红细胞比容与气虚血瘀证冠心病相关性临床研究

Clinical Study on the Relationship between Hematocrit and Coronary Heart Disease with Qi Deficiency and Blood Stasis Syndrome

目的观察气虚血瘀证冠心病患者的红细胞比容水平,初步探讨红细胞比容与气虚血瘀证冠心病的相关性。方法选取2018年3月—2018年12月南京中医药大学附属南京中医院心血管科住院及门诊就诊,经冠状动脉增强CT(CTA)检查确诊为冠心病的患者120例作为冠心病组。按照中医辨证分型标准,分为气虚血瘀证冠心病组以及非气虚血瘀证冠心病组两组,每组60例。两组患者又按照冠心病的临床分类标准,分为慢性冠状动脉病组和急性冠状动脉综合征组两个亚组,每个亚组30例。选取同一时间段因"胸痹"至心血管科门诊或住院,经冠状动脉CTA检查排除冠心病的患者70例作为对照组。按照中医辨证分型标准,分为气虚血瘀证对照组以及非气虚血瘀证对照组两组,每组35例。所有实验对象均详细记录临床资料,基本信息包括如姓名、性别、年龄、身高、体质量等;个人史包括有无吸烟史,既往病史包括有无2型糖尿病病史,有无高血压病病史以及家族史等;各项检查结果包括甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、总胆固醇(total cholesterol,TC)、红细胞计数(red blood cell count,RBC)、血红蛋白(hemoglobin,Hb)、红细胞比容(hematocrit,HCT)以及身体质量指数(body mass index,BMI)等,中医证候包括主症、次症、舌苔、脉象等。对所有临床资料使用SPSS软件进行统计分析。观察实验组与对照组之间在HCT以及其他各项指标上的差异,并采用多因素Logistic回归分析探究气虚血瘀证的危险因素。结果(1)发现虚血瘀证冠心病组的吸烟史例数、2型糖尿病病史例数、年龄及LDL-C、TG水平均高于气虚血瘀证对照组(P<0.05或P<0.01);HDL-C、RBC、Hb和HCT水平明显低于气虚血瘀证对照组(P<0.01)。(2)在气虚血瘀证冠心病组中,慢性冠状动脉病组RBC和HCT水平低于急性冠状动脉综合征组(P<0.05或P<0.01)。(3)非气虚血瘀证冠心病组的高血压病病史例数、年龄及LDL-C、TG、TC水平高于非气虚血瘀证对照组(P<0.05或P<0.01);HCT、RBC水平低于非气虚血瘀证对照组(P<0.05或P<0.01)。(4)在非气虚血瘀证冠心病组中,慢性冠状动脉病组的RBC、Hb和HCT水平低于急性冠状动脉综合征组(P<0.05或P<0.01)。(5)气虚血瘀证冠心病组的高血压病病史例数、A型性格者例数高于非气虚血瘀证冠心病组(P<0.05或P<0.01)。而前者的RBC、Hb、HCT水平均低于后者(P<0.05或P<0.01)。(6)将气虚血瘀证冠心病组与非气虚血瘀证冠心病组比较后差异有统计学意义的指标采用多因素Logistic回归分析,结果显示,A型性格、红细胞总数及Hb、HCT水平是气虚血瘀证冠心病患者的危险因素(P<0.05)。(7)HCT的ROC曲线分析:HCT预测冠心病发生的ROC曲线下面积为0.338(95%CI:0.239~0.437,P=0.002)。其中HCT截断点为31.50%,敏感性为90.0%,特异性为15%。结论冠心病患者的红细胞比容水平较非冠心病患者低。冠心病患者红细胞比容的降低与中医气虚血瘀证有相关性。红细胞比容降低与气虚血瘀证冠心病明显相关。红细胞比容水平与冠心病不同临床类型的相关性及机制尚不明确。

