急性冠状动脉综合征中医证候要素分析

Analysis on the TCM Syndrome Elements of Acute Coronary Syndrome

目的探讨急性冠状动脉综合征(ACS)中医证候要素的分布特点。方法收集经冠状动脉造影证实的ACS患者241例,根据其病史、症状、体征和相关实验室检查进行全球急性冠状动脉事件注册(GRACE)危险评分,并进行中医证候要素分类,使用多因子降维法(MDR)模型筛选出影响ACS预后的具有交互作用的中医证候要素,并且经Logistic回归分析验证。结果 241例ACS患者中血瘀证最为常见213例(88.4%),其次是气虚证、阴虚证、痰浊偏寒证、痰浊偏热证、阳虚证、气滞证;经GRACE危险分层,高危患者21例(8.7%),中低危患者220例(91.3%);应用MDR模型和Logistic回归分析得出Logistic回归方程为:logitP=-2.480+1.969(血瘀+痰浊偏寒+阳虚),发生不良预后危险的比数比例为7.167(OR=7.167,95%CI:1.583,32.441)。结论 ACS患者主要证候要素为血瘀和气虚,出现阳虚+血瘀+痰浊偏寒证的ACS患者较不出现的患者6个月内发生全因死亡事件可能性的百分比要高。

Objective To explore the distribution characteristics of TCM syndrome elements of acute coronary syndrome （ACS）. Methods We collect 241 ACS cases confirmed by coronary contrast examination. They were scored with the global registry of acute coronary events （GRACE） according to their medical history, symptoms and signs, and the related laboratory tests. After the TCM syndrome elements were classified, those having influence on the prognosis of ACS and interacting on each other were screened out by using multi-factors dimension reduction （MDR） models and verified with the Logistic regression analysis. Results Of the 241 ACS cases, the most common syndrome was blood stasis, which manifested in 213 cases （88.4%）. Those syndromes in the second place were qi deficiency, yin deficiency, phlegm turbidity with cold, phlegm turbidity with heat, yang deficiency, and qi stagnation. With the GRACE risk scoring, there were 21 cases （8.7%） of high-risk and 220 cases （91.3%） of medium-risk or low-risk. By using the MDR models and Logistic regression analysis, the Logistic regression equation was set up as logitP= - 2. 480＋1. 969 （blood stasis ＋ phlegm turbidity with cold ＋ yang deficiency）, and the rate of risk of poor prognosis was 7. 167 （OR=7. 167, 95%CI：1. 583,32. 441）. Conclusion The main syndrome elements of the ACS patients are blood stasis and qi deficiency, the occurrence of which is the highest in percentage. The accurence rate of all-cause death within 6 months is higher in those patients with the syndrome of yang deficiency ＋ blood stasis ＋ phlegm turbidity with cold than in those who were without the syndrome.