基于聚类分析的冠心病心绞痛中医证候特点研究

Study on the characteristics of TCM syndrome of angina pectoris of coronary heart disease based on cluster analysis

目的探索冠心病心绞痛的证候特点和规律,为该病的中医辨证分型规范化、标准化提供依据。方法制定《冠心病心绞痛中医病因病机证候规律调查表》,纳入2014年1月—2016年12月在陕西中医药大学第二附属医院心血管内科和陕西中医药大学附属医院心内三科住院并经冠脉造影确诊为冠心病心绞痛患者471例,采用横断面调查方法,收集患者中医四诊信息,选取频数>10%的条目,应用描述性分析及系统聚类法对冠心病心绞痛患者的证候特点进行分析研究。结果471例冠心病心绞痛患者的常见症状/体征为胸闷、气短、心悸、失眠、胸痛、头晕、乏力、神疲、心烦,出现频率在60%以上;患者舌质多见淡白舌,其次是紫暗舌;舌面多有瘀点和舌下络脉瘀滞;从苔质上看,以薄苔多见,其次是厚、腻,苔色多见白苔。脉象频次依次是脉细、脉沉、脉弦、脉滑、脉涩、脉数。聚类分析结果显示,冠心病心绞痛基本中医证候可大致分为热毒蕴结证、肝郁阴虚证、痰湿阻滞证、瘀血阻络证、阳气虚证、心肾气虚证6类。结论应用聚类分析方法研究冠心病心绞痛基本中医证候,不仅可为冠心病的中医证候分类提供数据支撑,也可为中医药规范化、标准化研究提供参考。

Objective It is to explore the characteristics and rules of TCM syndromes of angina pectoris of coronary heart disease,and to provide evidence for the standardization of TCM syndrome differentiation of this disease.Methods A“Questionnaire of TCM etiology and pathogenesis of coronary heart disease and angina pectoris”was developed.A total of 471 patients with angina pectoris who were hospitalized and diagnosed by coronary angiography in the Vasculocardiology Deparment of the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine and the Third Vasculocardiology Deparment Department of Shaanxi University of Traditional Chinese Medicine from January 2014 to December 2016 were included.A cross-sectional investigation method was used to collect the four diagnostic information of TCM of the patients.The items with a frequency of more than 10%were selected.Descriptive analysis and systematic clustering were applied to study and analyze the characteristics of syndromes of patients with angina pectoris of coronary heart disease.Results The common symptoms/signs of 471 patients with angina pectoris of coronary heart disease were chest tightness,shortness of breath,palpitations,insomnia,chest pain,dizziness,fatigue,upset,and the frequency of occurrence was above 60%.The pale tongue was more common in patients,followed by purple dark tongue;stasis points on the tongue surface and stagnation of the sublingual veins were common;from the coated tongue of view,thin coated tongue was more common,followed by thick and greasy coated tongue,white coated tongue was common.The pulse frequency was as follows:thin pulse,deep pulse,string pulse,slippery pulse,unsmooth pulse,rapid pulse.The results of cluster analysis show that the basic TCM syndromes of coronary heart disease and angina pectoris could be roughly divided into 6 types:syndromes of heat poisoning,liver stagnation and yin deficiency,phlegm dampness syndrome,stasis and blood clotting syndrome,yang deficiency syndrome,and heart and kidney qi deficiency syndrome 6 class.Conclusion The application of cluster analysis can not only provide data support for the classification of TCM syndromes of coronary heart disease,but also provide a reference for the standardization of traditional Chinese medicine in the study on the basic TCM syndromes of coronary heart disease and angina pectoris.