摘要
【目的】基于冠状动脉(简称冠脉)、颈动脉、心脏病变及其相关指标回顾性研究胸痹心痛患者热毒血瘀证血管及其相关因素的辨证特征。【方法】回顾性收集221例胸痹心痛患者,根据中医辨证分型情况将患者分为热毒血瘀证154例和非热毒血瘀证67例,进行人口学特征、心血管危险因素相关疾病、理化指标、冠脉Gensini评分、颈动脉超声、心脏超声等指标的采集。比较热毒血瘀证与非热毒血瘀证患者各项指标的差异,并采用Spearman或Pearson分析探讨胸痹心痛热毒血瘀证与冠脉、颈动脉病变及其相关指标的相关性。【结果】(1)人口学特征及相关疾病分析结果提示,与非热毒血瘀证相比,胸痹心痛热毒血瘀证患者以男性发病为主(P=0.001),吸烟史及不稳定型心绞痛(UA)、急性非ST段抬高型心肌梗死(NSTEMI)、急性ST段抬高型心肌梗死(STEMI)等冠心病类型的比例较高,且多合并血脂异常(P<0.01或P<0.001),而热毒血瘀证与非热毒血瘀证在合并其他疾病方面比较,差异均无统计学意义(P>0.05)。(2)理化指标分析结果提示,胸痹心痛热毒血瘀证患者的甘油三酯(TG)及肌酸激酶同工酶MB(CK-MB)较高,高密度脂蛋白胆固醇(HDL-C)较低,与非热毒血瘀证比较,差异均有统计学意义(P<0.01),而2组的糖化血红蛋白(HbA1c)、空腹血糖(FBG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、血清尿酸(UA)、同型半胱氨酸(Hcy)、B型钠尿肽(BNP)、体质量指数(BMI)比较,差异均无统计学意义(P>0.05)。(3)冠脉狭窄Gensini评分分析结果提示,热毒血瘀证患者的冠脉狭窄Gensini评分较非热毒血瘀证显著升高(P<0.01);且热毒血瘀证患者的冠脉狭窄以中重度为主,占54.55%(84/154),非热毒血瘀证患者以正常或轻度狭窄为主,占76.12%(51/67),差异有统计学意义(P<0.01)。(4)颈动脉斑块分析结果提示,与非热毒血瘀证比较,热毒血瘀证患者的左、右侧颈动脉内膜中层厚度(IMT)均增厚,存在斑块的比例较高[占79.79%(75/94)],差异均有统计学意义(P<0.01)。(5)心脏结构及功能分析结果提示,热毒血瘀证与非热毒血瘀证之间的左室舒张末期内径(LVDd)、左室射血分数(LVEF)、左心房收缩末期前后径(LA)、二尖瓣侧壁瓣环舒张期e’值及E/e’值均未见显著性差异(P>0.05),但左室舒张功能相关指标e’值较低、E/e’值较高,提示热毒血瘀证患者可能存在舒张功能受损。(6)相关性分析结果提示,胸痹心痛热毒血瘀证与冠心病类型、基于Gensini评分的冠脉狭窄程度及左、右侧颈动脉IMT相关,相关系数分别为0.418、0.320、0.269、0.205(P<0.001);与男性、吸烟、血脂异常、CK-MB具有一定相关性,相关系数分别为0.216、0.186、0.266、0.193(P<0.01)。【结论】胸痹心痛热毒血瘀证大多处于不稳定阶段,冠脉及颈动脉血管病变均较严重,与血脂异常及左、右侧颈动脉IMT有关,临证时应抓住中医热毒血瘀证的辨证特征,诊病于微,已病防变。
Objective To retrospectively investigate the syndrome-identification characteristics of vascular lesions and related factors in patients with chest qi-blockage and heart pain of heat-toxin and blood-stasis syndrome based on the pathological changes in the coronary artery,carotid artery,and heart.Methods The clinical information of 221 patients with chest qi-blockage and heart pain was retrospectively collected.The patients were divided into Redu Xueyu group(154 cases with heat-toxin and blood-stasis syndrome)and non-Redu Xueyu group(67 cases without heat-toxin and blood-stasis syndrome).The clinical information included the demographic characteristics,cardiovascular risk factor-related diseases,physiochemical parameters,coronary artery Gensini scores,carotid ultrasonography,and cardiac ultrasonography.Differences of the indicators in patients with or without heat-toxin and blood-stasis syndrome were compared,and the correlation of chest qi-blockage and heart pain of heat-toxin and blood-stasis syndrome with the pathological changes in the coronary artery and carotid artery were analyzed by Spearman’s or Pearson’s analysis.Results(1)The analysis results for demographic characteristics and cardiovascular risk factor-related diseases suggested that compared with non-Redu Xueyu group,Redu Xueyu group were predominated by the male patients(P=0.001),with higher percentages of smoking history and coronary heart diseases such as unstable angina pectoris(UA),acute non-ST-segment elevation myocardial infarction(NSTEMI),and acute ST-segment elevation myocardial infarction(STEMI),and with a high incidence of the complication of dyslipidemia(P<0.01 or P<0.001).However,no statistically significant difference was found in the incidence of other diseases between Redu Xueyu group and non-Redu Xueyu group(P>0.05).(2)The analysis results for physicochemical indexes suggested that patients with chest qi-blockage and heart pain in Redu Xueyu group had higher triglyceride(TG)and creatine kinase MB isoenzyme(CK-MB)levels and lower high-density lipoprotein cholesterol(HDL-C)level than non-Redu Xueyu group,and the differences were statistically significant(P<0.01).However,no statistically significant differences were presented in the glycated hemoglobin(HbA1c),fasting blood glucose(FBG),low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC),serum uric acid(UA),homocysteine(Hcy),B-type natriuretic peptide(BNP),and body mass index(BMI)between Redu Xueyu group and non-Redu Xueyu group(P>0.05).