冠心病不同发展阶段中医证演变规律研究
|
摘要
目的:探索冠心病不同发展阶段中医证演变规律。方法:系统检索中国知识基础设施(CNKI)、中文科技期刊数据库(VIP)、万方数据资源系统、PubMed等数据库,纳入2017年至2018年有关冠心病辨证分型的文献,对其中冠心病不同发展阶段单元证的分布进行统计分析。结果:①最终纳入80篇目标文献,合计21 361例冠心病患者,涉及22个省、市、自治区,单元证频数统计前4位为血瘀(54.98%)、气虚(40.41%)、痰湿(浊)(36.44%)、阴虚(20.34%),呈血瘀>气虚>痰湿(浊)>阴虚>热蕴>气滞>阳虚>内毒>寒凝>水饮>血虚的趋势;②纵向比较结果显示,冠心病发展大致经历稳定期、活动期、介入术后期、终末(心衰)期,稳定期患者以痰湿(浊)、血瘀、气虚、阴虚为主;活动期热蕴、内毒比例升高;介入术后期除气滞比例升高外,总体由实转虚,即血瘀、热蕴、内毒比例较术前下降,气虚、阳虚比例明显升高;终末期以血瘀、水饮、痰湿(浊)、气虚、阴虚、阳虚为主要证候表现。结论:冠心病发生发展可能存在证的演变规律,即"痰""瘀""虚"贯穿始终,活动期"热""毒"加重,介入术后期总体由实转虚,终末期则血瘀、水饮及气阴两虚之象显著加重。
Objective: To explore the evolution rule of traditional Chinese medicine(TCM) syndrome in different development stages of coronary heart disease(CHD). Methods: The Chinese National Knowledge Infrastructure(CNKI), Chinese Scientific Journal Database(VIP), Wanfang Database and PubMed were systematically searched and included in the literature on syndrome differentiation and classification of CHD from 2017 to 2018, and the distribution of unit syndromes in different stages of CHD was statistically analyzed. Results: Eighty literatures covering 22 provinces, municipalities and autonomous regions,and 21 361 patients with CHD were included. The top four TCM unit syndromes in frequency were blood stasis(54.98%), qi deficiency(40.41%), phlegm dampness(36.44%) and yin deficiency(20.34%), showing the trend of blood stasis > qi deficiency >phlegm dampness > yin deficiency > heat > qi stagnation > yang deficiency > internal toxicity > cold coagulation > excessive fluid> blood deficiency. The results of longitudinal comparison showed that the development of CHD generally goes through stable stage, active stage, post-interventional stage and end-stage(heart failure), while phlegm dampness, blood stasis, qi deficiency and yin deficiency were the main syndromes in the stable stage of CHD. During the active stage, the proportion of heat and internal toxicity increased. After interventional therapy, the ratio of blood stasis, heat and internal toxicity decreased, but qi deficiency,yang deficiency and qi stagnation increased significantly. At the end stage, blood stasis, excessive fluid, phlegm dampness, qi deficiency, yin deficiency and yang deficiency were the main symptoms. Conclusion: TCM syndrome in different development stages of CHD may have a rule of evolution: Phlegm dampness, blood stasis and deficiency run through the whole process of CHD; heat and toxicity increased during the active period; after surgery intervention, syndromes changed from excessive to deficiency. Lastly, blood stasis, excessive fluid, qi deficiency and yin deficiency increase significantly at the end stage of CHD.
