胸痹和不稳定型心绞痛中医证型与冠状动脉造影的相关性研究

Correlation between Anginal TCM Syndrome Types and Coronary Angiography

目的研究胸痹和不稳定型心绞痛各个中医证型与冠状动脉病变部位、病变程度之间的关系。方法对126例胸痹病人进行中医辨证分型和冠状动脉造影检查,行冠状动脉造影确诊其是否为不稳定型心绞痛,分析胸痹和不稳定型心绞痛不同中医证型与冠状动脉病变的相关性。结果经冠状动脉造影确诊为不稳定型心绞痛者105例,冠状动脉造影正常者21例。冠状动脉多支病变病例以痰阻心脉证与血瘀证比例显著高于其他各证型(P<0.05);冠状动脉正常的病例中,气滞血瘀证占38.10%,高于其他证型;不稳定型心绞痛病人8个证型间冠状动脉病变程度有统计学意义(P<0.001);各证型Gensini积分分值阴寒凝滞证>心血瘀阻证>阳气虚衰证>痰阻心脉证>气阴两虚证>气虚血瘀证>心肾阴虚证>气滞血瘀证。结论不稳定型心绞痛的中医证型以痰阻心脉证和心血瘀阻证最为常见。冠状动脉正常的胸痹病人,多见于气滞血瘀证;不稳定型心绞痛的冠状动脉多支病变多见于为血瘀证、痰浊证。不稳定型心绞痛中,标实方面,阴寒凝滞证冠状动脉狭窄程度最重,气滞血瘀证冠状动脉狭窄程度最轻,提示其中医病理变化依气滞→血瘀→痰浊次序由轻到重发展,标实证由滞到瘀,继而蕴久化浊;本虚方面,以阴虚→气虚→气阴两虚→阳虚顺序,冠状动脉病变程度逐渐加重,本虚证由阴虚、气虚逐渐耗伤阳气而向阳虚发展。

Objective To analyze the relationship between coronary angiography （CAG） and anginal TCM syndrome type in patients （pts） with chest Bi- syndrome and unstable angina pectoris（UAP）. Methods One hundred and twenty - six patients （pts） with chest stuffiness and pain were studied accordingto the theories of TCM and CAG, CAG was examined in 105 pts. Results Among 126 pts with chest Bi- syndrome and pains, there were 105 pts with UAP and 21 with normal CAG. There was 26.67% of pts with retention of turbid and 65.72% of pts with stagnation of blood and retention of turbid. There were more pts with multi- branches lesion in pts with retention of turbid and blood - stasis syndrome than that in other groups （P〈0. 05）. It was 38. 10% in pts with Qi - stagnation and blood - stasis syndrome and it was significantly more than that in other groups in pts with normal CAG. The Gensini score of CAG in the group of Yin -cold stagnation syndrome was the highest, and it was the least in group of Qi -stagnation and blood -stasis syndrome. Conclusion The type of retention of turbid and stagnation of blood in the heart were most common in UAP. Pts with multi - branches lesion in the retention of turbid and blood - stasis syndrome were more than that in Qi - stagnation group. The most serious damage of the artery coronary was found in group of Yin - cold stagnation syndrome. The results suggested that coronary damage was due to Qi - stagnation, blood - stasis and phlegm - turbid.