不同血瘀证围绝经期女性冠心病患者相关临床特点研究

Clinical Characteristics of Peri- menopausal Female Coronary Heart Disease Patients with Different Blood Stasis Syndromes

背景围绝经期冠心病患者危险因素基本相同情况下,冠状动脉病变进展及心血管事件发生率有明显差别,因此亟待重新思考和认识围绝经期女性冠心病患者的临床特点。目的分析不同血瘀证围绝经期女性冠心病患者的相关临床特点。方法选取2014年5月—2016年5月就诊于首都医科大学附属北京安贞医院且符合纳入标准的冠心病患者320例为研究对象。根据其年龄、合并慢性病情况及血瘀证类型(气虚血瘀、痰浊血瘀、气滞血瘀、其他),分为观察1组、观察2组、观察3组、对照组,各80例。记录患者一般资料〔年龄、合并疾病情况(糖尿病、高脂血症、高血压)、冠状动脉病变支数〕、实验室检查指标〔丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总蛋白(TP)、清蛋白(Alb)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、空腹血糖(FBG)、C反应蛋白(CRP)、同型半胱氨酸(HCY)〕、辅助检查指标〔左心房内径、左心室舒张末期内径、室间隔厚度、左心室后壁厚度、左心室射血分数(LVEF)〕。结果观察1组、观察2组1支病变所占比例低于对照组,3支病变、3支病变+左冠状动脉主干病变所占比例高于对照组(P<0.05);观察3组3支病变所占比例低于观察1组、观察2组,2支病变所占比例高于观察2组(P<0.05)。观察1组TG、TC、HDL-C、FBG水平高于对照组(P<0.05);观察2组TG、TC、FBG水平高于对照组(P<0.05);观察3组TC水平低于对照组,FBG水平低于观察1组、观察2组(P<0.05)。各组患者左心房内径、左心室舒张末期内径、室间隔厚度、左心室后壁厚度、LVEF比较,差异均无统计学意义(P>0.05)。结论围绝经期女性气虚血瘀、痰浊血瘀冠心病患者较其他类型的冠心病患者冠状动脉病变程度更严重,可能与更严重的糖脂代谢紊乱有关;围绝经期女性气滞血瘀证冠心病患者情志不舒导致的血压波动是其发病的主要原因;应根据不同血瘀证围绝经期女性冠心病患者的临床特点在早期进行针对性的干预和治疗。

Backgroud In case of the risk factors of peri- menopausal women with coronary heart disease are basically same, there are significantly differences in the progress of coronary artery disease and incidence of cardiovascular events,the clinical features of peri- menopausal women with coronary heart disease need to be rethought. Objective To evaluate the clinical characteristics of peri- menopausal patients with coronary heart disease with different blood stasis syndromes. Methods 320 patients who were admitted to Beijing Anzhen Hospital,Capital Medical University during May 2014 to May 2016 and met the inclusion criteria, were selected as study subjects. According to patients＇ age, combined chronic diseases and type of blood stasis syndrome（ qi deficiency and blood stasis,phlegm and blood stasis,qi stagnation and blood stasis,other syndromes）,they were divided into observation 1 group,observation 2 group,observation 3 group,and control group, with 80 cases in each group. General information 〔 age, combined diseases（ diabetes, hyperlipidemia and hypertension）, coronary artery lesions 〕, laboratory examination indicators 〔alanine aminotransferase（ ALT）, aspartate aminotransferase（ AST）,total protein（ TP）,albumin（ Alb）,three- glycerol（ TG）,total cholesterol（ TC）,high density lipoprotein cholesterol（ HDL-C）, low density lipoprotein cholesterol（ LDL-C）, urea nitrogen（ BUN）, creatinine（ Cr）,uric acid（ UA）, fasting blood glucose（ FBG）, C reactive protein（ CRP）, homocysteine（ HCY） 〕, and auxiliary examination indicators 〔left atrial diameter, left ventricular end diastolic diameter, interventricular septum thickness, left ventricular posterior wall thickness, left ventricular ejection fraction（ LVEF） 〕 of patients were recorded. Results The proportion of one- vessel coronary artery lesions in observation 1 group and observation 2 group was significantly lower than that in control group,respectively,while the proportion of three- vessel coronary artery lesions,and the proportion of three- vessel coronary artery lesions ＋ left main coronary artery lesions were higher than those in control group（ P 〈0. 05）. The proportion of three- vessel coronary artery lesions in observation 3 group was lower than that in observation 1 group and observation 2 group,respectively,while the proportion of two- vessel coronary artery lesions in observation 3 group was higher than that in observation2 group（ P 〈0. 05）. The levels of TG,TC,HDL-C,and FBG in observation 1 group were significantly higher than those in control group（ P 〈0. 05）. The levels of TG,TC,and FBG in observation 2 group were significantly higher than those in control group（ P〈 0. 05）. The level of TC in observation 3 group was significantly lower than that in control group,while the level of FBG in observation 3 group was lower than that in observation 1 group and observation 2 group,respectively（ P 〈0. 05）. There was no statistically significant difference in left atrial diameter, left ventricular end diastolic diameter, ventricular septal thickness,left ventricular posterior wall thickness,and LVEF among the four groups（ P 〉0. 05）. Conclusion The severity of coronary artery disease among peri- menopausal women with coronary heart disease with qi deficiency and phlegm blood stasis syndromes is more severe than that among peri- menopausal women with coronary heart disease with other types,which may be related to more serious disorder of glycolipid metabolism. The fluctuation in blood pressure caused by emotional discomfort is the main cause of coronary heart disease attack among peri- menopausal women with coronary heart disease with qi stagnation and blood stasis syndrome. Targeted intervention and treatment based on clinical characteristics of blood stasis syndromes should be given in the early stage.