急性冠脉综合征患者介入治疗前后气滞血瘀气虚血瘀证候演变规律及预后分析

Analysis of Evolution and Prognosis of Qi Stagnation Blood Stasis Syndrome and Qi Deficiency Blood Stasis Syndrome in Patients with Acute Coronary Syndrome Before and After Percutaneous Coronary Intervention

目的比较分析经皮冠状动脉介入治疗(PCI)前后急性冠脉综合征(ACS)患者不同时间点气滞血瘀、气虚血瘀证候的变化及临床结局,阐明介入前后气滞血瘀-气虚血瘀的动态转化规律及其与临床预后的关系。方法本研究为前瞻性、多中心、纵向研究设计,共纳入行PCI治疗的ACS患者共438例,其中气虚血瘀者211例,气滞血瘀者227例。所有入选患者行冠脉造影后应用Gensini评分对其冠脉病变的严重程度进行定量评估,同时以介入前、介入后3、6、12个月为随访时间点,动态记录入选患者1年内的气滞血瘀、气虚血瘀证候变化及主要不良心脑血管事件的发生情况。结果与本组介入前比较,气滞血瘀组与气虚血瘀组介入治疗12个月后Genisini评分降低(P<0.01);气滞血瘀组与气虚血瘀组介入治疗后血瘀证积分均出现逐渐下降,以术后12个月时下降最为显著(P<0.01)。PCI治疗前后气滞血瘀与气虚血瘀两种证型之间可相互转化,以气滞血瘀向气虚血瘀的转化形式为主,气虚血瘀证成为ACS患者介入治疗后的主要证候,术后6个月时这两种证候的转化最为频繁,且术后6、12个月时气虚血瘀患者比例较治疗前增加最为显著(术后6月χ^(2)=7.19,P=0.008;术后12月χ^(2)=6.311,P=0.013)。ACS患者1年的临床预后与介入治疗前证型要素的分布无明显相关性(P值均>0.05)。PCI治疗后气虚血瘀者1年内MACCE事件的发生率及累计风险明显高于术后气滞血瘀型冠心病者(分别为P=0.05;P=0.048),主要表现为非计划性再次血运重建事件的发生率及累计风险明显增高(分别为P=0.04;P=0.028)。结论ACS患者的气滞血瘀、气虚血瘀证候可伴随PCI而发生动态演变,整体演变趋势为由实转虚,虚实夹杂,以气虚为主,且术后气虚与患者预后密切相关。

Objective To compare and analyze the changes and clinical outcomes of Qi stagnation blood stasis syndrome(QSBS)and Qi deficiency blood stasis syndrome(QDBS)in patients with acute coronary syndrome(ACS) before and after percutaneous coronary intervention(PCI),so as to clarify the dynamic transformation pattern of QSBS and QDBS before and after PCI and its relationship with clinical prognosis.Methods This study was a prospective,multicenter,longitudinal study. A total of 438 ACS patients were treated with PCI,including 211 patients with QDBS and 227 patients with QSBS. The severity of coronary artery lesions was quantitatively evaluated by Gensini score after coronary angiography. At the same time,the syndrome changes and clinical events were dynamically recorded before and after PCI at 3,6 and 12 months.Results Compared with the group before PCI,the Genisini score of both groups decreased at 12 months after PCI(P<0.01). The blood stasis syndrome score of both groups decreased gradually after PCI,especially at 12 months(P<0.01). The QSBS and QDBS could be transformed into each other before and after PCI,mainly in the form of transformation from QSBS to QDBS. QDBS has become the main syndrome of ACS patients after PCI,and the two syndromes transformed most frequently at 6 months after PCI. The proportion of patients with QDBS increased significantly at 6 and 12 months after PCI compared with that before PCI(6 months after PCI χ^(2)=7.19,P=0.008;12 months after PCI χ^(2)=6.311,P=0.013). There was no significant correlation between the clinical prognosis in one year and the distributions of syndromes before PCI(P>0.05). The incidence and cumulative risk of MACCE events within one year after PCI in patients with QDBS were significantly higher than those with QSBS(P=0.05,P=0.048,respectively),which were mainly driven by unplanned revascularization events(P=0.04,P=0.028,respectively).Conclusions The QSBS and QDBS of ACS patients can evolve dynamically with PCI.The overall evolution trend is from excess to deficiency,mixed with deficiency and excess,and the QDBS was the main syndrome after PCI,which is closely related to the prognosis of patients.