急性冠脉综合征中医证型与相关生化指标及冠脉造影结果的相关性研究

Correlation Study Among the TCM Syndrome of Acute Coronary Syndrome,Blood Biochemical Indexes and Coronary Angiography

目的:研究急性冠脉综合征(ACS)患者血浆高敏C反应蛋白(Hs-CRP)、纤维蛋白原(FIB)和D-二聚体(DDi)水平与中医辨证分型的关系及三指标之间的相关性,并观察冠脉造影结果与中医辨证分型的相关性。探索对ACS中医辨证分型具有一定意义的客观化、量化指标。方法:确诊为ACS患者152例,男123例,女29例,分为心血瘀阻、痰阻心脉、气阴两虚、气虚血瘀、阳气虚衰五组证型。冠脉病变程度以病变支数及狭窄程度表示,冠脉病变积分按Gensini积分计算。测定Hs-CRP、FIB和DDi。应用SPSS 17.0统计软件进行统计分析。结果:(1)冠脉病变支数及冠脉病变严重程度在各证型组中均无显著性差异(P>0.05)。(2)ACS发病类型在各证型组差异具有显著性(P=0.032)。(3)冠脉病变按Gensini积分,痰阻心脉证组>阳气虚衰证组>气虚血瘀证组>心血瘀阻证组>气阴两虚证组。Gensini积分在各证型组有显著性差异(P=0.045)。痰阻心脉证组明显增高,差异有显著性(P<0.05),余各证型组未见显著性差异(P>0.05)。且冠脉Gensini积分与冠脉病变支数具有相关性。(4)血脂(HDL-C、LDL-C、TC、TG)水平在各证型组均无显著性差异(P>0.05)。Hs-CRP水平在各证型组有显著性差异(P=0.036),而FIB、DDi在各证型组均无显著性差异(P>0.05)。(5)血脂、Hs-CRP、FIB、DDi在各冠脉病变支数组均无显著性差异(P>0.05)。(6)ACS患者Hs-CRP与DDi呈显著正相关关系(r=0.778,P=0.039),Hs-CRP和FIB、FIB和Ddi均无相关关系(P>0.05)。结论:(1)冠脉病变严重程度与中医辨证分型无明显相关性。ACS发病类型与中医证型有一定的相关性。(2)冠脉Gensini积分及Hs-CRP水平在ACS辨证分型中有一定的相关性,可作为ACS辨证分型参考依据。血脂、FIB、DDi与中医辨证分型无明显相关性。(3)血脂、Hs-CRP、FIB、DDi水平与ACS病变严重程度均无明显相关性。(4)Hs-CRP水平与DDi有显著的正相关关系,因而提示ACS发病过程复杂,涉及多个环节,DDi参与了ACS发病的过程。

Objective：To study the relationship between the three TCM Syndrome types and the Acute Coronary Syndrome（ACS）patients with high-sensitivity C-reactive protein（hs-CRP）,fibrinogen（FIB）and D-Dimer（DDi）in patients,and to discuss the objectivity,quantitative indicators of the Chinese Medicine Syndromes.Methods：Treatment group had 152 ACS patients,among them,male 123,female 29,age 40～87 years,based on clinical data classification.They were divided into blood stasis,phlegm stasis,Qi and Yin deficiency,Qi deficiency and blood stasis,Yang and Qi deficiency groups.The severity of coronary lesions depended on the lesion vessels and the coronary artery score by Gensini.SPSS17.0 was used for statistical analysis on Hs-CRP,FIB and DDi.Results：（1）The severity of coronary artery disease and the number of coronary vessel disease syndrome in the ACS syndrome group showed no significance（P〈0.05）.（2）The incidence of ACS in the syndrome group showed significance（P=0.032）.（3）According to the Gensini scores,in all types of coronary artery disease,phlegm stasis group Yang and Qi deficiency groupQi deficiency and blood stasis groupblood stasis groupQi and Yin deficiency group.The Gensini scores in each syndrome group showed significanctce（P=0.045）.Among them,the phlegm stasis group got the highest score and it showed significance（P〈0.05）,there was no significance in the other groups.（P〈0.05）.The number of coronary artery disease and the Gensini score were relevant.（4）The lipids（HDL-C,LDL-C,TC,TG）levels in all groups showed no significance（P〈0.05）.The difference of Hs-CRP level in all groups was significant（P=0.036）,while the FIB and DDi in all groups showed no significance（P〈0.05）.（5）Lipids,Hs-CRP,FIB,DDi array in the coronary vessel disease had no significant difference（P〈0.05）.（6）The Hs-CRP level in ACS patients showed positive correlation with DDi（r=0.778,P=0.039）,while the difference of Hs-CRP and FIB,or DDi and FIB shows no significant（P〈0.05）.Conclusion：（1）The relationship between the severity of coronary artery disease anf TCM Syndrome groups shows no correlation,the incidence of ACS and TCM Syndrome groups have a certain correlation.（2）The Gensini scores and the Hs-CRP level have a certain correlation in TCM Syndrome groups and these also can be used to distingwish TCM syndrome groups.Lipids,FIB and DDi with TCM syndrome differentiation are not related.（3）Lipids,Hs-CRP,FIB,DDi levels and the severity of ACS have no correlation.（4）Hs-CRP levels and DDi have positive correlation,it indicates that the pathogenesis of ACS is complicated,involving several aspects,DDi is involved in the pathogenesis of ACS.