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冠心病不同阶段临床特征与证素分布的回顾性横断面调查

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回顾性采集2022年1月-2023年3月在广州中医药大学第一附属医院、深圳市中西医结合医院诊疗的冠心病(CHD)患者临床资料,描述性分析人口学特征、临床症状与舌脉特征,x2检验分析不同阶段的证素及证素组合分布差异,探讨CHD不同病理阶段的临床特征与证素规律。研究提取28条症状条目、10条舌象条目与7条脉象条目;归纳心、肺、肝、脾、肾5个主要病位,血瘀、痰湿、气滞、热(火)、水饮、气虚、阴虚、阳虚8个主要病性,凝练8种病性组合形式。证素分布的x2检验结果示,肺、肝、脾、肾、血瘀、气滞、热(火)、水饮、气虚、阴虚、阳虚证素在CHD不同阶段的分布差异显著,肝、血瘀、热(火)、气滞证素在不稳定期占比最高,肺、脾、肾、水饮、气虚、阴虚、阳虚证素在终末期占比最高;气虚证素在经皮冠状动脉介入术(PCI)术后不同时间段的分布差异显著。证素组合的x2检验结果示,单病位、多病位、单病性、双病性、多病性、单纯实证、虚实夹杂组合在CHD不同阶段的分布差异显著,单病位、单病性、单纯实证在稳定期占比最高,双病性在不稳定期占比最高,多病位、多病性、虚实夹杂在终末期占比最高。结果表明,稳定期痰瘀并重,不稳定期存在瘀毒致变的病理转折,PCI术后总体气虚加剧,终末期损及阴阳、水饮渐盛。CHD不同阶段的临床特征与证素分布存在显著差异,是以虚实消长、痰瘀共病为基本病机的病理过程。
Retrospective cross-sectional survey of clinical characteristics and syndrome elements distribution at different stages of coronary heart disease
The clinical data of coronary heart disease(CHD)patients treated in the First Affiliated Hospital of Guangzhou Universi-ty of Chinese Medicine and Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine from January 2022 to March 2023 were retrospectively collected.This study involved the descriptive analysis of demographic characteristics,clinical symptoms,and tongue and pulse features.The x2 test was conducted to analyze the distribution of syndrome elements and their combinations at diffe-rent stages of CHD,so as to reveal the clinical characteristics and syndrome patterns at various pathological stages of CHD.This study extracted 28 symptom entries,10 tongue manifestation entries,and 7 pulse manifestation entries,summarized the 5 main disease loca-tions of the heart,lung,liver,spleen,and kidney,and the 8 main disease natures of blood stasis,phlegm turbidity,Qi stagnation,heat(fire),fluid retention,Qi deficiency,Yin deficiency,and Yang deficiency and 8 combinations of disease natures.The x2 test showed significant differences in the distribution of syndrome elements including the lung,liver,spleen,kidney,blood stasis,heat(fire),Qi stagnation,heat syndrome,water retention,Qi deficiency,Yin deficiency,and Yang deficiency between different disease stages.Specifically,the liver,blood stasis,heat(fire),and Qi stagnation accounted for the highest proportion during unstable stage,and the lung,spleen,kidney,water retention,Qi deficiency,Yin deficiency,and Yang deficiency accounted for the highest proportion at the end stage.The distribution of Qi deficiency varied in the different time periods after percutaneous coronary intervention(PCI).As shown by the x2 test of the syndrome elements combination,the distribution of single disease location,multiple disease locations,single disease nature,double disease natures,multiple natures,excess syndrome,and mixture of deficiency and excess varied signifi-cantly at different stages of CHD.Specifically,single disease location,single disease nature,and excess syndrome accounted for the highest proportion during the stable stage,and double disease natures accounted for the highest proportion during the unstable stage.Multiple disease locations,multiple disease natures,and mixture of deficiency and excess accounted for the highest proportion during the end stage.In conclusion,phlegm turbidity and blood stasis were equally serious during the stable stage,and a pathological mecha-nism caused by blood stasis and toxin existed during the unstable stage.The overall Qi deficiency worsened after PCI,and the end stage was accompanied by the Yin and Yang damage and the aggravation of water retention.There were significant differences in the distribution of clinical characteristics and syndrome elements at different stages of CHD.The pathological process of CHD witnessed the growth and decline of deficiency and excess and the combination of phlegm turbidity and blood stasis,which constituted the basic pathogenesis.

coronary heart diseaseacute coronary syndromepercutaneous coronary interventionchronic heart failuresyndrome elementsretrospective research

钟森杰、赵新元、高翔、黄汝银、陈洁、吴辉、方红城、冼绍祥

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广州中医药大学第一附属医院,广东广州 510405

广州中医药大学博士后科研流动站,广东广州 510006

深圳市中西医结合医院,广东 深圳 518104

冠心病 急性冠脉综合征 经皮冠状动脉介入术 慢性心力衰竭 证素 回顾性研究

国家中医临床研究基地建设项目冼绍祥岐黄学者工作室项目广州市校(院)联合资助项目基础与应用基础研究项目广州市科技局重点研发项目(2022)深圳市医疗卫生三名工程项目

国中医药科技函[2018]131号2022010203422060404SZZYSM202106006

2024

中国中药杂志
中国药学会

中国中药杂志

CSTPCD北大核心
影响因子:1.718
ISSN:1001-5302
年,卷(期):2024.49(5)
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