基于心血管病危险因素研究596例冠心病患者中医证型分布特点及其关系

TCM Syndrome Distribution of 596 Patients withCoronary Heart Disease Based on Risk Factors of Cardiovascular Diseases

目的 通过回顾性病例调查,基于心血管病传统危险因素及非传统危险因素,探讨分析冠心病(Coronary heart disease, CHD)中医证型分布规律、临床特点及其与非传统危险因素的关系,进一步为新疆地区中医药防治CHD及中医辨证论治提供一定科学理论依据。方法 选取2015年2月—2016年3月期间就诊于新疆医科大学附属中医医院的CHD住院患者596例。由副主任医师及以上中医专家确定中医辨证分型,根据中医证型分布比例,分为秽浊痰阻证组、气虚血瘀证组、气阴两虚证组,对三个主要证型展开研究,采集心血管病传统危险因素和中医四诊信息,并对非传统危险因素:纤维蛋白原(Fibrinogen, Fib)、血尿酸(Uric acid, UA)、超敏C反应蛋白(Hypersensitive-c-reactive-protein, hs-CRP)、血同型半胱氨酸(Homocysteine, Hcy)、颈动脉内-中膜厚度(carotid intima media thickness, cIMT)指标进行检测。利用频数分析法观察传统危险因素在不同中医证型中的分布情况及其规律,利用方差分析研究非传统危险因素与CHD各中医证型的关系。结果 (1)各中医证型所占比例依次为秽浊痰阻证、气虚血瘀证、气阴两虚证、气滞血瘀证、寒凝心脉证、阳气虚衰证;性别比例存在差异:男性多于女性;秽浊痰阻证CHD患者年龄、BMI值均较大;(2)男性、吸烟、饮食厚腻在秽浊痰阻证中所占比率最大,血脂异常、不运动在气虚血瘀证中所占比率较大,糖尿病在气阴两虚证中所占比率大;(3)不同中医证型与CHD非传统危险因素之间的比较,秽浊痰阻证组CHD患者的TG和hs-CRP的水平明显要高于其他两组(P<0.05);三组证型的UA和Hcy的水平比较差异均有明显的统计学意义(P<0.01);秽浊痰阻证组、气虚血瘀证组CHD患者的Fib水平要高于气阴两虚证组,且差异明显(P<0.05)。结论 冠心病中医证型分布具有地域性特点,心血管非传统危险因素与中医证型分布具有一定关联性。

Objective Toanalyze the traditional Chinese medicine(TCM)syndrome distribution of coronary heart disease(CHD),clinical characteristics, and its correlations with non-conventional risk factors based on conventional/non-conventionalrisk factors of cardiovascular diseases by a retrospective case study to further provide a scientific theoretical basis for TCM prevention and treatment of CHD and TCM syndrome differentiation in Xinjiang.Methods A total of 596 patients with CHD treated in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University from February 2015 to March 2016 were included.The TCM syndrome types, determined by TCM experts with the title of deputy chief physician or above, were mainly divided into filthy turbidity and phlegm obstruction syndrome, qi deficiency and blood stasis syndrome, and qi and yin deficiency syndrome according to the distribution ratio of TCM syndromes.The information on conventional risk factors for cardiovascular diseases and four TCM examinations was collected.The non-conventional risk factors, including fibrinogen(Fib),uric acid(UA),hypersensitive C-reactive protein(hs-CRP),homocysteine(Hcy),and carotid intima-media thickness(cIMT),were detected.Frequency analysis was used to observe the distribution and regularity of conventional risk factors in different TCM syndromes, and variance analysis was used to investigatethe correlation between non-conventional risk factors and various TCM syndromes of CHD.Results(1)In terms of proportion, TCM syndromes were ranked as filthy turbidity and phlegm obstruction syndrome, qi deficiency and blood stasis syndrome, qi and yin deficiency syndrome, qi stagnation and blood stasis syndrome, cold congealing in heart vesselsyndrome, and yang qi deficiency and debilitationsyndrome.There wasa difference in the gender ratio, and specifically, male patients were more than female patients.The age and BMI of CHD patients with filthy turbidity and phlegm obstruction syndromewere higher.(2)The factors of male, smoking, and greasy diet accounted for the largest proportions in the filthy turbidity and phlegm obstruction syndrome, dyslipidemia and inactivity in the qi deficiency and blood stasis syndrome, and diabetes in the qi and yin deficiency syndrome.(3)As revealed by the comparison of different TCM syndromes and non-conventional risk factors of CHD,the levels of TG and hs-CRP in CHD patients in the filthy turbidity and phlegm obstruction syndrome group were higher than those in the other two groups(P<0.05).There were significant differences in the levels of UA and Hcy among the three groups(P<0.01).The Fib level of CHD patients in the filthy turbidity and phlegm obstruction syndrome group and the qi deficiency and blood stasis syndrome group was higher than that in the qi and yin deficiency syndrome group(P<0.05).Conclusion The distribution of TCM syndromes of CHD has regional characteristics, and the non-conventional risk factors of cardiovascular diseases have a certain correlation with the distribution of TCM syndromes.