Study on the Relationship between TCM Syndrome Types and Neurovascular Unit Injury and Prognosis in Patients with Acute Ischemic Stroke

ZHANG Leilei; CHANG Xiang; MA Jingying; HU Yangxue; HOU Yaqing; MA Wangran; FENG Xiangrui; YANG Lin

doi:10.12102/j.issn.1672-1349.2025.13.018

Abstract：Objective: To explore the distribution of TCM syndrome types in patients with acute ischemic stroke (AIS), and their relationship with neurovascular unit (NVU) injury and prognosis of AIS, to clarify the relationship between TCM syndrome types and AIS from a microscopic syndrome differentiation perspective. Methods: A total of 130 patients with AIS who visited the Department of Cerebrovascular Diseases at Xi'an Traditional Chinese Medicine Hospital from June 2021 to June 2023 were selected as the study subjects. TCM syndrome types were determined based on four diagnostic methods. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the degree of neurological deficits at admission, 7 days, 14 days, and 3 months. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of biological markers of NVU injury in serum [vascular endothelial growth factor A (VEGF-A), occludin, intercellular adhesion molecule-1 (ICAM-1), aquaporin-4 (AQP4), interleukin-1β (IL-1β), tumor necrosis factor α (TNF-α), interleukin-10 (IL-10), interleukin-4 (IL-4)]. The modified Rankin Scale (mRS) was used to assess the clinical prognosis. The relationship between different TCM syndrome types and NVU injury and prognosis was explored. Results: Among the 130 AIS patients, the male-to-female ratio was 1.55:1.00. The main TCM syndrome types were as follows: wind-phlegm stasis syndrome (43.08%), qi deficiency and blood stasis syndrome (29.23%), phlegm-heat internal excess syndrome (13.08%), wind-fire disturbance syndrome (8.46%), and yin deficiency with wind movement syndrome (6.15%). Wind-phlegm stasis syndrome was most common in males (45.57%), while qi deficiency and blood stasis syndrome was most common in females (43.15%). The differences in NIHSS scores between admission and 7 days, 14 days after admission were significantly higher in patients with wind-fire disturbance syndrome compared to other syndrome types (P < 0.05). Serum levels of VEGF-A, occludin, ICAM-1, and AQP4 in patients with wind-phlegm stasis syndrome were significantly different from those in patients with phlegm-heat internal excess syndrome and yin deficiency with wind movement syndrome (P < 0.05). In patients with qi deficiency and blood stasis syndrome, serum levels of VEGF-A and ICAM-1 were significantly different from those in patients with yin deficiency with wind movement syndrome, while occludin and AQP4 levels were significantly different from those in patients with phlegm-heat internal excess syndrome and yin deficiency with wind movement syndrome (P < 0.05). Serum levels of IL-1β, TNF-α, and IL-4 in patients with wind-fire disturbance syndrome and phlegm-heat internal excess syndrome were significantly different from those in patients with qi deficiency and blood stasis syndrome and yin deficiency with wind movement syndrome (P < 0.05). The prognosis of patients with wind-fire disturbance syndrome and phlegm-heat internal excess syndrome was better than that of other syndrome types (P < 0.05). Conclusion: Wind-phlegm stasis syndrome is the most common TCM syndrome type in AIS. There are significant differences in the improvement of neurological function among different syndrome types in the early stage, but no significant differences in the recovery stage. Syndrome types dominated by exogenous pathogens show better recovery of neurological function and short-term prognosis compared to syndrome types dominated by endogenous deficiencies, suggesting that serum biomarkers of NVU injury may provide a quantifiable reference for TCM syndrome differentiation in AIS.