冠心病不同发展阶段中医证演变规律研究

Study on the evolution rule of TCM syndromes in different development stages of coronary heart disease

目的:探索冠心病不同发展阶段中医证演变规律。方法:系统检索中国知识基础设施(CNKI)、中文科技期刊数据库(VIP)、万方数据资源系统、PubMed等数据库,纳入2017年至2018年有关冠心病辨证分型的文献,对其中冠心病不同发展阶段单元证的分布进行统计分析。结果:①最终纳入80篇目标文献,合计21 361例冠心病患者,涉及22个省、市、自治区,单元证频数统计前4位为血瘀(54.98%)、气虚(40.41%)、痰湿(浊)(36.44%)、阴虚(20.34%),呈血瘀>气虚>痰湿(浊)>阴虚>热蕴>气滞>阳虚>内毒>寒凝>水饮>血虚的趋势;②纵向比较结果显示,冠心病发展大致经历稳定期、活动期、介入术后期、终末(心衰)期,稳定期患者以痰湿(浊)、血瘀、气虚、阴虚为主;活动期热蕴、内毒比例升高;介入术后期除气滞比例升高外,总体由实转虚,即血瘀、热蕴、内毒比例较术前下降,气虚、阳虚比例明显升高;终末期以血瘀、水饮、痰湿(浊)、气虚、阴虚、阳虚为主要证候表现。结论:冠心病发生发展可能存在证的演变规律,即"痰""瘀""虚"贯穿始终,活动期"热""毒"加重,介入术后期总体由实转虚,终末期则血瘀、水饮及气阴两虚之象显著加重。

Objective:To explore the evolution rule of traditional Chinese medicine(TCM)syndrome in different development stages of coronary heart disease(CHD).Methods:The Chinese National Knowledge Infrastructure(CNKI),Chinese Scientific Journal Database(VIP),Wanfang Database and PubMed were systematically searched and included in the literature on syndrome differentiation and classification of CHD from 2017 to 2018,and the distribution of unit syndromes in different stages of CHD was statistically analyzed.Results:Eighty literatures covering 22 provinces,municipalities and autonomous regions,and 21 361 patients with CHD were included.The top four TCM unit syndromes in frequency were blood stasis(54.98%),qi deficiency(40.41%),phlegm dampness(36.44%)and yin deficiency(20.34%),showing the trend of blood stasis>qi deficiency>phlegm dampness>yin deficiency>heat>qi stagnation>yang deficiency>internal toxicity>cold coagulation>excessive fluid>blood deficiency.The results of longitudinal comparison showed that the development of CHD generally goes through stable stage,active stage,post-interventional stage and end-stage(heart failure),while phlegm dampness,blood stasis,qi deficiency and yin deficiency were the main syndromes in the stable stage of CHD.During the active stage,the proportion of heat and internal toxicity increased.After interventional therapy,the ratio of blood stasis,heat and internal toxicity decreased,but qi deficiency,yang deficiency and qi stagnation increased significantly.At the end stage,blood stasis,excessive fluid,phlegm dampness,qi deficiency,yin deficiency and yang deficiency were the main symptoms.Conclusion:TCM syndrome in different development stages of CHD may have a rule of evolution:Phlegm dampness,blood stasis and deficiency run through the whole process of CHD;heat and toxicity increased during the active period;after surgery intervention,syndromes changed from excessive to deficiency.Lastly,blood stasis,excessive fluid,qi deficiency and yin deficiency increase significantly at the end stage of CHD.