Abstract
The co-occurrence of rheumatoid arthritis (RA) and cerebral infarction is highly prevalent in clinical practice. While integrated traditional Chinese medicine (TCM) and Western medicine offers unique advantages in treatment, the objective indicators associated with TCM syndromes in this specific patient population remain unclear, hindering precise syndrome differentiation. This study, utilizing a screened cohort from 920 hospitalized patients with RA and cerebral infarction, aimed to address this research gap. Based on strict inclusion, exclusion, and elimination criteria, 142 patients were selected from the initial 920. The distribution of TCM syndromes and their associated influencing factors were analyzed using the Kolmogorov-Smirnov test, Brown-Forsythe ANOVA, the chi-square test, as well as both binary and multinomial logistic regression (employed complementarily to overcome the sample size limitations of less common syndromes). First, among the quantitative indicators, only hemoglobin (Hb) level showed significant differences between groups. The Hb level in the wind-cold obstruction syndrome was significantly higher than that in the dampness-heat obstruction syndrome (P = .007) and the phlegm-stasis obstruction syndrome (P = .029). Second, glucose-6-phosphate isomerase, anti-keratin antibody, and anti-cyclic citrullinated peptide IgG were significantly associated with TCM syndromes (P < .05). Specifically, they were identified as independent risk factors for dampness-heat obstruction syndrome (OR = 2.611, 2.218), while also serving as independent protective factors for liver-kidney deficiency syndrome relative to phlegm-stasis obstruction syndrome (OR = 0.294, 0.350). Within the studied population from East China, glucose-6-phosphate isomerase, anti-keratin antibody, anti-cyclic citrullinated peptide IgG, and Hb show associations with TCM syndrome differentiation in patients with RA complicated by cerebral infarction, particularly for the dominant damp-heat obstruction syndrome. The rigorous screening process enhances the reliability of the conclusions for the major syndromes studied, providing a preliminary evidence-based foundation for objective syndrome differentiation in this specific clinical context. Further multi-center studies with larger samples, especially of rare syndrome types, are needed to validate and generalize these findings.