冠状动脉粥样硬化性心脏病中医证型与冠状动脉造影及血液生化指标相关性研究

Correlation of Coronary Angiography and Blood Biochemical Indexes Among Different Chinese Medicine Syndromes of Coronary Atherosclerotic Heart Disease

目的 观察冠状动脉粥样硬化性心脏病(CAHD)不同中医证候与冠状动脉造影(CAG)、血液生化指标及主要不良心血管事件(MACE)的相关性。方法 选取2015年5月—2018年10月就诊于北京大学国际医院和北京大学人民医院的686例CAHD患者,根据中医证候进行分组(气滞血瘀型221例、痰浊阻络型189例、气虚血瘀型178例、气阴两虚型50例、阴寒凝滞型48例)。比较各证型间血液生化指标以及CAG结果,并对入选病例进行3年随访。结果 与气滞血瘀型比较,痰浊阻络型载脂蛋白B(ApoB)、载脂蛋白A1(ApoA1)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(a)[Lp(a)]、Gensini得分降低(P<0.05);气虚血瘀型ApoB、ApoA1、TC、LDL-C、Lp(a)、小而密低密度脂蛋白胆固醇(sdLDL-C)、Gensini得分降低(P<0.05),1支病变比例升高(P<0.05);气阴两虚型ApoA1、空腹血糖(FPG)、糖化血红蛋白(HbA1c)升高(P<0.05),ApoB、TC、LDL-C、Lp(a)、sdLDL-C、3支病变比例、Gensini得分和MACE总体发生率降低(P<0.05);阴寒凝滞型ApoA1、高密度脂蛋白胆固醇(HDL-C)、1支病变比例升高(P<0.05),ApoB、TC、LDL-C、Lp(a)、sdLDL-C、3支病变比例、Gensini得分和MACE总体发生率降低(P<0.05)。与痰浊阻络型比较,气虚血瘀型ApoA1、1支病变比例升高(P<0.05),ApoB、TC、Gensini得分降低(P<0.05);气阴两虚型ApoA1、HbA1c、1支病变比例升高(P<0.05),ApoB、TC、LDL-C、Lp(a)、sdLDL-C、3支病变比例和Gensini得分降低(P<0.05);阴寒凝滞型ApoA1、HDL-C、1支病变比例升高(P<0.05),ApoB、TC、LDL-C、sdLDL-C、3支病变比例、Gensini得分和MACE总体发生率降低(P<0.05)。与气虚血瘀型比较,气阴两虚型ApoA1升高(P<0.05),LDL-C、Lp(a)、Gensini得分降低(P<0.05);阴寒凝滞型ApoA1升高(P<0.05),TC、Gensini得分降低(P<0.05)。与气阴两虚型比较,阴寒凝滞型TC、FPG、HbA1c、Gensini得分降低(P<0.05)。各中医证型间生存曲线存在统计学差异(P=0.017),气虚血瘀型生存曲线最先出现了下降,最先出现MACE;随着时间的推移,气滞血瘀型及痰浊阻络型生存曲线下降趋势最明显,发生MACE比例增加最明显(P<0.05)。结论 CAG、生化指标及MACE与CAHD中医证候存在相关性,对CAHD辨证及预后具有指导意义。

Objective To observe the relationship between different Chinese medicine(CM)syndromes of coronary atherosclerotic heart disease(CAHD)with coronary angiography(CAG),blood biochemical indexes,and major adverse cardiovascular events(MACE).Methods A total of 686 CAHD patients who visited Peking University International Hospital and Peking University People's Hospital from May,2015 to Oct,2018 were enrolled.The patients were assigned to qi-stagnation and blood-stasis type(221 cases),phlegm-turbidity blocking collateral type(189 cases),qi-deficiency and blood-stasis type(178 cases),qi-yin deficiency type(50 cases),and yin-cold stagnation type(48 cases)according to CM syndromes.The levels of blood biochemical indexes and the results of CAG of different CM syndromes were compared.A 3 years followup was conducted.Results Compared with qi-stagnation and blood-stasis type,apolipoproteins B(ApoB),apolipoproteins A-1(ApoA1),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),lipoprotein(a)[Lp(a)],and Gensini score decreased in phlegm-turbidity blocking collateral type(P<0.05);ApoB,ApoA1,TC,LDL-C,Lp(a),small and dense LDL-C(sdLDL-C),and Gensini score decreased(P<0.05),proportion of 1 vessel disease increased in qi-deficiency and blood-stasis type(P<0.05);ApoA1,fasting plasma glucose(FPG),and glycated hemoglobin A1c(HbA1c)increased(P<0.05),ApoB,TC,LDL-C,Lp(a),sdLDL-C,proportion of 3 vessels disease,Gensini score,and overall incidence of MACE decreased in qi-yin deficiency type(P<0.05);ApoA1,high-density lipoprotein cholesterol(HDL-C),and proportion of 1 vessel disease increased(P<0.05),ApoB,TC,LDL-C,Lp(a),sdLDL-C,proportion of 3 vessels disease,Gensini score,and overall incidence of MACE decreased in yin-cold stagnation type(P<0.05).Compared with phlegmturbidity blocking collateral type,ApoA1 and proportion of 1 vessel disease increased(P<0.05),ApoB,TC,and Gensini scored decreased in qi-deficiency and blood-stasis type(P<0.05);ApoA1,HbA1c,and proportion of 1 vessel disease increased(P<0.05),ApoB,TC,LDL-C,Lp(a),sdLDL-C,proportion of 3 vessels disease,and Gensini score decreased in qi-yin deficiency type(P<0.05);ApoA1,HDL-C,and proportion of 1 vessel disease increased(P<0.05),ApoB,TC,LDL-C,sdLDL-C,proportion of 3 vessels disease,Gensini score,and overall incidence of MACE decreased yin-cold stagnation type(P<0.05).Compared with qideficiency and blood-stasis type,ApoA1 increased(P<0.05),LDL-C,Lp(a),and Gensini score decreased in qi-yin deficiency type(P<0.05);ApoA1 increased in qi-yin deficiency type(P<0.05),TC and Gensini score decreased in yin-cold stagnation type(P<0.05).Compared with qi-yin deficiency type,TC,FPG,HbA1c,and Gensini score decreased in yin-cold stagnation type(P<0.05).There were statistic differences in survival curves among different CM syndrome types(P=0.017).The survival curve of qi-deficiency and blood-stasis type decreased first,and MACE occurred first.With the passage of time,the survival curve of qi-stagnation and blood-stasis type and phlegm-turbidity blocking collateral type decreased obviously,and the proportion of MACE increased obviously(P<0.05).Conclusion There is a correlation between CAG,biochemical indicators,MACE and CM syndromes of CAHD,which has guiding significance for syndrome differentiation and prognosis of CAHD.