冠心病心绞痛中医证型分布及证型与客观指标相关性研究
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摘要
目的：
探索冠心病心绞痛患者中医证型分布特点,并通过对冠心病心绞痛中医分型与心脏结构及功能指标之间的相关性研究,探索能指导临床辨证分型的特异的指标,使冠心病心绞痛中医辨证分型更为客观,有利于辨证标准的统一,为临床论治提供可靠依据。
方法：
本研究共收集广州中医药大学第二临床医学院2012年3月—2013年2月住院及门诊的冠心病心绞痛患者281例,以患者的临床症状、舌象、脉象作为辨证依据,对病例进行中医辨证分型,明确冠心病心绞痛的中医证型分布特征。在纳入的病例中,每种辨证分型均选取一定数目的病例作为相关性研究对象,另选取健康体检人员20名作为健康对照组,在治疗前1周内对研究对象以及健康对照组进行心脏超声检查,检测心脏结构以及功能的相关指标并记录,分析证型与左心结构和功能指标的相关性,探索能指导临床辨证分型的特异的指标。
结果：
本研究结果显示,入选的281例冠心病心绞痛患者的中医证型的分布规律为：气虚痰瘀型103例,痰瘀阻络型39例,气虚血瘀型38例,气滞痰阻型28例,气虚痰阻型25例,气滞血瘀型24例,心阳虚衰型13例,气阴两虚型11例。心阳虚衰型以及气虚血瘀型患者的平均年龄明显偏大,而且病程也较长。
冠心病心绞痛患者与健康对照组之间心脏彩超指标比较结果显示,冠心病心绞痛患者的12项心脏结构及功能指标均要劣于健康对照组,差异均有统计学意义。冠心病心绞痛不同证型心脏结构及功能指标的组间两两比较结果显示,气滞痰阻型和痰瘀阻络型患者的心脏指标IST以及LVPWT均要大于其他证型的冠心病患者；心阳虚衰型和气虚血瘀型患者的LVEDd以及LVESd较其他证型的冠心病患者要大；心阳虚衰型以及气虚痰阻型患者的E以及E/A值小于其他证型的冠心病患者,这两型患者的A值要大于其他证型的冠心病患者；气滞痰阻型以及气虚痰阻型患者的LVRT值要高于其他证型的冠心病患者；与气阴两虚型、气滞痰阻型、痰瘀阻络以及气虚痰瘀型患者相比,心阳虚衰型患者FS值较低；气虚血瘀型患者的FS值低于气阴两虚型、气滞痰阻型、气滞血瘀型、痰瘀阻络型以及气虚痰瘀型患者；痰瘀阻络型患者的FS值高于气滞痰阻型、气滞血瘀型、以及气虚痰阻型患者；与气阴两虚型、气滞痰阻型、痰瘀阻络以及气虚痰瘀型患者相比,心阳虚衰型患者LVEF值较低；气虚血瘀型患者的LVEF值低于气阴两虚型、气滞痰阻型、气滞血瘀型、痰瘀阻络型以及气虚痰瘀型患者；痰瘀阻络型患者的LVEF值高于气滞痰阻型、气滞血瘀型、以及气虚痰阻型患者。
冠心病心绞痛常见证型与心脏彩超检测指标相关性分析结果显示,与气虚痰瘀呈正相关关系的心脏彩超指标有SV,呈负相关关系的指标有IST、A指标；与气滞痰阻证呈正相关关系的心脏彩超指标有E、LVRT,呈负相关关系的指标有A、SV；与气滞血瘀证呈负相关关系的指标有LVRT、SV;与痰瘀阻络证呈正相关关系的心脏彩超指标有LVPWT、E、CO、 FS,而呈负相关关系的指标有LVEDd、LVRT;与气虚血瘀证呈正相关关系的心脏彩超指标有LVESd、E/A,而呈负相关关系的指标有LVPWT、LVRT;与气虚痰阻证呈正相关关系的心脏彩超指标有LVRT,而呈负相关关系的指标有E/A。
结论：
中医学认为,冠心病包括本虚和标实两个方面,本虚即气虚、阴虚和阳虚,标实即气滞、痰浊和血瘀。本研究显示,气虚痰瘀型患者所占比例最多,这与气虚痰瘀构成了冠心病最基本的病机特点相符,此外,由于久病伤阳,久病成瘀,因此,研究中,心阳虚衰型、气虚血瘀型患者的平均年龄明显偏大,而且病程也较长。
