A diagnostic model for qi deficiency and blood stasis pattern in ischemic stroke recovery based on the theory of “observing the eyes to identify diseases”

To develop a nomogram diagnostic model for qi deficiency and blood stasis (QDBS) pattern during ischemic stroke recovery using bulbar conjunctival microcirculation parameters, based on the theory of “observing the eyes to identify diseases,” to guide clinical pattern differentiation.

From February 10, 2021 to December 7, 2023, 180 patients with QDBS pattern during ischemic stroke recovery were enrolled at the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, along with 180 healthy Shenyang residents as controls. Bulbar conjunctival microcirculation data were collected from both groups using a Zhonglian (ZL)104-type microcirculation detector. Least absolute shrinkage and selection operator regression combined with multivariable logistic regression was applied to identify bulbar conjunctival microcirculation indicators associated with the pattern, and a nomogram diagnostic model was constructed. Model discrimination and calibration were assessed using receiver operating characteristic curves and calibration curves, respectively, and clinical utility was evaluated using decision curve analysis.

Least absolute shrinkage and selection operator regression combined with multivariable logistic regression identified blurred vessels (odds ratio [OR] = 3.98), dark red or dark purplish blood color (OR = 3.00), arteriovenous shunt branches (OR = 9.95), microaneurysms (OR = 2.66), and ischemic areas (OR = 2.98) as risk factors for QDBS during ischemic stroke recovery, whereas arteriolar diameter (OR = 0.72), venular diameter (OR = 0.71), and microvessel number (OR = 0.75) were protective factors. The nomogram diagnostic model based on these factors achieved an area under the curve of 0.942. The calibration curve closely approximated the ideal curve, and decision curve analysis indicated favorable clinical applicability and net benefit.

Based on the theory of “observing the eyes to identify diseases,” bulbar conjunctival microcirculation examination provides an objective assessment of white eye collaterals. The diagnostic model for QDBS during ischemic stroke recovery may assist in the auxiliary diagnosis of clinical stroke patterns.