Objective: To explore the evolution rule of traditional Chinese medicine(TCM) syndrome in different development stages of coronary heart disease(CHD). Methods: The Chinese National Knowledge Infrastructure(CNKI), Chinese Scientific Journal Database(VIP), Wanfang Database and PubMed were systematically searched and included in the literature on syndrome differentiation and classification of CHD from 2017 to 2018, and the distribution of unit syndromes in different stages of CHD was statistically analyzed. Results: Eighty literatures covering 22 provinces, municipalities and autonomous regions,and 21 361 patients with CHD were included. The top four TCM unit syndromes in frequency were blood stasis(54.98%), qi deficiency(40.41%), phlegm dampness(36.44%) and yin deficiency(20.34%), showing the trend of blood stasis > qi deficiency >phlegm dampness > yin deficiency > heat > qi stagnation > yang deficiency > internal toxicity > cold coagulation > excessive fluid> blood deficiency. The results of longitudinal comparison showed that the development of CHD generally goes through stable stage, active stage, post-interventional stage and end-stage(heart failure), while phlegm dampness, blood stasis, qi deficiency and yin deficiency were the main syndromes in the stable stage of CHD. During the active stage, the proportion of heat and internal toxicity increased. After interventional therapy, the ratio of blood stasis, heat and internal toxicity decreased, but qi deficiency,yang deficiency and qi stagnation increased significantly. At the end stage, blood stasis, excessive fluid, phlegm dampness, qi deficiency, yin deficiency and yang deficiency were the main symptoms. Conclusion: TCM syndrome in different development stages of CHD may have a rule of evolution: Phlegm dampness, blood stasis and deficiency run through the whole process of CHD; heat and toxicity increased during the active period; after surgery intervention, syndromes changed from excessive to deficiency. Lastly, blood stasis, excessive fluid, qi deficiency and yin deficiency increase significantly at the end stage of CHD.
引文
[1]世界卫生组织.心血管疾病.http://www.who.int/zh/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds),2018-7-16
[2]马丽媛,吴亚哲,王文,等.《中国心血管病报告2017》要点解读.中国心血管杂志,2018,23(1):3-6
[3]国家卫生和计划生育委员会.中国卫生和计划生育统计年鉴2017.北京:中国协和医科大学出版社,2017:298
[4]Bi Y F,Mao J Y,Wang X L,et al.Study on syndrome differentiation and treatment in the management of chronic stable coronary artery disease to improve quality of life.Medicine,2018,97(36):e12097
[5]Zhao Y,Yu X,Cao X,et al.Cluster analysis for syndromes of realworld coronary heart disease with angina pectoris.Frontiers of Medicine,2018,12(5):566-571
[6]Zhu H M,Zhou J M,Jin X J,et al.Observational study of Chinese medicine syndrome distribution in patients with acute myocardial infarction and its impact on prognosis.Chinese Journal of Integrative Medicine,2016:1-6
