老年高血压合并冠心病心绞痛的中西医联合筛查模型研究

Study on the screening model of integrated Chinese and Western medicine in elderly hypertension complicated with angina pectoris and coronary heart disease

目的:建立老年高血压合并冠心病心绞痛的中西医风险评估指标体系与筛查模型。方法:采用多中心病例-对照研究,针对2017年8月-2019年6月在浙江中医药大学附属杭州市中医院、湖南省中医药研究院附属医院、湖南中医药大学第一附属医院住院的907例老年高血压患者,按是否合并冠心病心绞痛分为病例组与对照组,并进行1∶1配对,纳入分析的两组患者均为151例。收集两组患者人口学资料、生活方式现况、现病史、既往病史,及血压、血脂、糖化血红蛋白(HbA1c)、肾小球滤过率(eGFR)、同型半胱氨酸(Hcy)等心、脑、肾靶器官损害危险因素;采集患者中医四诊信息并辨证。通过单变量分析筛选风险评估模型指标,采用Logistic回归分析建立筛查模型。结果:经单变量分析,两组高血压病程、天门冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、中医证型(阴虚阳亢证、气虚血瘀证等)及特征性症状[头晕(痛)、胸闷(痛)、心慌(悸)、肢体活动不利、肢体麻木、气短(促)、失眠等]的差异有统计学意义(P<0.01,P<0.05)。以17个变量作为初筛指标构建中西医联合筛查模型,进入模型的指标包括高血压病程(X1)、胸闷(痛)(X2)、气短(促)(X3)、阴虚阳亢证(X4)、气虚血瘀证(X5)、痰湿(热)壅盛证(X6)、TC(X7)。该模型拟合度较好,整体筛查有效率为85.7%。结论:本研究为老年高血压合并冠心病心绞痛风险评估的前期探索,所构建的中西医联合筛查模型可为老年心血管病预后监测和防治提供参考依据。

Objective:To establish a risk assessment index system and screening model of integrated Chinese and Western medicine(ICWM)for elderly hypertension complicated with angina pectoris of coronary heart disease(CHD).Methods:A multi-center,case-control study covering 907 cases of elderly hypertensive patients was conducted at Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University,Hunan Traditional Academy of Chinese Medicine Affiliated Hospital,and the First Hospital of Hunan University of Chinese Medicine from August 2017 to June 2019.The included patients were divided into the case and control group according to whether they had secondary angina pectoris of CHD,and the two groups were matched 1∶1by propensity score matching(PSM),with 151 patients in both groups.Demographic data such as the history of present illness,past medical history,and the patient’s lifestyle status were collected.Blood pressure,blood lipid,estimated glomerular filtration rate(eGFR),glycosylated hemoglobin A1c(HbA1c),homocysteine(Hcy)and other renal and cardio-cerebrovascular diseases risk factors were detected in the two groups with Roche biochemical analyzer,enzyme-linked immunosorbent assay and other methods.The information of TCM syndromes was collected,and the syndrome differentiation was analyzed.The risk assessment indexes were screened by univariate analysis,and the screening model was established by Logistic regression analysis.Results:The duration of hypertension,aspartate transaminase(AST),alanine-aminotransferase(ALT),total cholesterol(TC),low-density lipoprotein-cholesterol(LDL-C),TCM syndromes(yin deficiency and yang hyperactivity syndrome,qi deficiency and blood stasis syndrome),dizziness,chest distress,palpitation,limb numbness,and insomnia were significantly different between both groups through comparative analysis(P<0.01,P<0.05).An ICWM combined screening model including the course of hypertension(X1),chest distress(pain)(X2),shortness of breath(X3),yin deficiency and yang hyperactivity syndrome(X4),qi deficiency and blood stasis syndrome(X5),excessive phlegm dampness(heat)syndrome(X6)and TC(X7)was constructed based on 17 variables.The model had a good fitting degree,and the overall screening efficiency was 85.7%.Conclusion:This study is a preliminary exploration of the risk assessment of elderly hypertension with angina pectoris of CHD.The constructed screening model can provide a simple and effective reference tool for monitoring and prevention of cardiovascular disease in the elderly.