急性ST段抬高型心肌梗死不同形态的机制及中医证型分布规律探讨

Mechanism of St-Elevation Acute Myocardial Infarction in Different Forms and Distribution of Its Traditional Chinese Medicine Syndrome Types

【目的】探讨急性心肌梗死ST段抬高不同形态的机制及其中医证型分布规律。【方法】将2015年3月~2017年1月确诊为急性ST段抬高型心肌梗死的212例住院患者,根据ST段抬高形态分为凹面抬高组102例和弓背抬高组110例,分析不同ST段抬高形态的中医证型分布及中医实证、虚证和虚实夹杂证分布情况。【结果】(1)急性心肌梗死ST段弓背抬高组患者多为青中年、男性、无或有短期冠心病病史及冠状动脉造影提示狭窄或闭塞血管无侧支循环者;而ST段凹面抬高组患者多为老年人、女性、有冠心病史及冠状动脉造影提示多有侧支循环者。(2)凹面抬高组的中医证型以气虚血瘀证为最多,其证型分布依次为:气虚血瘀证>气阴两虚证>热毒血瘀证>痰瘀互阻证>寒凝心脉证。弓背抬高组的中医证型以热毒血瘀证为最多,其证型分布依次为:热毒血瘀证>气虚血瘀证>气阴两虚证>寒凝心脉证>痰瘀互阻证。2组中医证型分布比较,差异有统计学意义(P<0.01)。(3)在中医虚实证方面,凹面抬高组患者以虚实夹杂证为主,而弓背抬高组患者以实证为主。2组虚实证分布比较,差异有统计学意义(P<0.01)。【结论】不同形态ST段抬高型心肌梗死患者存在不同的中医证型分布规律,为中西医结合临床研究急性心肌梗死提供了新的视角,对不同形态ST段抬高型心肌梗死的辨证论治提供了参考,对提高临床诊治效率、挽救生命、改善预后等有着重要的意义。

Objective To study the mechanism of different forms of ST- segment elevation in acute myocardial infarction（AMI）, and to investigate the distribution of its traditional Chinese medicine （TCM）syndrome types. Methods Two hundred and twelve hospitalized AMI patients with ST-segment elevation from March of 2015 to July of 2017 were divided into group A and group B. Group A had 102 cases with the elevation of concavity of ST- segment, and group B had 110 cases with the elevation of arch of ST-segment. The correlation of ST- segment elevation in different forms with TCM syndrome types was analyzed. Results （ 1 ） Patients of group B were usually male, young and middle-aged, with or without short-term medical history of coronary heart disease, and coronary angiography results indicated the stenosis or occlusion of the vessels without collateral circulation. Patients in group A were usually female, aged, with medical history of coronary heart disease, and coronary angiography results indicated the existence of collateral circulation. （2） Group A was dominated by Qi-deficiency and blood-stasis syndrome, and the frequency of its syndrome types was in decreasing sequence ： Qi-deficiency and blood-stasis syndrome, Qi-yin deficiency syndrome, heat-toxicity and blood-stasis syndrome, phlegm blended with blood- stasis syndrome, syndrome of cold stagnation in heart vessels. Group B was dominated by heat-toxicity and blood- stasis syndrome, and the frequency of its syndrome types was in decreasing sequence： heat-toxicity and blood- stasis syndrome, Qi-deficiency and blood-stasis syndrome, Qi-yin deficiency syndrome, syndrome of cold stagnation in heart vessels, phlegm blended with blood-stasis syndrome. The difference of the distribution of syndrome types was significant between the two groups （P 〈 0.01）. （3） In respect of the differentiation of deficiency and excess syndromes, group A was dominated by deficiency interweaved with excess syndrome, while group B was dominated by excess syndrome. The difference of the distribution of deficiency and excess syndrome was significant between the two groups （P 〈 0.01）. Conclusion AMI patients with different forms of ST- segment elevation have different TCM syndrome types. The investigation results will provide a new vision for the clinical trial of AMI treated with Chinese medicine integrated with western medicine, and will supply evidence for the syndrome differentiation and treatment of AMI patients with different forms of ST- segment elevation, which will contribute to enhancing clinical efficacy, saving life and improving prognosis.