PCI术后肝素诱导的血小板减少症Ⅰ型与Ⅱ型的中医证候特征及证候差异性研究

Study on syndrome characteristics and differences of heparin-induced thrombocytopenia typeⅠand typeⅡafter PCI surgery

目的比较PCI术后肝素诱导的血小板减少症(HIT)Ⅰ型与Ⅱ型的中医证候差异,探索差异产生的机制,为PCI术后HIT中医辨证论治提供证候学依据。方法连续纳入2012年10月—2018年3月在中国中医科学院望京医院胸痛中心行PCI术并符合纳入标准的冠心病患者,提取发生HIT患者的病历资料进行研究,分析HIT患者的中医证候分布规律及不同类型HIT患者的中医证候差异。结果1708例PCI术患者未发生HIT 1665例,发生HIT 43例。43例HIT患者中,Ⅰ型23例,Ⅱ型20例;辨证为气血两虚证17例,阳气虚衰证12例,气虚血瘀证5例,心肾阴虚证5例,气滞血瘀证2例,痰瘀互阻证1例,心血瘀阻证1例。HITⅠ型患者的证候分布以气血两虚证[65.2%(15/23)]占比最高,之后依次是气虚血瘀证[13.0%(3/23)]>气滞血瘀证[8.7%(2/23)]>心血瘀阻证[4.4%(1/23)]=痰瘀互阻证=心肾阴虚证,无寒凝血瘀证和阳气虚衰证;HITⅡ型患者的证候分布以阳气虚衰证[60.0%(12/20)]占比最高,之后依次是心肾阴虚证[20.0%(4/20)]>气血两虚证[10.0%(2/20)]=气虚血瘀证,无心血瘀阻证、气滞血瘀证、痰瘀互结证、寒凝血瘀证。HITⅠ型患者与Ⅱ型患者气血两虚证所占比[65.2%(15/23),10.0%(2/20)]和阳气虚衰证所占比[0,60.0%(12/20)]比较差异均有统计学意义(P均<0.05)。结论PCI术后HIT存在一定中医证候差异,HITⅠ型患者多为气血两虚证,HITⅡ型患者多为阳气虚衰证。

Objective It is to compare the differences in TCM syndromes between heparin-induced thrombocytopenia(HIT)typeⅠand HIT typeⅡafter PCI,explore the underlying mechanisms and provide syndrome evidence for the syndrome differentiation and treatment of this disease.Methods The patients with coronary heart disease who underwent PCI in the chest pain center of Wangjing Hospital of Chinese Academy of Chinese Medical Sciences and met the inclusion criteria were continuously enrolled from October 2012 to March 2018,the medical records of the patients with HIT were extracted for research,and analyzed the distribution of TCM syndromes of HIT and the differences in TCM syndromes of different types of HIT patients.Results Among 1708 patients underwent PCI,1665 patients did not had HIT,while 43 patients had in which there were 23 cases with typeⅠand 20 cases with typeⅡ.The result of distribution of TCM syndromes among 43 PCI postoperative HIT patients were:17 patients of Qi and blood deficiency syndrome,12 patients of Yang asthenia syndrome,5 patients of Qi deficiency and blood stasis syndrome,5 patients of heart and kidney Yin deficiency syndrome,2 patients of Qi stagnation and blood stasis syndrome,1 patient of phlegm and blood stasis syndrome;1 patient of heart blood stasis syndrome.Qi and blood deficiency syndrome[65.2%(15/23)]was the most prevalent syndrome among HIT typeⅠpatients,followed by Qi deficiency and blood stasis syndrome[13.0%(3/23)]>Qi stagnation and blood stasis syndrome[8.7%(2/23)]>heart blood stasis syndrome[4.4%(1/23)]=phlegm and blood syndrome=heart and kidney Yin deficiency syndrome,there was no cases of cold congeal and blood stasis syndrome and Yang asthenia syndrome.On the other hand,Yang asthenia syndrome[60.0%(12/20)]was the highest in the ratio of HIT typeⅡpatients’syndromes distribution,followed by heart and kidney Yin deficiency syndrome[20.0%(4/20)]>Qi and blood deficiency syndrome[10.0%(2/20)]=Qi deficiency and blood stasis syndrome,there was no cases with heart blood stasis syndrome,Qi stagnation and blood stasis syndrome,phlegm and blood stasis syndrome,cold congeal and blood stasis syndrome.There were significant differences in the proportion of Qi and blood deficiency syndrome[65.2%(15/23),10.0%(2/20)]and Yang asthenia syndrome[0,60.0%(12/20)]between HIT typeⅠpatients and HIT typeⅡpatients,respectively.Conclusion There were some differences in TCM syndromes of PCI postoperative HIT.Patients with HIT typeⅠmostly showed Qi and blood deficiency syndrome,while the majority of HIT typeⅡpatients showed Yang asthenia syndrome.