[7]Bi Y F,Mao J Y,Wang X L,et al.Expert survey for Chinese medicine syndrome characteristics of different clinical types of coronary artery disease based on the Delphi method.Chinese Journal of Integrative Medicine,2014,34(10):1192-1196
[8]Kong D,Wang Y,Liu Y,et al.The association between blood lipid and phlegm turbidity syndrome of angina pectoris:A systematic review and meta-analysis.Complementary Therapies in Medicine,2014,22(4):801-813
[9]Wang J,Yu G.Study on microRNA and Chinese medicine syndromes of coronary artery disease.Chinese Journal of Integrated Traditional&Western Medicine,2012,32(11):1562
[10]Ma X J,Yin H J,Chen K J.Differential gene expression profiles in coronary heart disease patients of blood stasis syndrome in traditional Chinese medicine and clinical role of target gene.Chinese Journal of Integrative Medicine,2009,15(2):101
[11]Bi Y F,Mao J Y,Wang X L,et al.Clinical epidemiology survey of the traditional Chinese medicine etiology and syndrome differentiation of coronary artery disease:Study protocol of a multicenter trial.Journal of Chinese Integrative Medicine,2012,10(6):619
[12]李贵华,姜红岩,谢雁鸣,等.基于大数据84697例冠心病中医证候及其中西药使用分析.中国中药杂志,2014,39(18):3462
[13]杨茗茜,张哲,袁东超,等.冠心病心绞痛中医证候的相关研究.中国实验方剂学杂志,2015,21(7):174-178
[14]毛静远,牛子长,张伯礼.近40年冠心病中医证候特征研究文献分析.中医杂志,2011,52(11):958-961
[15]毕颖斐,王贤良,赵志强,等.冠心病现代中医证候特征的临床流行病学调查.中医杂志,2017,58(23):2013-2019
[16]Nomenclature and criteria for diagnosis of ischemic heart disease.Report of the Joint International Society and Federation of Cardiology/World Health Organization task force on standardization of clinical nomenclature.Circulation,1979,59(3):607-609
[17]柯元南,陈纪林.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南.中华心血管病杂志,2007,35(4):295-304
[18]王阶,李军,毛静远,等.冠心病心绞痛主要证型的辨证诊断标准.中国中西医结合杂志,2018,38(2):154-155
[19]世界中医药学会联合会介入心脏病专业委员会.经皮冠状动脉介入治疗围手术期心肌损伤中医诊疗专家共识.中国中西医结合杂志,2017,37(4):389-393
[20]中国中西医结合学会心血管疾病专业委员会.慢性心力衰竭中西医结合诊疗专家共识.心脑血管病防治,2016,16(5):142-145
[21]陈可冀.冠心病(心绞痛、心肌梗塞)中医辨证试行标准.中华内科杂志,1980(5):375
[22]CFDA.中药新药临床研究指导原则.北京:中国医药科技出版社,2002:69
[23]王永炎,张志斌.再议完善辨证方法体系的几个问题.天津中医药,2007,24(1):1-4
[24]Yao H,Mo S,Wang J,et al.Genome-wide DNA methylation profiles of phlegm-dampness constitution.Cellular Physiology&Biochemistry,2018,45(5):1999-2008
[25]Gui Yu,Jie Wang.Susceptible gene polymorphisms for blood stasis syndrome of coronary heart disease.Chinese Journal of Integrative Medicine,2016:1-8
[26]Wang Y,Li C,Chang H,et al.Metabolomic profiling reveals distinct patterns of tricarboxylic acid disorders in blood stasis syndrome associated with coronary heart disease.Chinese Journal of Integrative Medicine,2016,22(8):1-8
[27]张红栓,贾钰华,华何与,等.冠心病心绞痛痰浊证、血瘀证的尿液代谢组学研究.中国中医基础医学杂志,2010,16(2):126-128
[28]Chen J,Cai H W,Miao J,et al.Danlou Tablet Fought against Inflammatory Reaction in Atherosclerosis Rats with Intermingled Phlegm and Blood Stasis Syndrome and Its Mechanism Study.Chinese Journal of Integrative Medicine,2016,36(6):703