Objective To observe the hematocrit level of patients with coronary heart disease caused by Qi deficiency and blood stasis syndrome,and to explore the correlation between hematocrit and Qi deficiency and blood stasis syndrome. Methods From March 2018 to December 2018,the patients admitted to the department of cardiology of Nanjing Chinese medicine hospital affiliated to Nanjing university of traditional Chinese medicine were enrolled in the hospital and outpatient clinic. 120 patients with coronary heart disease diagnosed as coronary heart disease were enrolled as coronary heart disease group. According to the criteria of TCM syndrome differentiation,the patients were divided into two groups:Qi deficiency and blood stasis syndrome and non-Qi deficiency and blood stasis syndrome coronary heart disease group,60 cases in each group. According to the clinical classification criteria of coronary heart disease,the two groups were divided into two subgroups:chronic coronary artery disease group and acute coronary syndrome group,30 cases in each subgroup. 70 patients with coronary heart disease who underwent coronary CTA examination in the same period of time were included as control group. According to the criteria of TCM syndrome differentiation,the control group was divided into two groups:Qi deficiency and blood stasis syndrome control group and non-Qi deficiency blood stasis syndrome control group,35 cases in each group. All subjects recorded clinical data in detail,including basic information such as name,gender,age,height,weight,etc. Personal history including history of smoking,past medical history including history of type 2 diabetes,history of hypertension,and family history etc. The results include triglycerides,lowdensity lipoprotein cholesterol,high-density lipoprotein cholesterol,total cholesterol,red blood cell count,hemoglobin,hematocrit and body mass index. TCM syndromes include major symptoms,secondary diseases,tongue coating,pulse,etc. Statistical analysis was performed using SPSS software for all clinical data. The differences in hematocrit and other indicators between the experimental group and the control group were observed,and multivariate logistic regression analysis was used to explore the risk factors of Qi deficiency and blood stasis syndrome. Results(1)The smoking history,DM history,age,low density lipoprotein cholesterol and triglyceride levels in Qi deficiency and blood stasis syndrome group were higher than the control group of Qi deficiency and blood stasis syndrome(P<0.05 or P<0.01). The high-density lipoprotein cholesterol,red blood cell count,hemoglobin and hematocrit levels in the Qi deficiency and blood stasis syndrome group were significantly lower than those in the Qi deficiency and blood stasis syndrome control group(P<0.01).(2)In the Qi deficiency and blood stasis syndrome group,the red blood cell count and hematocrit in the chronic coronary artery disease group were lower than those in the acute coronary syndrome group(P<0.05 or P<0.01).(3)The history of hypertension,age,low density lipoprotein cholesterol and triglyceride,total cholesterol in non-Qi deficiency and blood stasis syndrome coronary heart disease group were higher than that of the non-Qi deficiency and blood stasis syndrome control group(P<0.05 or P<0.01). The hematocrit,red blood cell count of the non-Qi deficiency and blood stasis syndrome group was lower than that of the non-Qi deficiency and blood stasis syndrome control group(P<0.05 or P<0.01).(4)In the non-Qi deficiency and blood stasis syndrome group,the red blood cell count,hemoglobin and hematocrit in the chronic coronary artery disease group were lower than those in the acute coronary syndrome group(P<0.05 or P<0.01).(5)It was found that the history of hypertension and type A personality of Qi deficiency and blood stasis syndrome coronary heart disease group was higher than non-Qi deficiency and blood stasis syndrome group(P<0.05 or P<0.01). The red blood cell count,hemoglobin and hematocrit of the former were lower than the latter(P<0.05 or P<0.01).(6)The statistically significant difference between the Qi deficiency and blood stasis syndrome coronary heart disease group and the non-Qi deficiency and blood stasis syndrome coronary heart disease group was analyzed by multivariate logistic regression analysis. The results showed that type A personality,total red blood cell count,hemoglobin and hematocrit.It was a risk factor for patients with coronary heart disease with Qi deficiency and blood stasis syndrome(P<0.05).(7)ROC curve analysis of hematocrit:The area under the ROC curve of hematocrit for coronary heart disease was 0.338(95%CI:0.239-0.437,P=0.002). The hematocrit cut-off point was 31.50%,the sensitivity was 90.0%,and the specificity was 15%. Conclusion Patients with coronary heart disease have lower hematocrit levels than patients with non-coronary heart disease. The decrease of hematocrit in patients with coronary heart disease is related to the syndrome of Qi deficiency and blood stasis in Chinese medicine.Reduced hematocrit is significantly associated with coronary heart disease with Qi deficiency and blood stasis syndrome. The correlation and mechanism of hematocrit levels with different clinical types of coronary heart disease are not clear.