动脉粥样硬化性心脑血管疾病中医证候分布规律文献研究

Distribution of TCM patterns of atherosclerotic cardiovascular disease:review of the literature

目的探讨动脉粥样硬化性心脑血管疾病中医证型、证候要素的分布规律。方法通过中国知识资源总库(CNKI)、万方数据库、维普(VIP)数据库,获取数据库中近10年(2004年至2013年)与冠状动脉粥样硬化性心脏病(冠心病)和动脉粥样硬化性脑梗死(脑梗死)中医证候相关的文献全文,将原始资料数据量化处理后输入计算机,将每一个证候类型作为一条信息进行录入,从证型中提取证素,将数据导入SPSS 20.0统计软件,对证型及证候要素进行频数、频率的统计。总结冠心病和脑梗死的相同证候、不同证候,寻找由动脉粥样硬化引起的心脑血管疾病在中医证候方面的分布规律。结果检索到中医证候相关文献346篇,共64 810例病人,在所纳入的文献中,冠心病和脑梗死出现的相同证型为气虚血瘀证、痰瘀互结证、气虚证、血瘀证、痰浊阻滞证,通过卡方检验,它们在冠心病与脑梗死的分布上的显著差异具有统计学意义。在气虚血瘀证的分布中脑梗死所占的百分数大于冠心病所占的百分数(P<0.05),痰瘀互结证、气虚证、血瘀证和痰浊阻滞证的分布中冠心病所占百分数大于脑梗死(P<0.05)。相同证素为痰浊、血瘀、热(毒)、阳亢、气虚和阴虚,通过卡方检验,它们在冠心病与脑梗死的分布上的显著差异具有统计学意义。血瘀、气虚和阴虚的分布中冠心病所占百分数大于脑梗死(P<0.05),在痰浊、热(毒)和阳亢的分布中脑梗死所占百分数大于冠心病(P<0.05)。冠心病不同于脑梗死的证素为气滞、阳虚和寒凝;脑梗死不同于冠心病的证素为风证。结论动脉粥样硬化引起的心脏病与脑血管病证型及证素存在异同点,分析掌握其证候规律,对疾病异病同治有指导意义。

Objective To explore the distribution rules of TCM syndromes and pattern elements of atherosclerotic cardiovascular diseases.Methods After searching China National Knowledge Infrastruc-ture （CNKI）,Wanfang Data and VIP from 2004 to 2013,the literature of coronary atherosclerotic cardi-opathy （CAD）and atherothrombotic cerebral infarction （ATCI）linked to TCM patterns was obtained. From the literature,the raw data quantized were input into computer.Each pattern type was recorded, and from which syndrome elements were extracted.Then the frequency and rate of syndrome type and pattern elements were calculated using SPSS 20.0 Software.Results Altogether 346 articles were eligible and 64810 cases were included.The common syndrome types in both CAD and ATCI were qi deficiency and blood stasis,intermingling of phlegm and blood stasis,qi deficiency,blood stasis,obstruc-tion of phlegm-turbidity,and the common pattern elements were phlegm-turbidity,blood stasis,toxic heat,yang hyperactivity,qi deficiency and yin deficiency,but the distributions of syndrome types or pattern elements in CAD or ATCI were significantly different using Chi-square test.The rate of syndrome of qi deficiency and blood stasis in patients with ATCI was higher than those in patients with CAD （P 〈0.05）,while the rates of syndromes of intermingling of phlegm and blood stasis,qi deficiency,blood stasis,obstruction of phlegm-turbidity in patients with CAD were higher than those in patients with ATCI （P 〈0.05）.The rates of blood stasis,qi deficiency and yin deficiency in CAD were higher than those in ATCI（P 〈0.05 ）,and the rates of phlegm-tuibidity,toxic heat and yang hyperactivity in ATCI were higher than those in CAD （P 〈0.05 ）.The pattern elements of qi stagnation,yang deficiency and congealing of cold were only found in patients with CAD,while the pattern element of wind were only in ATCI.Conclusion The differences and similarities of distribution of syndrome types and pattern elements evolved in cardiac and cerebrovascular diseases due to atherosclerosis,can guide the treatment of different diseases with the same method.