroke Risk Factors, Stroke Subtypes and Diagnostic Pattern in Korean Medicine of Acute Stroke - Multi Center Trials

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서론

2000 7 65

7%

.

, 2005

10 64.3

1)

2)

.

급성기 중풍 환자들의 위험요인 및 중풍유형과 변증분형의 관련성 연구

신애숙, 이인환, 곽자영, 조승연, 박성욱, 박정미, 고창남, 조기호, 배형섭

경희대학교 한의과대학 심계내과학교실

The Relationship between Stroke Risk Factors, Stroke Subtypes and Diagnostic Pattern in Korean Medicine of Acute Stroke - Multi Center Trials

Ae-Sook Shin, In-Whan Lee, Ja-Young Gwak, Seung-Yeon Cho, Seong-Uk Park, Jung-Mi Park, Chang-Nam Ko, Ki-Ho Cho, Hyung-Sup Bae

Department of Cardiocascular & Neurologic Disease(Stroke center), College of Oriental medicine, Kyung-Hee University, Seoul, Korea

Objectives : This study was conducted as part of the national project to standardize stroke diagnosis in Korean medicine. In this study, we assessed what categories of stroke diagnosis these three most common risk factors of cerebro-vascular attack(CVA), hypertension(HTN), diabetes mellitus(DM) and hyperlipidemia(HL) fall into. Also we looked into stroke subtypes and its diagnosis in Korean medicine.

Methods : 806 patients with acute stroke from 5 universities(Kyung-Hee University oriental medical center, Kyung-Hee University East-West Neo Medical Center, Kyungwon university Incheon oriental medical center, Kyungwon university Songpa oriental medical center and DongGuk university Ilsan oriental medical center) across the country were involved from April, 2007 til August, 2008. We had data of 482 patients to be analyzed and diagnosed by a Korean medicine training doctor and a professor.

Results : All three major stroke risk factors were diagnosed as being dampness-phlegm pattern, but no significant difference was observed except in hyperlipidemia patients. Stroke subtypes such as hemorrhage and infarction showed no significant difference in this study.

Conclusions : This study provides evidence that hyperlipidemia can be diagnosed as dampness-phlegm by Korean medicine. Further studies with various subtypes of stroke patients are required to prove solid evidence with other stroke risk factors.

Key Words : Stroke Risk Factors, Stroke subtypes, Diagnostic Pattern

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연구방법

1. 연구대상자의 선정

2007 4 2008 3

, ,

(Brain-CT) (Brain MR)

4 806

482 .

,

.

, .

(Transient ischemic attack, TIA)

(ICH)

(SAH), (SDH),

(EDH)

2. 임상연구 증례기록지와 표준 작업 지침서 및 임상시험 심사위원회

‘

’

(Informed concent) . (

) (Case Report Form)

(Standard Operating Procedures, SOP)

⁹⁾

. ,

(Institutional Review Board,

IRB) .

3. 변증평가

(CRF)

1 1

. 16 ,

, , , ,

, , , , , , , , ,

, , , , , .

4. 진단기준

.

Left Ventricular Hypertrophy

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(LVH) Joint National Committee

(JNC) 7

¹⁰⁾

140/90mmHg

, 2

,

.

1997 American Diabetes Association

(ADA)

¹¹⁾

(Fasting

blood sugar: FBS)>126mg/dl, 2

(2 hours postprandial plasma glucose level: PP2)

>200mg/dl, HbA1c>7.0%

. National Cholesterol Education Program

(NECP)

¹²⁾

(total cholesterol:

T-chol)>240mg/dl

(low density lipoprotein-cholesterol: LDL-chol)

>160mg/dl (triglyceride: TG)>200 mg/dl

.

5. 분류기준

Brain CT Brain MRI ischemic stroke hemorrhagic stroke

. Design of the Trial of Org 10172 in Acute Stroke Treatment( TOAST)

¹³⁾

Large Artery Atherosclerosis( LAA), Cardioe- mbolism( CE), Small Vessel Occlusion( SVO), Stroke of Other determined Etiology( SOE), Stroke of Undetermined Etiology( SUE)

.

6. 통계 분석

SPSS(Statistical Program for Social Science) 13.0K for Windows

. Mean±SD Number(%)

, Student T-test,

Chi-square test . P value

0.05 .

연구결과

1. 중풍변증분형과 환자의 인구학적 특성

482

Frequency(%) 100(20.7) 210(43.6) 10(2.1) 110(22.8) 52(10.8)

sex male(%) 77(77) 105(50) 6(60) 46(41.8) 22(42.3)

female(%) 23(23) 105(50) 4(40) 64(58.2) 30(57.7)

Age(yrs) 64.7±11.08 68.26±36.02 72.5±10.47 65.47±12.87 65.69±14.70

Height(cm) 163.13±8.18 161.22±8.24 158.7±12.86 158.39±7.70 155.85±24.13 Weight(kg) 64.47±9.81 64.36±10.59 58.42±12.51 57.30±9.17 56.65±10.60

Stroke Hrr.(%) 15(15.5) 18(33.3) 1(10) 13(12.5) 7(14)

Inf.(%) 82(84.5) 190(91.3) 9(90) 91(87.5) 43(86)

NIHSS 4.13±4.10 3.33±3.80 3.70±3.65 4.13±4.56 3.8±3.14

Family Hx.of CVA(%) 36(37.1) 67(32.2) 2(20) 33(30.3) 12(23.1)

Religion(%) 51(52) 133(64.3) 5(50) 71(65.7) 30(57.7)

Smoking(%) 38(38.4) 39(18.7) 0(0) 20(18.5) 13(25.0)

Drinking(%) 44(44.4) 50(24) 2(20.0) 24(22.0) 17(32.7)

Depression(%) 2(2) 3(1.4) 0(0) 3(2.8) 2(3.8)

Migraine(%) 5(5.1) 4(1.9) 0(0) 8(7.4) 7(13.5)

Values are Mean±SD or number(%)

Hrr, hemorrhage; Inf, infarction; NIHSS, National Institutes of Health Stroke Scale; CVA, cerebrovascular attack

Table 1. General characteristics of study participants

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210 (43.6%)

, 10 (2.1%) .

5 ( )

, , , , , NIHSS,

, , , , ,

(%) . (Table 1.)

2. 의학적 특성상 위험요인에 따른 중풍의 변증

346 158 (45.7%) 74 (21.4%)

. .

149 77 (51.7%)

. P=0.02 71

(52.6%) . (Table 2.)

3. 중풍 유형에 따른 변증

(Table 3.) 415

54 , (

) 10 .

. (Table 3.)

HTN DM HL

HTN Non-HTN DM Non-DM HL Non-HL

(N=100) 69(19.9) 31(22.8) 31(20.8) 69(20.7) 23(17) 77(22.2)

(N=210) 158(45.7) 52(38.2) 77(51.7) 133(39.9) 71(52.6)^* 139(40.1)

(N=10) 7(2) 3(2.2) 3(2) 7(2.1) 0(0) 10(2.9)

(N=110) 74(21.4) 36(26.5) 26(17.4) 84(25.2) 27(20) 83(23.9)

(N=52) 38(11) 14(10.3) 12(8.1) 40(12.0) 14(10.4) 38(11)

Total 346(100) 136(100) 149(100%) 333(100) 135(100%) 347(100)

Values are Number(%)

*

P < 0.05 by Chi-square test

Table 2. Stroke risk factors and 5 diagnostic classifications

Hrr.(N=54) Inf.(N=415)

Clinical manifestation of stroke(N=10) ICH(N=52) SAH(N=2) LAA (N=70) CE (N=36) SVO (N=299)

(n=100) 15(28.8) 0(0) 13(18.6) 5(13.9) 63(21.1) 3(30)

(n=208) 18(34.6) 0(0) 37(52.9) 16(44.4) 135(45.2) 0(0)

(n=10) 1(1.9) 0(0) 1(1.4) 0(0) 6(2.0) 0(0)

(n=109) 12(23.1) 1(50) 13(18.6) 9(25.0) 65(21.7) 5(50)

(n=52) 6(11.5) 1(50) 6(8.6) 6(16.7) 30(10.0) 2(20)

Hrr, hemorrhage; Inf, infarction; ICH, Intra Cerebral Hemorrhage; SAH, Subarachnoid Hemorrhage; LAA, Large Artery Atherosclerosis; CE, Cardiac Embolism; SVO, Small Vessel Occlusion; SOE, Stroke of other determined etiology; SUE, Stroke of Undetermined etiology SOE(N=5), SUE(N=3) was NOT calculated due to the small number of subjects.

Table 3. Stroke subtypes and 5 diagnostic classifications

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고찰 및 결론

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