基于冠状动脉病变程度、颈动脉超声及中医证候要素探讨血脉理论

Discussion on blood vessel theory based on the degree of coronary artery lesions,carotid ultrasound,and TCM syndrome elements

目的探讨不同冠状动脉(简称“冠脉”)病变程度在合并心血管疾病、颈动脉超声指标特征与中医证候要素(简称“证素”)分布规律,分析冠脉病变的影响因素以探讨血脉理论。方法横断面回顾性分析广州中医药大学第一附属医院心血管内科2021年8月—10月因胸痹心痛住院治疗并行冠状动脉造影术的患者227例,冠脉造影结果按照Gensini评分分为4组,即无狭窄组、轻度狭窄组、中度狭窄组及重度狭窄组。分析不同冠脉狭窄程度合并心血管疾病、中医证素、颈动脉内中膜(IMT)增厚程度及斑块分布规律,采用多分类Logistic回归分析冠脉狭窄的相关因素。结果冠脉病变合并糖尿病、血脂异常等在中度狭窄组比例最高;证素结果显示病位证素均为心,病性证素中热毒在中度狭窄组比例最高,而痰浊、气滞、气虚则在无狭窄组较高。在接受冠脉造影的227例患者中,仅有139例接受颈动脉超声检查,不同狭窄程度在左IMT和右IMT水平及有斑块检出的组间比较,差异有统计学意义(P<0.01),其中无冠脉狭窄组左IMT和右IMT<1.0 mm、无斑块比例最高;重度狭窄组以右IMT 1.0~1.5 mm、左IMT>1.5 mm、右IMT>1.5 mm、有斑块比例最高,这4个指标按照中度、轻度、无狭窄组逐渐下降,左IMT 1.0~1.5 mm以中度狭窄组最高,重度狭窄组次之,而轻度、无狭窄组逐渐减低。多分类Logistic回归分析结果提示影响冠脉狭窄最主要的因素有血脂异常、中医病性证素热毒及右IMT。结论冠脉与合并血脂异常、颈动脉病变相关,血脉同病,血脂异常、热毒、右IMT增厚是冠脉狭窄的影响因素,提出监测血脂水平、颈动脉超声结合中医辨证识病于微、未病先防、已病防变的疾病防治理念。

Objective We aimed to(i)explore the proportion of complication of cardiovascular risk-related diseases,the degree of thickening of the carotid intima media thickness(IMT)the detection rate of plaques,and the distribution law of traditional Chinese medicine(TCM)syndrome elements in different coronary artery lesions,(ii)analyze the factors influencing coronary artery lesions,and(iii)explore the theory of blood vessels.Methods A cross-sectional retrospective analysis including 227 patients admitted to the Department of Cardiovascular Medicine of The First Affiliated Hospital of Guangzhou University of Chinese Medicine between August 2021 and October 2021 who were diagnosed by coronary angiography because of chest pain was conducted.The patients were divided into four groups according to the Gensini score:the no stenosis group,the mild stenosis group,the moderate stenosis group and the severe stenosis group.The proportion of cardiovascular risk-related diseases,the distribution law of TCM syndrome elements,the carotid IMT thickening degree and the distribution law of plaque in different degrees of coronary stenosis were analyzed,and the factors related to coronary stenosis were analyzed by multi-classification logistic regression.Results The proportion of moderate coronary artery disease with diabetes and dyslipidemia was the highest in the moderate stenosis group.The analysis of syndrome elements showed that the factors related to disease location were all in the heart.Among the TCM syndrome elements,the proportion of heat toxin in the moderate stenosis group was the highest,while the proportions of phlegm-turbidity,qi stagnation and qi deficiency were the highest in the no stenosis group.Among the 227 patients who underwent coronary angiography,only 139 patients underwent carotid artery ultrasound examination.There are differences in the distribution of the degree of thickening in left IMT and right IMT and in the presence of plaques,which difference is statistically significant(P<0.01).In the no stenosis group,the proportion of left IMT and right IMT<1.0 mm and without plaques was the highest.In the severe stenosis group,the proportion of right IMT 1.0~1.5 mm or left and right IMT>1.5 mm,with plaques was the highest,and decreased gradually in the moderate,mild and no stenosis groups.The proportion of left IMT 1.0~1.5 mm was the highest in the moderate stenosis group,next to that in the severe stenosis group,decreased gradually in the mild and no stenosis groups.Multi-classification logistic regression showed that the main factors affecting coronary artery stenosis were complicated with dyslipidemia,heat toxin and right IMT.Conclusion Dyslipidemia,Carotid artery and coronary artery plaques damage due to the blood vessels.Dyslipidemia,heat toxin,right IMT thickening are factors influencing coronary artery stenosis.The concept of disease prevention and treatment based on blood lipid level,carotid ultrasound combined with TCM syndrome differentiation is put forward,which aims to identify the disease in a non-invasive way,prevent it before it aggravates,and prevent it from spreading.