(3)The analysis results for Gensini score of coronary artery stenosis showed that Redu Xueyu group had higher Gensini scores than non-Redu Xueyu group(P<0.01)and coronary artery stenosis in the patients of Redu Xueyu group was predominated by moderate and severe types,accounting for 54.55%(84/154),whereas the patients in non-Redu Xueyu group usually had no coronary artery stenosis or just mild stenosis,accounting for 76.12%(51/67),and the difference was statistically significant(P<0.01).(4)The analysis results for carotid artery plaque suggested that the intima-media thickness(IMT)of the left and the right carotid arteries in Redu Xueyu group was increased and the incidence of carotid artery plaque was relatively high[accounting for 79.79%(75/94)]compared with those in non-Redu Xueyu group,and the differences were statistically significant(P<0.01).(5)The analysis results for cardiac structure and function suggested that no significant differences were presented in left ventricular end-diastolic diameter(LVDd),left ventricular ejection fraction(LVEF),left atrial end-systolic anterior-posterior diameter(LA),mitral lateral wall annulus diastolic e’values and E/e’values between Redu Xueyu group and non-Redu Xueyu group(P>0.05),but in terms of left ventricular diastolic function indicators,the Redu Xueyu group had lower e’value and higher E/e’value,indicating the possibility of the presence of diastolic function damage.(6)The results of correlation analysis suggested that chest qi-blockage and heart pain of heat-toxin and blood-stasis syndrome was correlated with the type of coronary artery disease,the degree of coronary stenosis evaluated with the Gensini score,and the IMT of the left and right carotid artery,with the correlation coefficients of 0.418,0.320,0.269 and 0.205,respectively(P<0.001),and were also correlated with the male gender,smoking history,dyslipidemia,and CK-MB,with the correlation coefficients of 0.216,0.186,0.266,and 0.193,respectively(P<0.01). Conclusion Most of the patients with chest qi-blockage and heart pain of heat-toxin and blood-stasissyndrome are at the unstable stage and have severe vascular lesions of coronary artery and carotid artery,which iscorrelated with dyslipidemia and the thickening of IMT of left and right carotid artery. In clinic,the identificationof syndrome-differentiation features of heat-toxin and blood-stasis syndrome will be helpful for the early diagnosisof the disease and for the prevention of aggravation after disease.
作者
姚美丹
李雨
黄尉威
冼绍祥
王卢曦
陈洁
YAO Mei-Dan;LI Yu;HUANG Wei-Wei;XIAN Shao-Xiang;WANG Lu-Xi;CHEN Jie(Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Huazhong University of Science and Technology Union Shenzhen Hospital,Shenzhen 518000 Guangdong,China)
出处
《广州中医药大学学报》
CAS
2024年第2期263-271,共9页
Journal of Guangzhou University of Traditional Chinese Medicine
基金
国家自然科学基金项目(编号:81973776)
广州市市校(院)联合资助项目基础与应用基础研究项目(编号:202201020342)
广州市科技局2022年重点研发项目(编号:2060404)
深圳市医疗卫生三名工程项目(编号:SZZYSM202106006)
国家中医临床研究基地建设项目(编号:国中医药科技函[2018]131号)
冼绍祥全国名老中医药专家传承工作室项目[国中医药人教函(2022)75号]。
关键词
胸痹心痛
冠心病
热毒血瘀证
颈动脉斑块
GENSINI评分
相关性
chest qi-blockage and heart pain
coronary heart disease
heat-toxin and blood-stasis syndrome
carotid plaque
Gensini score
correlation
