冠状动脉粥样硬化性心脏病稳定期患者瘀毒舌象表征的研究

Characteristics of blood-activating and toxin-resolving tongue pictures of patients with stable coronary heart disease

目的探讨冠状动脉粥样硬化性心脏病（冠心病）稳定期患者“瘀毒”舌象表征及其预测心血管事件的价值。方法入选经冠状动脉造影确诊的处于症状稳定期的冠心病患者254例，采用统一型号数码相机记录舌象。选择1年随访中发生心血管事件者29例（事件组），以性别、年龄（±5岁）、糖尿病史、既往曾因急性冠状动脉综合征住院为匹配因素，按1：2比例匹配1年随访未发生心血管事件的患者54例（无事件组），比较2组舌象特点。结果无事件组和事件组青舌（含衬青舌和青紫舌）患者百分比分别为7．4％（4／54）和37．9％（11／29），差异有统计学意义（P〈0．05）；黄苔患者百分比分别为48．1％（26／54）和10．3％（3／29），差异有统计学意义（P〈0．05）；黏腻苔患者百分比分别为66．7％（36／54）和41．4％（12／29），差异有统计学意义（P〈0．05）；舌下脉紫红患者百分比分别为20．4％（11／54）和41．4％（12／29），差异有统计学意义（P〈0．05）。对青／青紫舌、舌下脉紫红、燥腻或垢腻苔进行随访心血管事件危险度分析，其随访发生心血管事件的比值比分别为11．67（95％ CI：3．34～40．81，P〈0．01）、2．76（95％CI：1．02～7．44，P〈0．05）和3．12（95％CI：0．89—10．92，P〉0．05）。结论冠心病患者舌色青、舌下脉色紫红为“瘀毒”的临床表征之一，舌苔由黏腻转为燥腻、垢腻可能是“化毒”的重要临床表征，可作为心血管事件的预测指标。

Objective To explore the tongue manifestations of blood stasis and toxin syndrome in patients of coronary heart disease （CHD） and its value of predicting acute cardiovascular events （ACEs）. Methods Totally 254 stable CHD patients diagnosed by coronary angiography were enrolled and the tongue appearances were recorded by digital camera of uniform type. ACEs occurred in 29 cases during one-year follow-up. Gender, age （ ± 5 years） , diabetes mellitus history and hospitalization history of acute coronary syndrome were observed. The tongue appearance in ACEs and control group was observed and compared. Results In ACEs and control group, the percentage of bluish tongue （including bluish-grounding or bluish purple tongue） was 7.4% （4/54） and 37.9% （11/29）,respectively （P=0.002） ; 48.1% （26/54） and 10.3% （3/29） showed yellow tongue coating （P=0.001） ; 66.7% （36/54） and 41.4% （12/29） showed sticky greasy tongue coating （P =0. 026） ; 20.4% （11/54） and 41.4% （12/29） showed purplish-red sublingual vessel （ P = 0.041 ）. Odd ratio （OR） analysis showed that patients with bluish tongue, purplish-red sublingual vessel, dry-greasy or dirty greasy coating were more likely to experience ACEs during one-year follow-up period （ OR 11.67, 95% CI： 3.34-40.81, P 〈 0.01 ; OR 2.76, 95% CI： 1.02-7.44, P 〈 0.05; OR 3.12, 95% CI： 0. 89-10.92, P 〉 0.05）. Conclusion The bluish tongue and purplish-red sublingual vessel are potential tongue manifestations of ＂blood-stasis and toxin＂, and the tongue coating changing from sticky greasy to dry greasy or dirty greasy is probably a tongue manifestation of ＂transforming toxin＂ in CHD patients.