本研究冠心病心绞痛患者与健康对照组之间心脏指标的比较结果显示,冠心病心绞痛患者12项心脏的结构和功能指标均劣于健康对照组,这说明冠心病心绞痛患者均不同程度存在左室重构现象。冠心病心绞痛不同证型的心脏指标的组间两两比较结果我们可以发现,不同中医证型的冠心病心绞痛患者可以出现不同的心血管重构征象和表现,其中气滞痰阻型以及痰瘀阻络型患者要比其他证型患者的左室壁增厚更加明显,心阳虚衰型和气虚血瘀型患者的左室内径扩大程度比其他证型严重。心阳虚衰型以及气虚痰阻型患者的左室舒张功能要明显劣于其他证型患者。此外,与冠心病心绞痛其余大部分中医证型患者相比,心阳虚衰型以及气虚血瘀型患者的收缩功能减退的情况更为显著。已有研究表明,心脏结构以及功能的改变与病程及疾病的严重程度相关,综合研究结果,我们可以看出心阳虚衰型以及气虚血瘀型患者较其它证型相比有更为明显的心血管重构的表现,因此,我们认为这两型患者的冠脉病变较为显著,病情较重,为冠心病中、晚期患者。
冠心病心绞痛常见证型与心脏彩超客观指标相关性分析结果表明,冠心病心绞痛气虚痰瘀证与心脏指标SV、IST、A密切相关,当SV数值越大,IST、A数值越小时,患者诊断为气虚痰瘀证的可能性愈大；冠心病心绞痛气滞痰阻证与心脏指标E、LVRT、A、SV明显相关,当E、LVRT的数值越高,而A、SV数值越低时,患者的证型就越倾向于气滞痰阻证；冠心病心绞痛气滞血瘀证与心脏指标LVRT、SV密切相关,LVRT、SV的数值越小时,患者诊断为气滞血瘀证的可能性就越大；痰瘀阻络证与心脏指标LVPWT、E、CO、FS、LVEDd、LVRT显著相关,LVPWT、E、CO、FS的数值越高,LVEDd、 LVRT数值越低时,患者的中医证型就越倾向于痰瘀阻络证；冠心病心绞痛气虚血瘀证与心脏指标LVESd、E/A、LVPWT、LVRT显著相关,LVESd、E/A的数值越大,LVPWT、 LVRT数值越小时,患者辨证为气虚血瘀证的可能性越大；冠心病心绞痛气虚痰阻证与心脏指标LVRT、E/A明显相关,LVRT的数值越大,E/A数值越小时,则患者诊断为气虚痰阻证的可能性也愈大。由此,我们可以得出结论,冠心病心绞痛常见中医证型与心脏彩超客观指标有着明显的相关性,这些特异性的指标可为冠心病心绞痛临床辨证分型提供客观依据,成为中医四诊范围外的一种中医辨证依据的拓展,有利于更好地进行冠心病心绞痛中医临床辨证论治。
Objective
The aim of the study is to explore the syndrome distribution of coronary heart disease angina. And through relative researches of heart structure, heart function and the TCM syndrome patterns of coronary heart disease angina, trying to find some peculiar indexs and leading them to the TCM differentiation of coronary heart disease angina. These indexes which make the differentiation more practical can help unify the differentiation standard and provide reliable basis for clinical trearment.
