浅析冠心病病变血管与中医证型的关系及冠脉支架术后中医证型的演变

Relationship between Coronary Artery Disease and TCM Syndromes and Evolution of TCM Syndromes after PCI

目的探讨胸痹患者冠脉介入治疗后中医证型的分布及演变规律,分析各证型及其变化与介入治疗的相关性,为冠心病介入治疗后中医辨证治疗、预防冠状动脉再狭窄及改善病人术后症状提供参考。方法2014年12月—2016年2月天津中医药大学第二附属医院心内二科中医诊断为胸痹且符合冠脉造影手术适应症的患者87例,行冠脉造影检查,同时进行冠脉狭窄程度、病变支数、冠脉积分等信息采集,并分析其与中医证型的相关性;按调查时段的不同随机抽取5例冠脉支架术后的患者进行中医四诊信息采集,并运用舌诊仪及脉诊仪对其进行舌象、脉象的信息检测,记录相关数据,分析冠脉介入术后中医证型的演变规律。结果冠脉无狭窄患者26例,冠脉狭窄<50%患者6例,冠脉轻度狭窄患者9例,中度狭窄患者9例,重度狭窄患者29例,冠脉完全闭塞患者8例。经统计分析,冠脉不同狭窄程度中的证型分布差异无统计学意义。经冠脉造影检查诊断为冠心病的55例患者中,单支病变24例,双支病变20例,多支病变11例;冠心病患者所属中医证型中气虚血瘀比例最大,其次为痰阻心脉、气阴两虚;对所有冠脉狭窄的患者进行冠脉积分评价,经非参数检验,气虚血瘀、气阴两虚、气滞血瘀、痰阻心脉4种证型的积分,组间比较差异无统计学意义;行冠脉支架植入术的患者术前跟术后1周中医证型未见明显变化,仍然是气虚血瘀为主要证型。术后3个月的随访患者,气虚证与血瘀证的积分比例开始出现变化,气虚的症状加重,而血瘀的症状较术前有减轻的趋势。术后6个月~1年的随访患者中,这种表现更加明显。结论气虚血瘀证是经冠脉造影诊断冠心病的主要中医证型;冠心病不同中医证型对应冠脉病变支数有所不同:气虚血瘀证多见单支及双支病变,痰阻心脉多见多支病变,而气滞血瘀证可见于多支病变中;冠脉造影结果分析显示:冠脉狭窄程度、病变积分、病变支数与中医证型的相关性不明显;冠脉支架术后患者主要中医证型仍为气虚血瘀型,随着介入术后患者病程的延长,气虚症状较前明显,而血瘀症状较前减轻,这提示冠心病介入治疗在一定程度上可以改善患者的标实症状,但不能从根本上改变冠心病本虚标实的病机特点。

Objective To explore the distribution and evolution of TCM syndromes in patients with chest arrhythmia after coronary intervention and analyze the correlation between different syndromes and their changes and interventional therapy so as to provide reference for TCM syndrome differentiation,prevention of coronary restenosis and improvement of postoperative symptoms.Methods From December 2014 to February 2016,in The Second Affiliated Hospital of Tianjin Medical University,87 cases of patients with operation indications,coronary angiography examination,at the same time,narrowed coronary arteries lesion counts,coronary points such as information collection,and analyze its correlation with TCM syndrome type.Five patients were randomly selected according to different investigation periods for the information collection of TCM four diagnosis,and the information detection of tongue image and pulse condition was carried out by using tongue diagnosis instrument and pulse diagnosis instrument,and the relevant data was recorded to analyze the evolution rule of TCM syndromes after coronary intervention.Results There were 26 patients without coronary artery stenosis,6 patients with coronary artery stenosis less than 50%,9 patients with mild coronary artery stenosis,9 patients with moderate coronary artery stenosis,29 patients with severe coronary artery stenosis,and 8 patients with complete coronary artery occlusion.The distribution of syndromes of coronary artery stenosis showed no significant difference.Among the 55 patients diagnosed with coronary artery disease by coronary angiography,24 patients had single-vessel disease,20 patients had double-vessel disease and 11 patients had multi-vessel disease.The proportion of Qi deficiency and blood stasis was the largest among the TCM syndromes of coronary heart disease patients,followed by phlegm obstruction of heart collateral and Qi Yin deficiency.All patients with coronary artery stenosis were evaluated by coronary artery score.By non-parametric test,the scores of four syndromes including Qi deficiency and blood stasis,Qi Yin deficiency,Qi stagnation and blood stasis,and phlegm obstruction to heart collateral were not statistically significant.There was no significant change in TCM syndromes of patients undergoing coronary stent implantation before and one week after the operation,and qi deficiency and blood stasis were still the main syndromes.Following up the patients three months after the operation,the integral ratio of Qi deficiency syndrome and blood-stasis syndrome began to change,and the symptoms of Qi deficiency increased,while the symptoms of blood stasis tended to decrease compared with that before operation.This was more pronounced in patients followed up 6 months to 1 year after surgery.Conclusion Qi deficiency and blood stasis syndrome was the main TCM syndrome in coronary angiography diagnosis of coronary heart disease.Different types of TCM syndromes of coronary heart disease had different numbers of coronary artery lesions:Qi deficiency and blood stasis syndrome were more common in single branch and double branch lesions,phlegm-obstructed heart collateral were more common in multiple branch lesions,while Qi stagnation and blood stasis syndrome can be seen in multiple branch lesions.The results of coronary angiography showed that the degree of coronary stenosis,lesion score and lesion number were not significantly correlated with TCM syndromes.After coronary stent in patients with Qi deficiency type of syndrome is still the main blood stasis type,with the extension of step in patients with postoperative course,the significant deficiency symptoms,and blood stasis symptom alleviate earlier,suggesting coronary intervention treatment to a certain extent,can improve the symptoms of patients with the solid,but not fundamentally change this empty mark the pathogenesis characteristics of the real coronary heart disease.