[29]Wang S H,Wang J,Li J.Efficacy assessment of treating patients with coronary heart disease angina of phlegm and stasis mutual obstruction syndrome by Danlou tablet.Chinese Journal of Integrated Traditional&Western Medicine,2012,32(8):1051
[30]任得志,张军茹,申仙利.丹蒌片治疗痰瘀互结型冠心病不稳定型心绞痛的临床观察.中西医结合心脑血管病杂志,2014,12(8):1022-1023
[31]胡媛媛.荷丹片痰瘀同治的临床应用.中西医结合心脑血管病杂志,2014,12(6):767-768
[32]Xu R X,Wu N Q,Li S,et al.Effects of Hedan Tablet,on lipid profile,proprotein convertase subtilisin/kexin type 9 and high-density lipoprotein subfractions in patients with hyperlipidemia:A primary study.Chinese Journal of Integrative Medicine,2016,22(9):1-6
[33]卢红蓉,杜松,胡镜清.痰瘀互结证治理论源流考.中医杂志,2015,56(10):811-815
[34]杜松,胡镜清,卢红蓉.痰瘀互结证现代理论研究进展述评.中国中医基础医学杂志,2015,21(4):477-482
[35]胡镜清,王传池,段飞,等.冠心病痰瘀互结证宏观诊断标准研究.中国中西医结合杂志,2016,36(10):1164-1168
[36]段飞,胡镜清.冠心病痰瘀互结证病机转化为阻络、化火、生毒证候宏观及微观诊断指标的权重研究.中国中西医结合杂志,2017,37(5):612-616
[37]王传池,胡镜清,江丽杰,等.痰瘀互结证病证结合研究疗效评价指标回顾分析.世界科学技术:中医药现代化,2016,18(5):800-804
[38]陈苍舒,雷励.冠心病炎症机理与热毒痰瘀相关性探讨.中国中医急症,2007,6(3):311-312
[39]卢红蓉,杜松.冠心病病因病机理论研究概述.环球中医药,2015,8(2):186-189
[40]钮瑶,张哲,白弘,等.论急性冠脉综合征的痰瘀热毒.时珍国医国药,2016,27(11):2708-2710
[41]胡镜清.病机兼化理论框架下的冠心病病机解析.中国中医基础医学杂志,2017,23(1):4-7
[42]彭锐,吴伟,葛昕.从炎症因子角度谈冠心病热毒病机.世界中西医结合杂志,2010,5(8):732-735
[43]Choi J Y,Lee J A,Lee J B,et al.Anti-inflammatory activity of houttuynia cordata against Lipoteichoic acid-induced Inflammation in human dermal fibroblasts.Chonnam Medical Journal,2010,46(3):140-147
[44]Ma C,Zhu L,Wang J,et al.Anti-inflammatory effects of water extract of Taraxacum mongolicum hand-Mazz on lipopolysaccharideinduced inflammation in acute lung injury by suppressing PI3K/Akt/mTOR signaling pathway.Journal of Ethnopharmacology,2015,168(3):349-355
[45]Nikzad-Langerodi R,Ortmann S,Pferschy-Wenzig E M,et al.Assessment of anti-inflammatory properties of extracts from Honeysuckle(Lonicera sp.L.Caprifoliaceae)by ATR-FTIR spectroscopy.Talanta,2017,175:264-272
[46]Zheng F,Qu D,Xu H.Relationship between Chinese medicine syndrome and serum level of high-sensitivity C-reactive protein in patients with stable coronary heart disease.Chinese Journal of Integrated Traditional&Western Medicine,2009,29(6):485-488
[47]荣杰,许颖智,张军平.冠心病患者介入术前后中医证候演变规律分析.中医杂志,2012,53(23):2027-2030
[48]褚福永,王阶,刘红旭,等.不稳定型心绞痛冠脉介入期间中医证候动态演变规律研究.中华中医药杂志,2013,28(3):627-630
[49]葛均波,徐永健.内科学.8版.北京:人民卫生出版社,2013:227
[50]张琳,于鑫婷,徐浩.冠心病中医证候特点的分析与思考.中西医结合心脑血管病杂志,2009,7(5):578-581
[51]杜莹,贾连群,王列,等.冠心病心绞痛证型分布及辨证规律系统综述.实用中医内科杂志,2014,28(3):1-2
[52]李施新,李远,刘孟敏.基于关联规则和复杂系统熵聚类的100位全国名老中医治疗冠心病证治规律研究.中华中医药杂志,2016,31(4):1258-1261
[2]马丽媛,吴亚哲,王文,等.《中国心血管病报告2017》要点解读.中国心血管杂志,2018,23(1):3-6
[3]国家卫生和计划生育委员会.中国卫生和计划生育统计年鉴2017.北京:中国协和医科大学出版社,2017:298
[4]Bi Y F,Mao J Y,Wang X L,et al.Study on syndrome differentiation and treatment in the management of chronic stable coronary artery disease to improve quality of life.Medicine,2018,97(36):e12097
