不同中医证型急性心梗患者TyG指数、病变血管及心室重构分析观察

Analysis of TyG Index,Culprit Vessel and Ventricular Remodeling in Patients with Acute Myocardial Infarction of Different Traditional Chinese Medicine Syndrome Types

目的观察不同中医证型急性心肌梗死患者TyG指数、病变血管类型及心室重构的临床差异。方法选取急性心肌梗死患者115例,根据《急性心肌梗死中医临床诊疗指南》分为6种中医证型:痰瘀互结证、气虚血瘀证、气滞血瘀证、寒凝心脉证、气阴两虚证及正虚阳脱证,分析不同证型急性心肌梗死患者冠脉病变支数、病变血管类型、TyG指数、心室重构的差异。结果115例急性心肌梗死患者中痰瘀互结证41例、气虚血瘀证28例、气滞血瘀证29例、气阴两虚证15例、正虚阳脱证2例、寒凝心脉证0例。病变血管为前降支病变的急性心肌梗死中医证型分布:气滞血瘀>气阴两虚>痰瘀互结>气虚血瘀。病变血管为右冠状动脉病变的急性心肌梗死中医证型分布:痰瘀互结>气阴两虚>气虚血瘀>气滞血瘀。病变血管为回旋支的急性心肌梗死中医证型以气虚血瘀和痰瘀互结为主。单支病变以气滞血瘀为主,其次痰瘀互结;双支病变以气虚血瘀为主,其次气滞血瘀,3支病变则以气阴两虚为主,其次痰瘀互结。痰瘀互结证患者的TyG指数与气虚血瘀证、气滞血瘀证患者TyG指数相比较高,差异有统计学意义(P<0.05);与气阴两虚证患者比较差异无统计学意义(P>0.05)。痰瘀互结证患者的甘油三酯水平高于气虚血瘀证、气阴两虚证、气滞血瘀证患者,比较差异有统计学意义(P<0.05)。4组证型急性心肌梗死患者总胆固醇、高密度脂蛋白、低密度脂蛋白水平比较,差异无统计学意义(P>0.05)。4组证型患者心脏射血分数(EF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)值对比无明显差异(P>0.05)。Spearman相关性分析显示,急性心肌梗死中医痰瘀互结证与LVEDD呈正相关(r=0.204,P<0.05)。结论急性心肌梗死患者冠脉病变支数、TyG指数、甘油三酯、病变血管类型与中医证型有关;痰瘀互结证患者TyG指数最高;多支病变的急性心肌梗死患者均存在气虚证;痰瘀互结证与LVEDD呈正相关。TyG指数、LVEDD对急性心肌梗死的痰瘀互结证辨证具有参考意义。

Objective:To observe the clinical differences in TyG index,types of lesion vessels,and ventricular remodeling in patients with acute myocardial infarction(AMI)of different TCM syndrome types.Methods:A total of 115 patients were selected.According to the“Clinical Guidelines for the TCM Diagnosis and Treatment of Acute Myocardial Infarction”,they were classified into six TCM syndromes:phlegm-stasis intermingled syndrome,qi deficiency and blood stasis syndrome,qi stagnation and blood stasis syndrome,cold coagulation in the heart meridian syndrome,qi and yin deficiency syndrome,and qi deficiency and yang collapse syndrome.The differences in the number of coronary artery lesions,types of lesion vessels,TyG index,and ventricular remodeling among patients with different TCM syndromes were analyzed.Results:Among the 115 patients with AMI,there were 41 cases of phlegm-stasis intermingled syndrome,28 cases of qi deficiency and blood stasis syndrome,29 cases of qi stagnation and blood stasis syndrome,15 cases of qi and yin deficiency syndrome,2 cases of qi deficiency and yang collapse syndrome,and 0 cases of cold coagulation in the heart meridian syndrome.For lesions in the anterior descending branch,the distribution of TCM syndromes was in order of qi stagnation and blood stasis>qi and yin deficiency>phlegm-stasis intermingled>qi deficiency and blood stasis.For lesions in the right coronary artery,the distribution was phlegm-stasis intermingled>qi and yin deficiency>qi deficiency and blood stasis>qi stagnation and blood stasis.For lesions in the circumflex artery,the predominant TCM syndromes were qi deficiency and blood stasis and phlegm-stasis intermingled.Single vessel lesions were predominantly qi stagnation and blood stasis,followed by phlegm-stasis intermingled.Two-vessel lesions were predominantly qi deficiency and blood stasis,followed by qi stagnation and blood stasis.Three-vessel lesions were predominantly qi and yin deficiency,followed by phlegm-stasis intermingled.The TyG index in patients with phlegm-stasis intermingled syndrome was significantly higher than in patients with qi deficiency and blood stasis syndrome and qi stagnation and blood stasis syndrome(P<0.05),but not significantly different from patients with qi and yin deficiency syndrome(P>0.05).The triglyceride levels in patients with phlegm-stasis intermingled syndrome were significantly higher than in patients with qi deficiency and blood stasis syndrome,qi and yin deficiency syndrome,and qi stagnation and blood stasis syndrome(P<0.05).There was no significant difference in total cholesterol,high-density lipoprotein,and low-density lipoprotein levels among the four groups(P>0.05).There was no significant difference in ejection fraction(EF),left ventricular end-diastolic diameter(LVEDD),and left ventricular end-systolic diameter(LVESD)values among the four groups(P>0.05).Spearman correlation analysis showed a positive correlation between the phlegm-stasis intermingled syndrome in LVEDD(r=0.204,P<0.05).Conclusion:The number of coronary artery lesions,TyG index,triglycerides,and types of lesion vessels are associated with TCM syndromes in patients with AMI.Patients with phlegm-stasis intermingled syndrome have the highest TyG index.Patients with multi-vessel lesions in AMI all have qi deficiency syndrome.The phlegm-stasis intermingled syndrome in AMI is positively correlated with LVEDD.The TyG index and LVEDD have reference significance for the differentiation of the phlegm-stasis intermingled syndrome in AMI.