冠心病经皮冠状动脉介入术后氯吡格雷抵抗及阿司匹林抵抗患者中医舌诊临床观察

Clinical Research of Chinese Medical Tongue Diagnosis in Coronary Heart Disease Patients with Clopidogrel Resistance or Aspirin Resistance after PCI

目的探讨中医舌诊在冠心病患者经皮冠状动脉介入术(PCI)后发生氯吡格雷抵抗(CR)及阿司匹林抵抗(AR)的诊断参考价值。方法共102例冠心病PCI术后患者完成观察,其中AR 1例,CR 37例,将37例CR患者作为CR组,64例未发生AR和CR的患者作为对照组,比较两组患者的临床资料、实验室检查指标、病变血管分布及支架植入情况的差异,寻找CR的独立危险因素。运用中医舌诊分析CR患者舌色、舌体形质、舌下络脉、舌苔色、舌苔质的特征,并将舌色按淡红、淡白、红绛、青紫分为4级,舌下络脉按瘀滞程度由正常至严重分为4级,分析CR组与对照组舌诊特征的差异。最后运用ROC曲线下面积分析中医舌诊指标单独或与其他指标联合应用诊断冠心病PCI术后患者发生CR的可靠性。结果高血压病史(OR=3.115,95%CI:1.201~8.077)、较低水平的纤维蛋白原浓度(OR=1.919,95%CI:1.081~3.408)是冠心病PCI术后患者发生CR的独立危险因素。与对照组比较,CR组患者舌色分级水平较高(P<0.05),舌下络脉分级水平亦较高(P<0.01)。ROC曲线下面积分析提示舌下络脉分级(AUC=0.679)、舌色分级(AUC=0.613)诊断冠心病PCI术后发生CR具有一定的准确性,联合舌下络脉分级、舌色分级、高血压病史、纤维蛋白原四个指标诊断冠心病PCI术后患者发生CR具有较好的准确性(AUC=0.766)。结论中医舌诊对冠心病患者PCI术后发生CR具有较好的准确性和临床应用价值。

Objective To evaluate the accuracy and reference value of Chinese medical tongue diagnosis in coronary heart disease（CHD）patients with clopidogrel resistance（CR）or aspirin resistance（AR）after percutaneous coronary intervention（PCI）.Methods Totally 102 CHD patients after PCI were classified into AR group（1 cases）,CR group（37 casess）and control group（64 casess）according to the presence of AR or CR.Then,the clinical data,laboratory examination,the distribution of lesion coronaries between CR group and control group were compared to explore the independent risk factors of CR in CHD patients after PCI.Next,colors of tongue changed from pink,pale,crimson into cyanosis were classified from grade 0,1,2 to 3,and sublingual vein changed from grade 0,1,2 to 3 with the bloodstream stagnation worsen.Analysis of the characteristics of tongue color,tongue texture,sublingual vein,color and feature of tongue coating were carried out between CR group and control group.Finally,ROC curve analysis was used to evaluate the accuracy of diagnosing CR by Chinese medical tongue diagnosis.ResultsThe history of hypertension（OR=3.115,95% CI：1.201-8.077）and low level fibrinogen（OR=1.919,95% CI：1.081-3.408）were independent risk factors of CR in CHD patients after PCI.Compared with the control group,higher level of tongue color classification（P〈0.05）and sublingual venation grade（P〈0.01）were observed in CR group.Both tongue color classification（AUC=0.613）and sublingual venation grade（AUC=0.679）were diagnostic parameter for clopidogrel resistance in CHD patients after PCI.The diagnostic power was increased after combining the two parameters and further improved after combining the two parameters with the history of hypertension and fibrinogen（AUC=0.766）.Conclusion Chinese medical tongue diagnosis has been proved to be accurate and reliability in CHD patients with CR after PCI.