基于2015—2021年天津地区临床诊疗数据的冠心病现代中医证候特征回顾性研究

A Retrospective Study on the Modern Traditional Chinese Medicine Syndrome Characteristics of Coronary Heart Disease based on the Clinical Diagnosis and Treatment Data in Tianjin from 2015 to 2021

目的探讨冠心病现代中医证候特征及演变趋势。方法回顾性收集2015年1月1日至2021年9月30日天津中医药大学第一附属医院心血管科西医诊断明确为冠心病、心绞痛、急性冠脉综合征、心力衰竭、心律失常、经皮冠状动脉介入术后、冠状动脉旁路移植术后、陈旧性心肌梗死的住院患者,通过提取性别、年龄以及临床症状、舌脉特征等四诊信息,开展证候类型二次校对判定和证候要素提取后进行统计学处理,并对各证候要素间进行关联性分析。结果共纳入3374例冠心病患者。患者临床症状频次由高到低排名前四位依次为胸闷(1791例,53.08%)、胸痛(1612例,47.78%)、憋气(1484例,43.98%)、心悸(1387例,41.11%);脉象频次由高到低排名前四位依次为弦脉(2261例,67.01%)、细脉(1067例,31.62%)、滑脉(795例,23.56%)、沉脉(755例,22.38%);舌色以紫暗舌为主(1703例,50.47%),苔质以白苔(2184例,64.73%)、薄苔(1321例,39.15%)、腻苔(1181例,35.00%)为主。中医证型分布由高到低排名前四位依次为气虚血瘀证(737例,21.84%)、气虚痰瘀证(432例,12.80%)、痰瘀互结证(427例,12.66%)、心血瘀阻证(393例,11.65%)。其证候多为虚实夹杂,且多兼夹血瘀、痰浊。中医证候要素由高到低排名前四位依次为血瘀(2814例,83.40%)、气虚(1928例,57.14%)、痰浊(1495例,44.31%)、阴虚(560例,16.60%)。证候要素关联规则中以痰浊、血瘀、气虚关联度强,其中又以痰浊、血瘀组合关联度最强。各证候要素在2015—2020年各年度间分布结果显示,阴虚、痰浊、血瘀各年度比较差异有统计学意义(P<0.05),其余证候要素差异无统计学意义(P>0.05)。结论现代冠心病基本病机仍属本虚标实,证候特征以虚实夹杂为主,痰瘀兼夹特征明显,标实证候要素占比升高,尤以痰浊、血瘀明显。

Objective To explore the characteristics and evolution trend of modern traditional Chinese medicine(TCM)syndromes of coronary heart disease.Methods Data of the inpatients with the first diagnosis of coronary heart disease,angina pectoris,acute coronary syndrome,heart failure,arrhythmia,post-percutaneous coronary in⁃tervention,post-coronary artery bypass grafting,and old myocardial infarction by western medicine in the Depart⁃ment of Cardiology,The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 1st,2015 to September 30th,2021 were enrolled,and gender,age,clinical symptoms,tongue and pulse manifes⁃tations were retrospectively collected.Secondary proofreading judgment of the syndrome type was re-checked and judged,and the syndrome elements were extracted.Correlation analysis was performed for the syndrome elements.Results A total of 3374 patients with coronary heart disease were included.The top four symptoms were chest tight⁃ness(1791,53.08%),chest pain(1612,47.78%),breathlessness(1484,43.98%),and palpitations(1387,41.11%).The top four pulse manifestations were wiry pulse(2261,67.01%),thready pulse(1067,31.62%),slippery pulse(795,23.56%),and deep pulse(755,22.38%).The tongue color was mainly purple dusky(1703,50.47%),and white coating(2184,64.73%),thin coating(1321,39.15%),and greasy coating(1181,35.00%)were mostly common seen.The top four TCM syndromes were qi deficiency and blood stasis(737,21.84%),qi deficiency and phlegm stasis(432,12.80%),binding of phlegm and stasis(427,12.66%),and heart and blood stasis obstruction(393,11.65%).The syndromes were mostly deficiency-excess complex,and ac⁃companied by blood stasis and phlegm turbidity.The top four syndrome elements were blood stasis(2814,83.40%),qi deficiency(1928,57.14%),phlegm turbidity(1495,44.31%),and yin deficiency(560,16.60%).Syndrome elements association analysis showed that phlegm turbidity,blood stasis,and qi deficiency have the strongest correla⁃tion,among which the combination of phlegm turbidity and blood stasis is the strongest.The annual distribution of the syndrome elements between 2015 to 2020 showed that the proportions of the syndrome elements of yin deficiency,phlegm turbidity and blood stasis were statistically different(P<0.05),while the differences among other syn⁃drome elements were not statistically significant(P>0.05).Conclusion The basic pathogenesis of modern coro⁃nary heart disease is still root deficiency and branch excess,and the syndromes are mainly deficiency-excess com⁃plex,accompanied with phlegm and stasis.The syndrome elements related to branch excess account for the largest proportion,especially manifested as phlegm and blood stasis.