冠心病痰瘀互结证和气虚血瘀证鉴别诊断的实验室指标筛选

Screening Laboratory Indices for Differential Diagnosis of Coronary Artery Disease Between Phlegm and Blood Stasis Evidence and Qi Deficiency Evidence

目的对冠心病(coronary heart disease,CHD)痰瘀互结证和气虚血瘀证患者实验室指标及超声心动图分析,寻找两种证型的差异性指标,为筛选CHD痰瘀互结证和气虚血瘀证的特异性诊断标志物提供参考。方法采集前来辽宁中医药大学附属医院诊治的60例痰瘀互结证和69例气虚血瘀证CHD患者的静脉全血用于外周全血细胞分析计数,血液离心取上清检测凝血7项、心肌酶、生化指标,检测患者的超声心动图,对其结果进行统计分析,筛选差异指标,并分析两证型间差异指标的相关性以及利用受试者工作特征(receiver operating characteristic,ROC)曲线判断各指标对CHD的诊断效能。结果将两证型CHD患者血液指标及超声心动图的定量指标对比发现,平均红细胞血红蛋白含量(mean corpuscular hemoglobin,MCH)、血清葡萄糖水平(glucose,GLU)、主动脉根部内径(aortic root internal diameter,AAO)、血小板压积(platelet pressure product,PCT)、D-二聚体水平(D-Dimer)在两组间差异均有统计学意义(P<0.05)。痰瘀互结证MCH与PCT具有相关性(P<0.05);气虚血瘀证MCH与AAO具有相关性(P<0.05)。AAO、GLU及D-Dimer对CHD的诊断效能较好,AAO联合GLU检测CHD的诊断性能最佳。结论MCH、PCT、D-Dimer、GLU、AAO可作为冠心病痰瘀互结证和气虚血瘀证分型诊断指标,有可能成为CHD辨证的标志物,对于CHD的中医分型具备良好的应用价值。

Objective To analyze the laboratory parameters and echocardiograms of patients with coronary heart disease(CHD)with phlegm-blood stasis and Qi deficiency and blood stasis and find out the differential parameters of the two types of CHD,so as to provide reference for screening specific diagnostic markers of CHD with phlegm-blood stasis and Qi deficiency.Methods Venous whole blood was collected from 60 patients with phlegm-blood stasis and 69 patients with Qi deficiency and blood stasis who came to the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine for peripheral whole blood cell analysis,and the supernatant was centrifuged to test coagulation 7 items,cardiac enzymes and biochemical indexes.The diagnostic efficacy of each index for CHD was analyzed by(receiver operating characteristic,ROC)curve.Results Comparing the blood indices and quantitative echocardiographic indices of patients with CHD in the two evidence types,it was found that mean erythrocyte hemoglobin content(MCH),serum glucose level(GLU),aortic root internal diameter(AAO),platelet pressure product(PCT)and D-Dimer level were significantly different between the two groups(P<0.05).The diagnostic efficacy of AAO,GLU and D-Dimer for CHD was better,and AAO combined with GLU had the best diagnostic performance for detecting CHD.Conclusion The levels of MCH,PCT,D-Dimer,GLU and AAO can be used as diagnostic indicators for the typing of coronary heart disease with phlegm and blood stasis,and may become markers for the identification of CHD,which has good application value for the TCM typing of CHD.