[5]Zhao Y,Yu X,Cao X,et al.Cluster analysis for syndromes of realworld coronary heart disease with angina pectoris.Frontiers of Medicine,2018,12(5):566-571
[6]Zhu H M,Zhou J M,Jin X J,et al.Observational study of Chinese medicine syndrome distribution in patients with acute myocardial infarction and its impact on prognosis.Chinese Journal of Integrative Medicine,2016:1-6
[7]Bi Y F,Mao J Y,Wang X L,et al.Expert survey for Chinese medicine syndrome characteristics of different clinical types of coronary artery disease based on the Delphi method.Chinese Journal of Integrative Medicine,2014,34(10):1192-1196
[8]Kong D,Wang Y,Liu Y,et al.The association between blood lipid and phlegm turbidity syndrome of angina pectoris:A systematic review and meta-analysis.Complementary Therapies in Medicine,2014,22(4):801-813
[9]Wang J,Yu G.Study on microRNA and Chinese medicine syndromes of coronary artery disease.Chinese Journal of Integrated Traditional&Western Medicine,2012,32(11):1562
[10]Ma X J,Yin H J,Chen K J.Differential gene expression profiles in coronary heart disease patients of blood stasis syndrome in traditional Chinese medicine and clinical role of target gene.Chinese Journal of Integrative Medicine,2009,15(2):101
[11]Bi Y F,Mao J Y,Wang X L,et al.Clinical epidemiology survey of the traditional Chinese medicine etiology and syndrome differentiation of coronary artery disease:Study protocol of a multicenter trial.Journal of Chinese Integrative Medicine,2012,10(6):619
[12]李贵华,姜红岩,谢雁鸣,等.基于大数据84697例冠心病中医证候及其中西药使用分析.中国中药杂志,2014,39(18):3462
[13]杨茗茜,张哲,袁东超,等.冠心病心绞痛中医证候的相关研究.中国实验方剂学杂志,2015,21(7):174-178
[14]毛静远,牛子长,张伯礼.近40年冠心病中医证候特征研究文献分析.中医杂志,2011,52(11):958-961
[15]毕颖斐,王贤良,赵志强,等.冠心病现代中医证候特征的临床流行病学调查.中医杂志,2017,58(23):2013-2019
[16]Nomenclature and criteria for diagnosis of ischemic heart disease.Report of the Joint International Society and Federation of Cardiology/World Health Organization task force on standardization of clinical nomenclature.Circulation,1979,59(3):607-609
[17]柯元南,陈纪林.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南.中华心血管病杂志,2007,35(4):295-304
[18]王阶,李军,毛静远,等.冠心病心绞痛主要证型的辨证诊断标准.中国中西医结合杂志,2018,38(2):154-155
[19]世界中医药学会联合会介入心脏病专业委员会.经皮冠状动脉介入治疗围手术期心肌损伤中医诊疗专家共识.中国中西医结合杂志,2017,37(4):389-393
[20]中国中西医结合学会心血管疾病专业委员会.慢性心力衰竭中西医结合诊疗专家共识.心脑血管病防治,2016,16(5):142-145
[21]陈可冀.冠心病(心绞痛、心肌梗塞)中医辨证试行标准.中华内科杂志,1980(5):375
[22]CFDA.中药新药临床研究指导原则.北京:中国医药科技出版社,2002:69
[23]王永炎,张志斌.再议完善辨证方法体系的几个问题.天津中医药,2007,24(1):1-4
[24]Yao H,Mo S,Wang J,et al.Genome-wide DNA methylation profiles of phlegm-dampness constitution.Cellular Physiology&Biochemistry,2018,45(5):1999-2008
[25]Gui Yu,Jie Wang.Susceptible gene polymorphisms for blood stasis syndrome of coronary heart disease.Chinese Journal of Integrative Medicine,2016:1-8
[26]Wang Y,Li C,Chang H,et al.Metabolomic profiling reveals distinct patterns of tricarboxylic acid disorders in blood stasis syndrome associated with coronary heart disease.Chinese Journal of Integrative Medicine,2016,22(8):1-8
