冠心病伴微量白蛋白尿患者冠状动脉病变特点及与中医证型的相关性

The Pathological changes in the Coronary Arteries and Its Correlations with Traditional Chinese Medicine Pattens in Patients of Coronary Heart Disease with Microalbuminuria

目的探讨并比较冠心病伴微量白蛋白尿患者与单纯冠心病患者的冠状动脉病变程度及中医证型分布特征。方法纳入冠心病伴微量白蛋白尿患者90例(观察组)、单纯冠心病患者78例(对照组),采集全部患者证候表现并辨证分为心血瘀阻证、气滞血瘀证、痰阻心脉证、气虚血瘀证、阴寒凝滞证、心肾阴虚证、气阴两虚证、阳气虚衰证8个证型,采用冠状动脉造影确定两组患者冠状动脉病变支数,采用Gensini积分对冠状动脉狭窄程度进行量化积分及分级,并对冠心病伴微量白蛋白尿患者与中医证型的相关性进行Logistic回归分析。结果观察组患者冠状动脉狭窄支数以双支和多支病变为主,狭窄程度分级以Ⅳ级为主,中医证型以心血瘀阻证、气滞血瘀证、气虚血瘀证、痰阻心脉证居多;对照组患者冠状动脉狭窄支数以单支和双支病变为主,狭窄程度分级以Ⅲ级为主,中医证型以心血瘀阻证、痰阻心脉证、阳气虚衰证、气虚血瘀证居多,两组比较差异均有统计学意义(P<0.01)。观察组患者Gensini积分高于对照组(P<0.01),观察组单一证型和兼夹证型患者Gensini积分均高于对照组(P<0.01)。Logistic回归分析结果显示,冠心病伴微量白蛋白尿患者冠状动脉病变与心血瘀阻证、气滞血瘀证、痰阻心脉证、气虚血瘀证关系密切(P<0.01)。结论单纯冠心病患者中医证型以心血瘀阻证、痰阻心脉证、阳气虚衰证居多,冠心病伴微量白蛋白尿患者则与心血瘀阻证、气滞血瘀证、痰阻心脉证和气虚血瘀证关系密切,其冠状动脉病变程度较单纯冠心病患者更为严重。

Objective To explore and compare the pathological changes in the coronary arteries as well as the distribution of traditional Chinese medicine(TCM)pattens in coronary heart disease(CHD)patients with or without microalbuminuria.Methods Ninety CHD patients with microalbuminuria were included in the observation group,while 78 patients with only CHD were included in control group.The TCM pattens of all the patients were collected and classified into eight types,including heart blood stasis obstruction patten,qi stagnation and blood stasis patten,phlegm obstructing heart vessel patten,qi deficiency and blood stasis patten,yin and cold coagulation and stagnation patten,heart-kidney yin deficiency patten,both qi and yin deficiency patten,and yang decline and qi deficiency patten.Coronary angiography was used to measure the number of the coronary lesions.Gensini score was used to quantitatively assess and grade the degree of the coronary artery stenosis.Logistic regression analysis was performed to calculate the correlation between TCM pattens and pathological changes in coronary arteries.Results In the observation group,double-vessel and multiple-vessel stenosis were most commonly seen of the coronary lesions,and the degree of stenosis was mainly gradeⅣ.The most frequent TCM pattens were heart blood stasis obstruction patten,qi stagnation and blood stasis patten,qi deficiency and blood stasis patten,and phlegm obstructing heart vessel patten.In the control group,the stenosis was mainly involved with single and double vessels,and degree of stenosis was mainly at gradeⅢ.The TCM pattens were principally distributed in heart blood stasis obstruction patten,phlegm obstructing heart vessel patten,yang decline and qi deficiency patten,and qi deficiency and blood stasis patten.The comparison between groups were statistically significant(P<0.01).The Gensini score of the observation group was significantly higher than that of control group(P<0.01);the results kept consistency in favor of the observation group when analyzing patients with single TCM patten and combined pattens separately(P<0.01).Logistic regression analysis showed that the pathological changes in coronary arteries were correlated with heart blood stasis obstruction patten,qi stagnation and blood stasis patten,phlegm obstructing heart vessel patten,and qi deficiency and blood stasis patten in patients with CHD and microalbuminuria(P<0.01).Conclusion Patients with only CHD are mainly manifested as heart blood stasis obstruction patten,phlegm obstructing heart vessel patten,and yang decline and qi deficiency patten,while CHD patients with microalbuminuria are mostly related with heart blood stasis obstruction patten,qi stagnation and blood stasis patten,phlegm obstructing heart vessel patten,and qi deficiency and blood stasis patten.And the pathological changes in coronary arteries are more severe in CHD patients with microalbuminuria than without microalbuminuria.