Methods
Collecting281patients with coronary heart disease angina in Guangzhou University of Chinese Medicine Second School of Clinic Medicine from March2012to February2013. Taking the clinical symptoms, tongue Picture, pulse condition of these patients with coronary heart disease angina as the dialectical basis, dividing the patients by differentiation standard, comfirming the syndrome distribution of coronary heart disease angina. Selecting randomly some patients from each syndrome pattern as the study group, in addition, selecting20healthy Persons as control group, all subjects received cardiac structral and functional examination with Doppler ultrasonic cardiogram a week before the treatment. Analyzing the relationship of heart structure, heart function and the TCM syndrome patterns of coronary heart disease angina.
ResuIts
This study shows that The TCM dialectical types of281patients with coronary heart disease angina were distributed as follow:103patients with qi deficiency and phlegm and blood stasis syndrome,39patients with phlegm-stasis blocking collateral syndrome,38patients with qi-deficiency and blood-stasis syndrome,28patients with phlegm stagnation of qi stagnation syndrome,25patients with qi deficiency and phlegm stasis syndrome,24patients with qi stagnation and blood stasis syndrome,13patients with heart yang deficiency syndrome,11patients with qi and yin deficiency syndrome. The patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome are older than the other patients, and disease course of the patients with the two syndromes are also longer than that of the other patients.
The results of comparison of echocardiography index between patients with coronary heart disease angina group and healthy control group show that, the12cardiac structure and function indexes of the patients with coronary heart disease angina are all inferior to the healthy control group, and the difference has statistical significance. The results of comparison of cardiac structure and function indexes between patients with different syndromes of coronary heart disease angina shows that, the data of cardiac indexes of IST and LVPWT in patients with phlegm stagnation of qi stagnation syndrome and phlegm-stasis blocking collateral syndrome are higher than the patients of other syndromes with coronary heart disease angina. The data of cardiac indexes of LVEDd and LVESd in patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome are higher than the patients of other syndromes with coronary heart disease angina. The data of cardiac indexes of E and E/A in patients with heart yang deficiency syndrome and qi deficiency and phlegm stasis syndrome are lower than the patients of other syndromes with coronary heart disease angina, the data of cardiac indexes of A in patients with heart yang deficiency syndrome and qi deficiency and phlegm stasis syndrome are higer than the patients of other syndromes with coronary heart disease angina. The data of cardiac indexes of LVRT in patients with phlegm stagnation of qi stagnation syndrome and qi deficiency and phlegm stasis syndrome are higer than the patients of other syndromes with coronary heart disease angina. Compared with patients with qi and yin deficiency syndrome、phlegm stagnation of qi stagnation syndrome、phlegm-stasis blocking collateral syndrome and qi deficiency and phlegm and blood stasis syndrome, patients with heart yang deficiency syndrome has lower FS. The data of cardiac index of FS in patients with qi-def iciency and blood-stasis syndrome is lower than that of patients with qi and yin deficiency syndrome、phlegm stagnation of qi stagnation syndrome、qi stagnation and blood stasis syndrome、 phlegm-stasis blocking collateral syndrome and qi deficiency and phlegm and blood stasis syndrome. The data of cardiac index of FS in patients with phlegm-stasis blocking collateral syndrome is higer than that of patients with phlegm stagnation of qi stagnation syndrome、qi stagnation and blood stasis syndrome and qi deficiency and phlegm stasis syndrome. Compared with patients with qi and yin deficiency syndrome、phlegm stagnation of qi stagnation syndrome、phlegm-stasis blocking collateral syndrome and qi deficiency and phlegm and blood stasis syndrome, patients with heart yang deficiency syndrome has lower LVEF. The data of cardiac index of LVEF in patients with qi-def iciency and blood-stasis syndrome is lower than that of patients with qi and yin deficiency syndrome、phlegm stagnation of qi stagnation syndrome、qi stagnation and blood stasis syndrome、phlegm-stasis blocking collateral syndrome and qi deficiency and phlegm and blood stasis syndrome. The data of cardiac index of LVEF in patients with phlegm-stasis blocking collateral syndrome is higer than that of patients with phlegm stagnation of qi stagnation syndrome、qi stagnation and blood stasis syndrome and qi deficiency and phlegm stasis syndrome.
