11383例健康人群及冠心病不同阶段患者痰瘀互结证分布规律的多中心横断面研究

Distribution of Phlegm and Stasis Binding Pattern in Healthy Subjects and All Stages of Coronary Heart Disease: A Multi-centered, Cross-sectional Study of 11383 Cases

目的探讨冠心病不同阶段患者痰瘀互结证分布规律。方法运用临床流行病学横断面调查方法,将全国6个地区48家临床研究中心的11383例健康人群及冠心病不同阶段患者分为健康对照组、低危人群组、代谢综合征组、冠心病稳定期组、急性冠脉综合征组、介入治疗围手术期组、冠心病心力衰竭组6组,参照《冠心病痰瘀互结证宏观诊断标准》对6组人群痰瘀互结证的分布规律进行描述,并对证的量化评分进行分析。结果 1)痰湿证分布(占比)与量化评分(95%置信区间)呈现健康对照组(27.7%,3.4~3.8分)、低危人群组(43.3%,5.0~5.4分)、代谢综合征组(65.1%,7.4~7.9分)、冠心病稳定期组(75.1%,9.0~9.3分)、急性冠脉综合征组(78.5%,9.3~10.0分)、冠心病心力衰竭组(78.6%,9.5~10.2分)依次增高趋势。2)血瘀证分布与量化评分呈现健康对照组(6.8%,1.0~1.3分)、低危人群组(16.0%,2.2~2.4分)、代谢综合征组(21.9%,2.9~3.3分)、冠心病稳定期组(63.5%,7.9~8.3分)、冠心病心力衰竭组(69.2%,8.8~9.5分)、急性冠脉综合征组(78.9%,10.0~10.8分)依次增高趋势。3)痰瘀互结证分布与量化评分呈现健康对照组(3.0%,4.5~5.0分)、低危人群组(8.9%,7.2~7.7分)、代谢综合征组(15.8%,10.3~11.0分)、冠心病稳定期组(51.2%,16.9~17.5分)、冠心病心力衰竭组(57.2%,18.3~19.5分)、急性冠脉综合征组(64.7%,19.4~20.6分)依次增高趋势。4)不同地区冠心病患者痰湿证、血瘀证、痰瘀互结证分布及量化评分差异均具有统计学意义(P<0.05)。华北和西北地区的冠心病患者痰瘀互结证占比及程度重于其他地区,而华东地区冠心病患者的痰湿证、血瘀证、痰瘀互结证占比及程度均为最轻。南方(含华南与西南)地区患者在冠心病前阶段(健康对照组、低危人群组、代谢综合征组)痰湿证、血瘀证、痰瘀互结证占比及程度均重于其他地区。结论痰瘀互结证是贯穿冠心病全程的主要证候,并且存在一定的地域差异。

Objective To explore the distribution law of phlegm and stasis(PSB) binding pattern in different stages of coronary heart disease(CHD). Methods In a cross-section study design, 11383 heathy people and CHD patients from 48 clinics in six regions of China were included and classified into healthy control group(HC), low-risk group(LR), metabolic syndrome(MS) group, CHD stable period(SP) group, acute coronary syndrome(ACS) group, perioperative period(PP) group, and CHD heart failure(HF) group according to the stages of CHD. Diagnosis Standards on CHD with PSB pattern was referred to when describing the distribution of PSB pattern, and the quantitative pattern score was calculated and analyzed. Results The proportion of phlegm-damp pattern and score(95% confidence interval) of HC group(27.7%, 3.4-3.8 points), LR group(43.3%, 5.0-5.4 points), MS group(65.1%, 7.4-7.9 points), SP group(75.1%, 9.0-9.3 points), ACS group(78.5%, 9.3-10.0 points), and HF group(78.6%, 9.5-10.2 points) showed an increase trend. The proportion of blood stasis pattern and score increased from HC group(6.8%, 1.0-1.3 points), to LR group(16.0%, 2.2-2.4 points), MS group(21.9%, 2.9-3.3 points), SP group(63.5%, 7.9-8.3 points), HF group(69.2%, 8.8-9.5 points), and ACS group(78.9%, 10.0-10.8 points). The proportion of PSB pattern and score also increased from HC group(3.0%, 4.5-5.0 points), LR group(8.9%, 7.2-7.7 points), MS group(15.8%, 10.3-11.0 points), SP group(51.2%, 16.9-17.5 points), HF group(57.2%, 18.3-19.5 points), and ACS group(64.7%, 19.4-20.6 points). There were significant differences among six regions in pattern distribution and scores of phlegm-damp pattern, blood stasis pattern and PSB pattern(P<0.05). The proportion and degree of PSB pattern were larger in North China and Northwest China than in other regions, while the proportion and degree of phlegm-damp pattern, blood stasis pattern, and PSB pattern were smallest in East China. The proportion and degree of three patterns in early stage of CHD including HC, LR, MS group were the largest in southern region including South China and Southwest China. Conclusion PSB pattern is the main pattern throughout all stages of CHD, and there are certain regional differences.