基于聚类分析的稳定型与不稳定型心绞痛证候特点及差异性研究

Study of the Pattern Characteristics and Diversity of Stable and Unstable Angina Pectoris Based on Cluster Analysis

目的采用聚类分析探讨稳定型心绞痛与不稳定型心绞痛的中医证候特点及差异性。方法于2009年2月～2010年6月对山东省7家省、市级中医医院的2029例冠心病心绞痛患者填写临床信息采集表,运用聚类分析研究不同类型心绞痛的中医证候特点及其之间的差异性。结果 (1)气虚、血瘀是冠心病心绞痛的最重要的证候要素,不稳定型心绞痛组中舌质暗红或瘀斑、舌底脉络迂曲的构成比均高于稳定型心绞痛组,经χ2检验,差异有统计学意义(P<0.01);而稳定型心绞痛组中体力劳动、气短、心慌、腰膝酸软、休息的构成比均高于不稳定型心绞痛组,经χ2检验,差异有统计学意义(P<0.01);(2)稳定型与不稳定型心绞痛组中含有气虚证素覆盖病例分别为84.0%、53.2%,含有血瘀证素为84.3%、100%,含有痰浊证素为22.8%、11.8%,含有肝气郁滞或肝气不舒证素为16.0%、27.6%,含有阳虚证素为14.8%、29.9%,寒凝致病只有在不稳定型心绞痛组体现。结论稳定型心绞痛多气虚等本虚表现,不稳定型心绞痛多血瘀、气滞、寒凝、阳虚等实邪为患。

Objective To explore the pattern characteristics of Chinese medicine and diversity of stable angina pectoris and unstable angina pectoris with cluster analysis. Methods From February 2009 to June 2010 ,for the clinical information form filled up by 2029 patients with coronary angina pectoris in seven provincelevel and municipal Chinese medicine hospitals in Shandong, with cluster analysis, the pattern characteristics of Chinese medicine and their diversity were studied for angina pectoris of different types. Re- suits （1）Qi deficiency and blood stagnation were the most important pattern factors for coronary angina pectoris, in the group of unstable angina pectoris, the constituent ration of dark red or ecchymotic tongue and the curved vein at the tongue bottom was higher than that in the group of stable angina pectoris. With X2 test, the difference was significant statistically in comparison（P 〈 0.01 ）. The constituent ration of physical labor, shortness of breath ,palpitation, soreness and weakness of lumbar region and knees and resting in the group of stable angina pectoris was higher than that in the group of unstable angina peetoris. With x2 test, the difference was significant statistically in comparison （P 〈 0.01 ）. （2）Separately, in the group of stable angina pectoris and the group of unstable angina pectoris, the factor coverage of qi deficiency pattern was 84.0% and 53.2% ,that of blood stagnation pattern was 84.3% and 100%, that of phlegm pattern was 22.8% and 11.8% ,that of liver qi stagnation pattern was 16.0% and 27.6% and that of yang deficiency pattern was 14.8% and 29.9%. Cold stagnation pattern was only involved in unstable angina pectoris. Conclusion Stable angina pectoris is mainly manifested as qi deficiency, in which the root cause of disease is deficiency. Unstable angina pectoris is mainly manifested as blood stagnation, qi stagnation, cold stagnation and yang deficiency, in which the pathogenic factors are excess.