The results of correlation analysis between the common syndromes of coronary heart disease angina and cardiac ultrasonography detection indexes show that, qi deficiency and phlegm and blood stasis syndrome has positive relationship with echocardiography index SV, and shows negative correlation with IST, A. Phlegm stagnation of qi stagnation syndrome has positive relationship with echocardiography indexes E、LVRT, and shows negative correlation with A、SV. Qi stagnation and blood stasis syndrome has negative correlation with LVRT、SV. Phlegm-stasis blocking collateral syndrome has positive relationship with echocardiography indexes LVPWT、E、CO、FS, and shows negative correlation with LVEDd、LVRT. Qi-deficiency and blood-stasis syndrome has positive relationship with echocardiography indexes LVESd、E/A, and shows negative correlation with LVPWT、LVRT. Qi deficiency and phlegm stasis syndrome has positive relationship with echocardiography index LVRT,and shows negative correlation with E/A.
Conelusion
Traditional Chinese medicine believes that,pathogenesis of coronary heart disease angina contains two respects:deficiency in origin and excess in superficiality. Deficiency in origin contains qi deficiency, yin deficiency and yang deficiency. Excess in superficiality contains qi stagnation, phlegm stasis and blood stasis. This study shows the largest proportion of coronary heart disease angina patients is the patients with qi deficiency and phlegm and blood stasis syndrome. This result consistent with the basic characteristics of the pathogenesis of qi deficiency、phlegm and blood stasis. In addition, chronic diseases injury Yang and form blood stasis, the study also shows that patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome are older than the other patients, and disease course of the patients with the two syndromes are also longer than that of the other patients.
The results of comparison of echocardiography index between patients with coronary heart disease angina group and healthy control group show that, the12cardiac structure and function indexes of the patients with coronary heart disease angina are all inferior to the healthy control group, this means that all types of patients with coronary heart disease angina have phenomenon of cardiovascular remodeling. From the results of comparison of cardiac structure and function indexes between patients with different syndromes of coronary heart disease angina, we can find that, different TCM syndrome types in patients with coronary heart disease angina have different features and performance in cardiovascular remodeling.The left ventricular wall of patients with phlegm stagnation of qi stagnation syndrome and phlegm-stasis blocking collateral syndrome is more thick than patients with other ayndromes remarkably. The extent of left ventricular density of patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome is more evident than patients with other syndromes. The left ventricular diastolic function of the patients with heart yang deficiency syndrome and qi deficiency and phlegm stasis syndrome is inferior to the left ventricular diastolic function of patients with other syndromes evidently. In addition, compared with the patients with coronary heart disease angina of most of the other syndromes, the condition of systolic dysfunction of patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome is more obvious. Previous studies have suggested that, the change of cardiac structure and function is associated with the severity of disease and the course of disease. Comprehensive the results, we can find that the manifestation of cardiovascular remodeling of patients with heart yang deficiency syndrome and qi-def iciency and blood-stasis syndrome is more obvious than that of patients with other syndromes. Therefore, we believe that the patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome have more seriours coronary artery disease, the condition of the patients with these two syndromes is also seriours, the patients are in the advanced or erminal stage of coronary heart disease angina.
The results of correlation analysis between the common syndromes of coronary heart disease angina and cardiac ultrasonography detection indexes show that, qi deficiency and phlegm and blood stasis syndrome of coronary heart disease angina is closely related to cardiac indexes SV,IST, A, when the SV value is larger, the IST, A value are smaller, the possibility of the diagnosis of patients with Qi deficiency and blood stagnation syndrome is greater. