胸痹诱因及证型与冠状动脉造影结果相关性研究
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摘要
目的
探讨胸痹患者诱因及证型与冠状动脉造影结果的关系,为胸痹病证提供量化参考指标,为胸痹冠状动脉造影(CAG)阳性的预防和胸痹的诊疗提供客观化依据。
方法
回顾性抽取844份白2006年7月～2011年6月入住江苏省中医院心内科确诊为胸痹并行冠状动脉造影的病例,应用Epidata3.02软件建立专门数据库对数据进行管理,用SPSS17.0软件进行统计分析,观察胸痹患者各诱因发生频数,并分析发生频数最高的前5位诱因与CAG结果的相关性；观察胸痹各证型分布频数及发生频数最多的前6位证型与CAG结果的相关性。
结果
1.胸痹患者男性531例(62.91%),女性313例(37.09%)；性别与CAG结果有相关性,男性胸痹患者CAG阳性构成比较女性高,且差异有统计学意义(X2=4.3415P=0.037)：
2.胸痹患者年龄集中在50-80岁之间(83.06%)；年龄与CAG结果有相关性,随着年龄增长,80岁前各年龄组CAG阳性构成比呈逐渐上升趋势,且差异有统计学意义(X2=13.2216P=0.010)；
3.胸痹诱因中,发生频数最高的前5位依次为劳倦、饮食、情志、季节、吸烟；
4.劳倦与胸痹患者CAG结果无相关性(X2=0.1924P=0.661)；
5.饮食因素与CAG结果无相关性(X2=0.0949P=0.758)；
6.情志与CAG结果有相关性,有情志影响的胸痹患者CAG阳性构成比较无情志影响者高,且差异有统计学意义(X2=4.1688P=0.041)；
7.季节与CAG结果有相关性,冬季发病的胸痹患者CAG阳性者构成比较非冬季发病者为高,且差异有统计学意义(X2=4.0482P=0.044)；
8.吸烟与否与CAG结果有相关性,吸烟夺者CAG阳性构成比较不吸烟者高,且差异有统计学意义(X2=8.3882P=0.004);
9.胸痹证型中,发生频数最多的前6位依次为气虚血瘀、痰瘀互结、气阴两虚、痰阻心脉、心坦率血瘀阻、气虚痰瘀。以上6证型间CAG阳性构成比总体差别有统计学意义(X2=19.9402P=0.003)。痰瘀互结组CAG阳性构成比最高,气虚痰瘀组次之。6证型间冠状动脉阻塞支数差别统计学意义(X2=43.9019P=0.001)。痰瘀互结组3支病变数构成比最高,气虚血瘀组次之；痰瘀互结组0支病变数构成比最低,气虚痰瘀组次之。
结论
1.性别、年龄、情志、寒冷、吸烟是导致胸痹患者CAG阳性的重要原因；
2.痰饮和瘀血是导致胸痹重要的病理基础,痰瘀互结是胸痹的重要病机,痰瘀互结证是胸痹的危险证型；
3.本虚标实为胸痹病机特点,气虚、阴虚是发生胸痹的病理基础,气虚血瘀和气虚痰瘀是胸痹的危险证型。
Objective
To investigate the correlation between results obtained through coronary angiography (CAG) and triggers, syndromes of Thoracic Obstruction to provide an objective basis for the prevention and treatment of thoracic obstruction.
Methods
Through a retrospective study of844patients who received CAG and were diagnosed with thoracic obstruction by cardiology department of Jiangsu TCM hospital from2006.7-2011.6, establishing special database with Epidata3.02software, having completed statistical analyses with SPSS17.0software, we observed the frequencies of various triggers to thoracic obstruction and analyzed the correlation between the results of CAG and the top5triggers; We observed the frequencies of various syndromes to thoracic obstruction and the correlation between the results of CAG and the top6syndromes.
Results
1.531(62.91%) male and313(37.09%) female patients are included in the research, and statistical difference exists in CAG results between the two sexes. The proportion of CAG-positive for male is higher than female (χ2=4.3415P=0.037);
2. The age is concentrate on50-80years (83.08); there is a statistical difference between the CAG results and the age, with the age increasing,the proportion of CAG-positive is also increasing before80years old (χ2=13.2216P=0.010)
3. The top5triggers of Thoracic Obstruction are fatigue, diet, emotional stress, climate and smoking;
4. There is no statistically significant relationship between the CAG results and fatigue (χ2=0.1924P=0.661)
5. There is no statistically significant relationship between the CAG results and diet (χ2=0.0949P=0.758)
6. There is a statistical difference between the CAG results and emotional distress. The proportion of CAG-positive is higher among thoracic obstruction patients susceptible to emotional stress (χ2=4.1688P=0.041)
7. There is a statistical difference between the CAG results and climate, the proportion of CAG-positive is higher for Thoracic Obstruction patients during the winter than other seasons (χ2=4.0482P=0.044)
8. There is a statistical difference between the CAG results and smoking, the proportion of CAG-positive is higher for smokers than those who are not (χ2=8.3882P =0.004);
9. The top6syndrome groups of thoracic obstruction, in order, are qi asthenia and blood-stasis, Phlegm and blood stasis, asthenia of both qi and yin, vein obstruction of phlegm, stagnant blockade of heart blood, qi asthenia and phlegm-stasis. Among the6groups above, there is an obvious statistical difference in the proportion of CAG-positive (χ2=19.9402P=0.003). Phlegm and blood stasis group has the highest proportion of CAG-positive, which follows qi asthenia and phlegm-stasis group. Among the6syndrome groups above, there is an obvious statistical difference in the count of branch with coronary artery obstruction (χ2=43.9019P=0.001). Phlegm and blood stasis group has the highest risk in three-branch lesion and smallest chance in zero-branch lesion, which follows qi asthenia and blood-stasis group and qi asthenia and phlegm-stasis group.
Conclusion
1. Sex, age, fatigue, diet, emotional stress, climate and smoking are the important reasons for CAG-positive of Thoracic Obstruction;
2. Phlegm and blood stasis are important pathological bases and pathogenesis of thoracic obstruction, the TCM syndrome type of phlegm and blood stasis is a dangerous type of thoracic obstruction.
3. Asthenia in origin and sthenia in superficiality is a pathogenesis characteristic of thoracic obstruction. Asthenia of qi and asthenia of yin are pathological basis of thoracic obstruction. Qi asthenia and blood stasis, qi asthenia and phlegm-stasis are dangerous TCM syndrome types of thoracic obstruction.
探讨胸痹患者诱因及证型与冠状动脉造影结果的关系,为胸痹病证提供量化参考指标,为胸痹冠状动脉造影(CAG)阳性的预防和胸痹的诊疗提供客观化依据。
方法
回顾性抽取844份白2006年7月～2011年6月入住江苏省中医院心内科确诊为胸痹并行冠状动脉造影的病例,应用Epidata3.02软件建立专门数据库对数据进行管理,用SPSS17.0软件进行统计分析,观察胸痹患者各诱因发生频数,并分析发生频数最高的前5位诱因与CAG结果的相关性；观察胸痹各证型分布频数及发生频数最多的前6位证型与CAG结果的相关性。
结果
1.胸痹患者男性531例(62.91%),女性313例(37.09%)；性别与CAG结果有相关性,男性胸痹患者CAG阳性构成比较女性高,且差异有统计学意义(X2=4.3415P=0.037)：
2.胸痹患者年龄集中在50-80岁之间(83.06%)；年龄与CAG结果有相关性,随着年龄增长,80岁前各年龄组CAG阳性构成比呈逐渐上升趋势,且差异有统计学意义(X2=13.2216P=0.010)；
3.胸痹诱因中,发生频数最高的前5位依次为劳倦、饮食、情志、季节、吸烟；
4.劳倦与胸痹患者CAG结果无相关性(X2=0.1924P=0.661)；
5.饮食因素与CAG结果无相关性(X2=0.0949P=0.758)；
6.情志与CAG结果有相关性,有情志影响的胸痹患者CAG阳性构成比较无情志影响者高,且差异有统计学意义(X2=4.1688P=0.041)；
7.季节与CAG结果有相关性,冬季发病的胸痹患者CAG阳性者构成比较非冬季发病者为高,且差异有统计学意义(X2=4.0482P=0.044)；
8.吸烟与否与CAG结果有相关性,吸烟夺者CAG阳性构成比较不吸烟者高,且差异有统计学意义(X2=8.3882P=0.004);
9.胸痹证型中,发生频数最多的前6位依次为气虚血瘀、痰瘀互结、气阴两虚、痰阻心脉、心坦率血瘀阻、气虚痰瘀。以上6证型间CAG阳性构成比总体差别有统计学意义(X2=19.9402P=0.003)。痰瘀互结组CAG阳性构成比最高,气虚痰瘀组次之。6证型间冠状动脉阻塞支数差别统计学意义(X2=43.9019P=0.001)。痰瘀互结组3支病变数构成比最高,气虚血瘀组次之；痰瘀互结组0支病变数构成比最低,气虚痰瘀组次之。
结论
1.性别、年龄、情志、寒冷、吸烟是导致胸痹患者CAG阳性的重要原因；
2.痰饮和瘀血是导致胸痹重要的病理基础,痰瘀互结是胸痹的重要病机,痰瘀互结证是胸痹的危险证型；
3.本虚标实为胸痹病机特点,气虚、阴虚是发生胸痹的病理基础,气虚血瘀和气虚痰瘀是胸痹的危险证型。
Objective
To investigate the correlation between results obtained through coronary angiography (CAG) and triggers, syndromes of Thoracic Obstruction to provide an objective basis for the prevention and treatment of thoracic obstruction.
Methods
Through a retrospective study of844patients who received CAG and were diagnosed with thoracic obstruction by cardiology department of Jiangsu TCM hospital from2006.7-2011.6, establishing special database with Epidata3.02software, having completed statistical analyses with SPSS17.0software, we observed the frequencies of various triggers to thoracic obstruction and analyzed the correlation between the results of CAG and the top5triggers; We observed the frequencies of various syndromes to thoracic obstruction and the correlation between the results of CAG and the top6syndromes.
Results
1.531(62.91%) male and313(37.09%) female patients are included in the research, and statistical difference exists in CAG results between the two sexes. The proportion of CAG-positive for male is higher than female (χ2=4.3415P=0.037);
2. The age is concentrate on50-80years (83.08); there is a statistical difference between the CAG results and the age, with the age increasing,the proportion of CAG-positive is also increasing before80years old (χ2=13.2216P=0.010)
3. The top5triggers of Thoracic Obstruction are fatigue, diet, emotional stress, climate and smoking;
4. There is no statistically significant relationship between the CAG results and fatigue (χ2=0.1924P=0.661)
5. There is no statistically significant relationship between the CAG results and diet (χ2=0.0949P=0.758)
6. There is a statistical difference between the CAG results and emotional distress. The proportion of CAG-positive is higher among thoracic obstruction patients susceptible to emotional stress (χ2=4.1688P=0.041)
7. There is a statistical difference between the CAG results and climate, the proportion of CAG-positive is higher for Thoracic Obstruction patients during the winter than other seasons (χ2=4.0482P=0.044)
8. There is a statistical difference between the CAG results and smoking, the proportion of CAG-positive is higher for smokers than those who are not (χ2=8.3882P =0.004);
9. The top6syndrome groups of thoracic obstruction, in order, are qi asthenia and blood-stasis, Phlegm and blood stasis, asthenia of both qi and yin, vein obstruction of phlegm, stagnant blockade of heart blood, qi asthenia and phlegm-stasis. Among the6groups above, there is an obvious statistical difference in the proportion of CAG-positive (χ2=19.9402P=0.003). Phlegm and blood stasis group has the highest proportion of CAG-positive, which follows qi asthenia and phlegm-stasis group. Among the6syndrome groups above, there is an obvious statistical difference in the count of branch with coronary artery obstruction (χ2=43.9019P=0.001). Phlegm and blood stasis group has the highest risk in three-branch lesion and smallest chance in zero-branch lesion, which follows qi asthenia and blood-stasis group and qi asthenia and phlegm-stasis group.
Conclusion
1. Sex, age, fatigue, diet, emotional stress, climate and smoking are the important reasons for CAG-positive of Thoracic Obstruction;
2. Phlegm and blood stasis are important pathological bases and pathogenesis of thoracic obstruction, the TCM syndrome type of phlegm and blood stasis is a dangerous type of thoracic obstruction.
3. Asthenia in origin and sthenia in superficiality is a pathogenesis characteristic of thoracic obstruction. Asthenia of qi and asthenia of yin are pathological basis of thoracic obstruction. Qi asthenia and blood stasis, qi asthenia and phlegm-stasis are dangerous TCM syndrome types of thoracic obstruction.
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