血瘀证及其兼证与冠脉造影所示病变及介入治疗后再狭窄的相关性研究

Study on Correlation of Blood-stasis Syndrome and Its Accompanied Syndromes with Pathological Changes Showed in Coronary Angiography and Restenosis after Percutaneous Coronary Intervention

目的探讨血瘀证及其兼证与冠脉造影所示病变及介入治疗后再狭窄的相关性。方法335例冠心病介入治疗成功的患者,随机分为治疗组(给予活血中药芎芍胶囊治疗)和安慰剂对照组,疗程6个月。术前及术后6个月各进行1次血瘀证计分评价,术后6个月进行冠脉造影随访。对血瘀证及其兼证与术前冠脉造影所见病变类型及复杂程度进行相关性分析,并采用Logistic多元逐步回归方法分析冠脉造影随访再狭窄患者的影响因素。结果冠脉造影资料完整患者334例,308例(91．9％)患者完成本研究,其中147例进行了冠脉造影随访。血瘀证计分与术前冠脉造影所示冠脉病变最重狭窄程度和病变计分均明显相关(P<0．01),且随着年龄增长和病程增加,血瘀证与冠脉病变狭窄及复杂程度的相关性逐渐增加。在兼症中,阳虚辨证与病变复杂程度和冠脉狭窄程度明显相关,痰浊辨证与病变钙化与否有一定相关性。治疗前后血瘀证计分差值治疗组明显大于对照组(P<0．01)。Logistic多元逐步回归分析结果表明,随访时血瘀证计分总分与术后心绞痛复发是冠脉造影所示再狭窄与否的重要影响因素。各种兼证有无及各兼证之间再狭窄率比较差异无显著性。结论血瘀证与冠脉病变复杂程度有一定相关性,合并阳虚者病变较重;血瘀程度轻重是再狭窄发生与否的重要影响因素,与合并兼证类型无明显相关。

Objective To investigate the correlation of blood-stasis syndrome （BSS） and its accompanied syndromes with pathological changes showed in coronary angiography and restenosis after percutaneous coronary intervention （PCI）. Methods A total of 335 coronary heart disease patients after successful PCI were randomized into the treated group treated with Xiongshao Capsule （XC） and the control group treated with placebo for 6 months. BSS score was evaluated before and 6 months after PCI, and coronary angiography was followed up 6 months after the operation to perform the correlation analysis on BSS and its accompanied syndromes with types and complexity of coronary lesion, and the Logistic multivariate stepwise regression analysis （LMSRA） on the influencing factors of restenosis. Results There were 334 cases with complete angiographic data, of which 308 cases （91.9 % ） finished the study, and among them 147 cases received a follow-up with angiography. Correlation analysis showed that the BSS score was significantly correlated to the maximal stenosis degree and coronary lesion score demonstrated by coronary angiography before PCI （P 〈 0.01）, and the correlation was accentuated along with the increasing of the patients＇ age and the course of disease. Among the accompanied syndromes, the yang-deficiency syndrome was significantly correlated to the complexity of coronary lesions and the degree of stenosis, while the turbidphlegm syndrome was correlated with calcification of the lesions. The difference of BSS score before and after treatment in the treated group was significantly higher than that in the control group. LMSRA showed that the recurrence of angina and BSS score were the important influencing factors on the occurrence of coronary restenosis after PCI. The incidence of restenosis was not correlated to the accompanied syndromes, and also showed no significant difference among patients with different syndrome types. Conclusion There is a certain correlation between BSS and the complexity of coronary lesions. The lesion is more severe in patients accompanied with yang-deficiency syndrome. The severity of BSS was an important influencing factor on the occurrence of restenosis after PCI, but no significant correlation was found between the occurrence and the type of accompanied syndromes.