冠心病中医证型与冠脉狭窄程度、心脏相关指数及血脂水平的相关性研究

Study on the correlation between TCM Syndromes of coronary heart disease and the stenosis degree of coronary artery,cardiac correlation index and blood lipid level

目的探讨冠心病(CHD)中医证型与冠脉狭窄程度、心脏相关指数及血脂的相关性,为CHD的辨证提供客观化的参考依据。方法将206例CHD患者依据《中药新药临床研究指导原则(试行)》辨证为心血瘀阻证、气虚血瘀证、气滞血瘀证、痰阻心脉证、阴寒凝滞证、气阴两虚证、心肾阴虚证及阳气虚衰证8种证型,并对患者进行冠脉造影和心脏彩超、血脂检查,比较不同证型患者一般资料[年龄、性别、体质量指数(BMI)、病程及冠脉狭窄程度]、冠脉狭窄程度积分法(Gensini法)积分、心脏相关指数[心脏指数(CI)、左室质量指数(LVMI)]及血脂[甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)]。结果 206例CHD患者证型人数分布为痰阻心脉证>气虚血瘀证>心血瘀阻证>气滞血瘀证>气阴两虚证>阳气虚衰证>心肾阴虚证>阴寒凝滞证。阳气虚衰证CHD患者年龄高于其他7种证型(P<0.05),气阴两虚证CHD患者年龄高于气虚血瘀证患者(P<0.05);痰阻心脉证患者BMI高于其他7种证型(P<0.05),阳气虚衰证、气阴两虚证患者BMI高于心血瘀阻证、气虚血瘀证、气滞血瘀证、阴寒凝滞证、心肾阴虚证(P<0.05);8种证型CHD患者病程之间存在显著差异(P<0.05),病程较长的前3个证型分别为阳气虚衰证、心肾阴虚证、气阴两虚证(P<0.05);8种证型CHD患者冠脉狭窄程度比较差异无统计学意义(P>0.05)。痰阻心脉证CHD患者Gensini积分显著高于其他7种证型(P<0.05);气阴两虚证和阳气虚衰证CI低于其他6种证型(P<0.05),LVMI高于其他6种证型(P<0.05);痰阻心脉证LVMI高于心血瘀阻证、气虚血瘀证、气滞血瘀证(P<0.05),心肾阴虚证高于心血瘀阻证、气虚血瘀证(P<0.05),阴寒凝滞证高于心血瘀阻证(P<0.05)。痰阻心脉证CHD患者TC、TG、LDL-C水平显著高于其他7种证型(P<0.05);阳气虚衰证HDL-C水平低于心血瘀阻证、气虚血瘀证、气滞血瘀证、痰阻心脉证、气阴两虚证、心肾阴虚证(P<0.05),但是与阴寒凝滞证比较无明显差异(P>0.05)。结论 CHD中医证型与Gensini积分、CI、LVMI、TC、TG、LDL-C、HDL-C具有显著相关性,结合患者年龄、病程和BMI,可作为CHD中医辨证分型辅助诊断的客观指标。

Objective To explore the correlation between traditional Chinses medicine( TCM) syndromes of coronary heart disease( CHD) and the stenosis degree of coronary artery,cardiac related index and blood lipids,and to provide an objective reference for the syndrome differentiation of CHD. Methods The syndrome differentiation of 205 CHD patients were cardiac blood stasis syndrome,qi deficiency – blood stasis syndrome,qi stagnation-blood stasis syndrome,phlegm blocking heart vessel syndrome,yin and cold stagnation syndrome,qi-yin deficiency syndrome,yin deficiency syndrome of heart and kidney,yang deficiency syndrome according to "Guidelines for clinical research on new drugs of traditional Chinese medicine( trial) ". All patients were recevied the detection of coronary angiography,echocardiography and lipids. The general data of patients with different syndromes including age,gender,body mass index( BMI),course of disease and stenosis degree of coronary artery,and the integral method of stenosis degree of coronary artery( Gensini method),the cardiac correlation indexes including cardica index( CI),left ventricular mass index( LVMI),and serum lipids including triglyceride( TG),total cholesterol( TC),high density lipoprotein cholesterol( HDL-C) and lipoprotein cholesterol( LDL-C) were compared. Results The number of syndrome distribution of 206 CHD patients were phlegm blocking heart vessel > qi deficiency – blood stasis > cardiac blood stasis > qi stagnation-blood stasis > qi-yin deficiency > yang deficiency > yin deficiency of heart and kidney >yin and cold stagnation The age of CHD patients with yang deficiency syndrome was higher than that of the other seven syndromes( P < 0. 05). The age of CHD patients with qi-yin deficiency syndrome were older than that of qi deficiency-blood stasis syndrome( P < 0. 05). The BMI in patients with phlegm-damp heart syndrome was higher than those in the other 7 syndromes( P < 0. 05). The BMI in patients with yang deficiency syndrome and qi-yin deficiency syndrome were higher than those in patients with cardiac blood stasis syndrome,qi deficiency-blood stasis syndrome,qi stagnation-blood stasis syndrome,yin and cold stagnation syndrome and yin deficiency syndrome of heart and kidney( P < 0. 05). There were significant differences on the course of CHD among the 8 syndromes( P <0. 05),the first three syndromes of higher age were yang deficiency syndrome,yin deficiency syndrome of heart and kidney and qi-yin deficiency syndrome( P < 0. 05). There was no significant difference on the stenosis degree of coronary artery among the 8 syndromes( P > 0. 05). The Gensini score of CHD patients with phlegm blocking heart vessel was significantly higher than the other 7 syndromes( P < 0. 05). The CI of CHD patients with qi-yin deficiency syndrome and yang deficiency syndrome was lower than that of the other 6 syndromes( P < 0. 05),and the LVMI was higher( P < 0. 05). The LVMI of phlegm blocking heart vessel syndrome was higher than that of cardiac blood stasis syndrome,qi deficiency – blood stasis syndrome and qi stagnation-blood stasis syndrome( P < 0. 05),and the LVMI of yin deficiency syndrome of heart and kidney was higher than cardiac blood stasis syndrome and qi deficiency– blood stasis syndrome( P < 0. 05),and the LVMI of yin and cold stagnation syndrome was higher than cardiac blood stasis syndrome( P < 0. 05). The TC,TG,LDL-C of CHD patients with phlegm blocking heart vessel syndrome were significantly higher than the other 7 syndromes( P < 0. 05). The LDL-C of yang deficiency syndrome was lower that cardiac blood stasis syndrome,qi deficiency – blood stasis syndrome,qi stagnation-blood stasis syndrome,phlegm blocking heart vessel syndrome,qi-yin deficiency syndrome,yin deficiency syndrome of heart and kidney,yang deficiency syndrome( P < 0. 05),but there was no significantly difference on LDL-C between the yang deficiency syndrome and yin and cold stagnation syndrome( P > 0. 05). Conclusion There was a significant correlation between TCM syndrome of CHD and Gensini score,CI,LVMI,TC,TG,LDL-C and HDL-C,TCM syndrome of CHD combine with patient's age,course of disease and BMI can be used as an auxiliary diagnosis of objective indicators.