154例血栓前状态患者的临床特征及中医证候回顾性调查研究
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摘要
研究背景
血栓前状态(Prethrombotic State, PTS)又称血液高凝状态(hypercoagulable state, HCS),是指先天或获得性原因使血液处于极易凝结的病理状态,具体地讲,是血管内皮细胞、血小板、凝血及纤溶系统等发生改变所引起的,有利于血栓形成的病理状态；亦是多种因素引起的止血、凝血和抗凝系统失调的一种病理过程,具有易导致血栓形成的多种血液学变化,是动静脉及微循环中血栓形成的主要病理基础和潜在危险因素。
“血栓前状态”是由最初的“高凝状态”和“血栓前期”这2个描述有血栓形成倾向的术语演变而来,以更突出和强调“血栓形成”可能的概念。该病理状态的发生发展可贯穿在许多疾病中,诸如冠心病、肺心病、缺血性脑血管病、糖尿病、肾病综合征、血脂异常、血栓性疾病及多种恶性肿瘤,并对其诊断、治疗和预后产生影响,是近年来研究的热门课题。
研究目的
通过横断面调查分析,对血栓前状态的临床特征与中医证候的相关性研究,探讨血栓前状态下其临床特征、结合相应实验检测指标与中医证候的内在联系,为中西医结合治疗血栓前状态以及阻断其进一步发展为其它相关疾病提出综合措施。
研究方法
在广东省中医院心脏科、内分泌科、呼吸科、肿瘤科、急诊综合病区EICU住院患者中搜集血栓前状态的患者154例,采集中医四诊信息及相关实验室指标,将所采集数据录入数据库,并导入SPSS18.0进行统计分析,中医证候群的筛选采用系统聚类分析(Hierarchical Cluster)中的变量聚类法(Variables Cluster),得出五大类证候的证型指标,参照《中医诊断学》及《中药新药临床研究指导原则(试行)》,归纳出多脏器衰竭的中医证型；实验室数据采用描述性分析、卡方分析、判别分析、相关性分析及主成分分析法,根据统计分析结果,总结血栓前状态患者的临床特征。
研究结果
1.本研究共采集154例多脏器衰竭的患者,经聚类分析后辨证,归纳出血栓前状态的中医证型,主要包括：阳虚血瘀证、痰湿蕴热兼气滞证、气阴两虚证、寒凝证。可见气虚湿瘀证是最常见的证候。既往史中高血压病、高脂血症、糖尿病病史史所占比例居前三,可见微循环的病理改变本研究中重要的病理基础。
2.影响血栓前状态病例过程的发生、发展的主成分分析,概括出6大主要成份：凝血功能筛查指标、血液流变学指标、炎症因子、肝功能指标、肾功能指标、血脂异常指标。
3.归纳出实验室指标与中医证候分类的相关性及特异性。
研究结论
1.血栓前状态在临床上的中医证候归纳为四大证型,分别阳虚血瘀证、痰湿蕴热兼气滞证、气阴两虚证、寒凝证。其中以阳虚血瘀证最为常见。
2.实验室指标凝血指标、血流动力学筛查指标、血脂、肝功能、心肌损伤标记物、肾功能等指标对判定中医证候归类有一定参考意义。其中凝血功能、血流动力学筛查指标,炎症因子指标、血脂是导致血栓前状态发生、进展的主要因素。
3.研究启发：重视高脂血症对血栓前状态发生、发展的影响作用。
Object ive
This exploratory study attempted to know the distribution of prethrombotic state on the syndrome of TCM and the clinical characters.
Methods
This study collected154cases of patients with prethrombotic state, the four methods of examination information of Chinese Traditional Medicine and information of laboratory were collected. Input the data to Spssl8.0to statistical analysis, type of Syndrome about TCM analysis use of cluster analysis system (Hierarchical Cluster), in the variable clustering method (Variables Cluster), combined with expert opinions to determine the representatives symptoms of each type, and summed up the syndrome of TCM and the clinical characters. Laboratory data adopted descriptive analysis、 chi-square analysis、corresponding analysis and primary component analysis to summarize the clinical characters.
Results
After cluster analysis, summed up four types of TCM, including Yang deficiency and blood stasis, Phlegm wetness heat and Qi stagnation, Qi-Yin deficiency, cold accumulation. And Yang deficiency and blood stasis type is the most common syndrome of TCM. Since to the past medical history, hypertension diabetes mellitus or hyperlipidemia accounted for the most ratio. So it proved that the pathology modify of microcirculation is the important pathological basis in this research.
After principal component analysis, there are five main factors to influence the development of prethrombotic state, including coagulation function index、hemorheology index、hepatic function index、renal function index and blood fat index.
To sum up the relationship and specificity between the laboratory index and the classification of TCM.
Conclusion
There are four types of TCM in prethrombotic state, including Yang deficiency and blood stasis, Phlegm wetness heat and Qi stagnation, Qi-Yin deficiency, cold accumulation. And Yang deficiency and blood stasis type is the most common syndrome of TCM. There is something reference value to sort out the syndrome of TCM in laboratory indexes, including blood coagulation index、hemorheology index、hepatic function index、renal function index and blood fat index. And coagulation function、hemorheology index、inflammatory index、blood fat are the main factors to influence the development of prethrombotic state.
血栓前状态(Prethrombotic State, PTS)又称血液高凝状态(hypercoagulable state, HCS),是指先天或获得性原因使血液处于极易凝结的病理状态,具体地讲,是血管内皮细胞、血小板、凝血及纤溶系统等发生改变所引起的,有利于血栓形成的病理状态；亦是多种因素引起的止血、凝血和抗凝系统失调的一种病理过程,具有易导致血栓形成的多种血液学变化,是动静脉及微循环中血栓形成的主要病理基础和潜在危险因素。
“血栓前状态”是由最初的“高凝状态”和“血栓前期”这2个描述有血栓形成倾向的术语演变而来,以更突出和强调“血栓形成”可能的概念。该病理状态的发生发展可贯穿在许多疾病中,诸如冠心病、肺心病、缺血性脑血管病、糖尿病、肾病综合征、血脂异常、血栓性疾病及多种恶性肿瘤,并对其诊断、治疗和预后产生影响,是近年来研究的热门课题。
研究目的
通过横断面调查分析,对血栓前状态的临床特征与中医证候的相关性研究,探讨血栓前状态下其临床特征、结合相应实验检测指标与中医证候的内在联系,为中西医结合治疗血栓前状态以及阻断其进一步发展为其它相关疾病提出综合措施。
研究方法
在广东省中医院心脏科、内分泌科、呼吸科、肿瘤科、急诊综合病区EICU住院患者中搜集血栓前状态的患者154例,采集中医四诊信息及相关实验室指标,将所采集数据录入数据库,并导入SPSS18.0进行统计分析,中医证候群的筛选采用系统聚类分析(Hierarchical Cluster)中的变量聚类法(Variables Cluster),得出五大类证候的证型指标,参照《中医诊断学》及《中药新药临床研究指导原则(试行)》,归纳出多脏器衰竭的中医证型；实验室数据采用描述性分析、卡方分析、判别分析、相关性分析及主成分分析法,根据统计分析结果,总结血栓前状态患者的临床特征。
研究结果
1.本研究共采集154例多脏器衰竭的患者,经聚类分析后辨证,归纳出血栓前状态的中医证型,主要包括：阳虚血瘀证、痰湿蕴热兼气滞证、气阴两虚证、寒凝证。可见气虚湿瘀证是最常见的证候。既往史中高血压病、高脂血症、糖尿病病史史所占比例居前三,可见微循环的病理改变本研究中重要的病理基础。
2.影响血栓前状态病例过程的发生、发展的主成分分析,概括出6大主要成份：凝血功能筛查指标、血液流变学指标、炎症因子、肝功能指标、肾功能指标、血脂异常指标。
3.归纳出实验室指标与中医证候分类的相关性及特异性。
研究结论
1.血栓前状态在临床上的中医证候归纳为四大证型,分别阳虚血瘀证、痰湿蕴热兼气滞证、气阴两虚证、寒凝证。其中以阳虚血瘀证最为常见。
2.实验室指标凝血指标、血流动力学筛查指标、血脂、肝功能、心肌损伤标记物、肾功能等指标对判定中医证候归类有一定参考意义。其中凝血功能、血流动力学筛查指标,炎症因子指标、血脂是导致血栓前状态发生、进展的主要因素。
3.研究启发：重视高脂血症对血栓前状态发生、发展的影响作用。
Object ive
This exploratory study attempted to know the distribution of prethrombotic state on the syndrome of TCM and the clinical characters.
Methods
This study collected154cases of patients with prethrombotic state, the four methods of examination information of Chinese Traditional Medicine and information of laboratory were collected. Input the data to Spssl8.0to statistical analysis, type of Syndrome about TCM analysis use of cluster analysis system (Hierarchical Cluster), in the variable clustering method (Variables Cluster), combined with expert opinions to determine the representatives symptoms of each type, and summed up the syndrome of TCM and the clinical characters. Laboratory data adopted descriptive analysis、 chi-square analysis、corresponding analysis and primary component analysis to summarize the clinical characters.
Results
After cluster analysis, summed up four types of TCM, including Yang deficiency and blood stasis, Phlegm wetness heat and Qi stagnation, Qi-Yin deficiency, cold accumulation. And Yang deficiency and blood stasis type is the most common syndrome of TCM. Since to the past medical history, hypertension diabetes mellitus or hyperlipidemia accounted for the most ratio. So it proved that the pathology modify of microcirculation is the important pathological basis in this research.
After principal component analysis, there are five main factors to influence the development of prethrombotic state, including coagulation function index、hemorheology index、hepatic function index、renal function index and blood fat index.
To sum up the relationship and specificity between the laboratory index and the classification of TCM.
Conclusion
There are four types of TCM in prethrombotic state, including Yang deficiency and blood stasis, Phlegm wetness heat and Qi stagnation, Qi-Yin deficiency, cold accumulation. And Yang deficiency and blood stasis type is the most common syndrome of TCM. There is something reference value to sort out the syndrome of TCM in laboratory indexes, including blood coagulation index、hemorheology index、hepatic function index、renal function index and blood fat index. And coagulation function、hemorheology index、inflammatory index、blood fat are the main factors to influence the development of prethrombotic state.
引文
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