超高危动脉粥样硬化性心血管疾病证候分布规律研究

Investigation of Syndrome Distribution Patterns in Ultra High-risk Atherosclerotic Cardiovascular Disease

目的 调查超高危动脉粥样硬化性心血管疾病(ASCVD)患者的中医证候分布规律,探索超高危ASCVD的核心病机。方法 纳入2022年3月1日—2022年12月31日就诊于中国中医科学院西苑医院心血管病中心诊断为超高危ASCVD的患者,收集患者基本信息、病史及中医四诊信息,进行频数分析、因子分析、聚类分析和关联规则分析。结果 纳入的200例患者中,最常见的症状为口苦、反复发作胸痛、胸痛发作进行性加重、气短、口干、倦怠乏力、口气臭秽、急躁易怒、小便黄、口唇色暗等;频率最高的脉象为弦脉和滑脉,相兼脉象为弦滑脉;最常见的舌象为苔黄、舌色紫暗、老舌。通过因子及聚类分析可将证候分为三类:瘀毒互结证、气虚兼阳虚证及痰热内阻证。常见证素为瘀毒、气虚、阳虚、痰浊、气滞。结论 超高危ASCVD患者常见证候为瘀毒互结证、气虚证、阳虚证、痰热内阻证,其核心病机可归纳为“正气亏虚,痰瘀蕴毒”。

Objective To investigate the distribution of Chinese medicine(CM)syndromes in patients with ultra high-risk atherosclerotic cardiovascular disease(ASCVD),and to explore the core pathogenesis.Methods Patients diagnosed with ultra high-risk ASCVD who visited Center for Chinese Medicine Cardiology,Xiyuan Hospital from March 1,2022,to December 31,2022,were included.Data of patients'demographics,medical history,and CM diagnostic information were collected.Analytical methods such as frequency analysis,factor analysis,cluster analysis,and association rule analysis were utilized to assess the data.Results Among the 200 patients included in the study,the most frequently reported symptoms were bitter mouth,recurrent chest pain,progressively worsening chest pain,shortness of breath,dry mouth,fatigue,foul breath,irritability,dark yellow urine,and dark lip color,etc.The most common pulse types observed were string and slippery pulses,and string-slippery pulse was the most common concurrent pulse.The most common tongue manifestations were yellow coating,dark purple tongue,and old tongue.Through factor and cluster analysis,it can be divided into three types:intermingled blood stasis and toxins,qi and yang deficiency,and phlegm-heat internal obstruction.The predominant CM syndromes identified were blood stasis and toxins,qi deficiency,yang deficiency,phlegm turbidity,and qi stagnation.Conclusions The most prevalent syndromes in ultra highrisk ASCVD patients were intermingled blood stasis and toxins,qi deficiency,yang deficiency,and phlegm-heat internal obstruction.The fundamental pathogenesis in these patients can be summarized as a"deficiency of vital energy,and accumulation of phlegm and blood stasis containing toxins".