[27]张红栓,贾钰华,华何与,等.冠心病心绞痛痰浊证、血瘀证的尿液代谢组学研究.中国中医基础医学杂志,2010,16(2):126-128
[28]Chen J,Cai H W,Miao J,et al.Danlou Tablet Fought against Inflammatory Reaction in Atherosclerosis Rats with Intermingled Phlegm and Blood Stasis Syndrome and Its Mechanism Study.Chinese Journal of Integrative Medicine,2016,36(6):703
[29]Wang S H,Wang J,Li J.Efficacy assessment of treating patients with coronary heart disease angina of phlegm and stasis mutual obstruction syndrome by Danlou tablet.Chinese Journal of Integrated Traditional&Western Medicine,2012,32(8):1051
[30]任得志,张军茹,申仙利.丹蒌片治疗痰瘀互结型冠心病不稳定型心绞痛的临床观察.中西医结合心脑血管病杂志,2014,12(8):1022-1023
[31]胡媛媛.荷丹片痰瘀同治的临床应用.中西医结合心脑血管病杂志,2014,12(6):767-768
[32]Xu R X,Wu N Q,Li S,et al.Effects of Hedan Tablet,on lipid profile,proprotein convertase subtilisin/kexin type 9 and high-density lipoprotein subfractions in patients with hyperlipidemia:A primary study.Chinese Journal of Integrative Medicine,2016,22(9):1-6
[33]卢红蓉,杜松,胡镜清.痰瘀互结证治理论源流考.中医杂志,2015,56(10):811-815
[34]杜松,胡镜清,卢红蓉.痰瘀互结证现代理论研究进展述评.中国中医基础医学杂志,2015,21(4):477-482
[35]胡镜清,王传池,段飞,等.冠心病痰瘀互结证宏观诊断标准研究.中国中西医结合杂志,2016,36(10):1164-1168
[36]段飞,胡镜清.冠心病痰瘀互结证病机转化为阻络、化火、生毒证候宏观及微观诊断指标的权重研究.中国中西医结合杂志,2017,37(5):612-616
[37]王传池,胡镜清,江丽杰,等.痰瘀互结证病证结合研究疗效评价指标回顾分析.世界科学技术:中医药现代化,2016,18(5):800-804
[38]陈苍舒,雷励.冠心病炎症机理与热毒痰瘀相关性探讨.中国中医急症,2007,6(3):311-312
[39]卢红蓉,杜松.冠心病病因病机理论研究概述.环球中医药,2015,8(2):186-189
[40]钮瑶,张哲,白弘,等.论急性冠脉综合征的痰瘀热毒.时珍国医国药,2016,27(11):2708-2710
[41]胡镜清.病机兼化理论框架下的冠心病病机解析.中国中医基础医学杂志,2017,23(1):4-7
[42]彭锐,吴伟,葛昕.从炎症因子角度谈冠心病热毒病机.世界中西医结合杂志,2010,5(8):732-735
[43]Choi J Y,Lee J A,Lee J B,et al.Anti-inflammatory activity of houttuynia cordata against Lipoteichoic acid-induced Inflammation in human dermal fibroblasts.Chonnam Medical Journal,2010,46(3):140-147
[44]Ma C,Zhu L,Wang J,et al.Anti-inflammatory effects of water extract of Taraxacum mongolicum hand-Mazz on lipopolysaccharideinduced inflammation in acute lung injury by suppressing PI3K/Akt/mTOR signaling pathway.Journal of Ethnopharmacology,2015,168(3):349-355
[45]Nikzad-Langerodi R,Ortmann S,Pferschy-Wenzig E M,et al.Assessment of anti-inflammatory properties of extracts from Honeysuckle(Lonicera sp.L.Caprifoliaceae)by ATR-FTIR spectroscopy.Talanta,2017,175:264-272
[46]Zheng F,Qu D,Xu H.Relationship between Chinese medicine syndrome and serum level of high-sensitivity C-reactive protein in patients with stable coronary heart disease.Chinese Journal of Integrated Traditional&Western Medicine,2009,29(6):485-488
[47]荣杰,许颖智,张军平.冠心病患者介入术前后中医证候演变规律分析.中医杂志,2012,53(23):2027-2030
[48]褚福永,王阶,刘红旭,等.不稳定型心绞痛冠脉介入期间中医证候动态演变规律研究.中华中医药杂志,2013,28(3):627-630
[49]葛均波,徐永健.内科学.8版.北京:人民卫生出版社,2013:227
[50]张琳,于鑫婷,徐浩.冠心病中医证候特点的分析与思考.中西医结合心脑血管病杂志,2009,7(5):578-581
[51]杜莹,贾连群,王列,等.冠心病心绞痛证型分布及辨证规律系统综述.实用中医内科杂志,2014,28(3):1-2
[52]李施新,李远,刘孟敏.基于关联规则和复杂系统熵聚类的100位全国名老中医治疗冠心病证治规律研究.中华中医药杂志,2016,31(4):1258-1261
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |