颈动脉粥样硬化患者中医证候分布与短期内心脑血管事件的关系分析

Analysis of the relationship between traditional Chinese medicine syndromes classification of carotid atherosclerosis and early major adverse cardio-cerebrovascular events

目的分析颈动脉粥样硬化(CAS)患者中医证候分布与短期内心脑血管事件的关系。方法收集428例CAS患者的一般资料(年龄、性别等)和临床资料(颈动脉粥样斑块类型、合并情况、中医证候类型及短期内心脑血管事件等),统计患者的中医证候类型及其比例、短期内心脑血管事件的发生率;采用多因素Logistics回归模型分析不同中医证候是否为CAS短期内心脑血管事件的独立危险因素;统计分析不同中医证候与其他危险因素的关系。结果428例CAS患者短期内心脑血管事件发生率为12.15%(52/428),其中痰热内蕴证11例,血脉瘀阻证15例,痰瘀互结证21例,其他证候5例。Logistics分析显示年龄(OR=1.183)、男性(OR=1.260)、吸烟(OR=1.079)、饮酒(OR=1.084)、硬斑(OR=1.151)、软斑(OR=1.531)、混合斑(OR=1.425)、2种斑(OR=1.130)、3种斑(OR=2.126)、高TC含量(OR=1.428)、高cTnT含量(OR=1.513)、痰热内蕴证(OR=1.288)、血脉瘀阻证(OR=1.583)和痰瘀互结证(OR=2.243)是CAS患者短期内发生心脑血管事件的独立危险因素。痰热内蕴证主要以硬斑和2种斑为主,血脉瘀阻证主要以软斑为主,痰瘀互结证以混合斑和3种斑为主。结论中医证候分型为痰热内蕴证、血脉瘀阻证、痰瘀互结证的CAS患者短期内心脑血管事件发生风险较高,CAS中医证候分布主要与血清cTnT含量、斑块类型和斑块合并方面有关,临床医生可依据中医证候分型更好地进行早期心脑血管事件的一级预防。

Objective To analyze the relationship between the distribution rules of traditional Chinese medicine(TCM)syndromes of carotid atherosclerosis(CAS)and early major adverse cardio-cerebrovascular events(MACCE).Methods CAS patients(n=428)were as the research objects,and the general information(age,gender,etc.)and clinical data(CAS plaques types,complications,TCM syndromes and MACCE)of these patients were recored.The classifications and proportions of TCM syndromes in CAS patients,and early MACCE were calculated.Multivariate logistics regression model was porformed to analyze whether different TCM syndromes were independent risk factors for early MACCE in CAS patients,and to assess the statistical analysis of the relationship between different TCM syndromes and other risk factors.Results The early MACCE was 12.15%(52/428),including 11 cases of phlegm-heat internal accumulation syndrome,15 cases of blood stasis syndrome.21 cases of intermingled phlegm-stasis blood syndrome,and 5 cases of other syndromes.logistics analysis showed that age(OR=1.183),male(OR=1.260),smoking(OR=1.079),drinking(OR=1.084),hard plaques(OR=1.151),soft plaques(OR=1.531),mixed plaques(OR=1.428),two kinds of plaques(OR=1.130),three kinds of plaques(OR=2.126),high total cholesterol(TC)levels(OR=1.428),high cardiac troponin T(cTnT)level(OR=1.513),Phlegm-heat internal accumulation syndrome(OR=1.288),blood stasis syndrome(OR=1.583)and phlegm-stasis syndrome(OR=2.243)are independent risk factors for CAS patients.Differences was significant in plaque type and plaque combination of TCM syndrome classification in different CAS(P<0.05),and no significant difference in other syndromes(P>0.05).Phlegm-heat internal accumulation syndrome was mainly hard plaques and two kinds of plaques,blood stasis syndrome for soft plaques,and plaques of phlegm-stasis syndrome for mixed plaques and three kinds.Conclusion CAS inpatients with phlegm-heat internal accumulation,blood stasis syndrome,phlegm-stasis syndrome have a higher risk of MACCE.TCM syndromes of CAS is closey related with cTnT level,plaque type and plaque combination.Clinicians can better carry out primary prevention of early MACCE based on TCM syndrome classification.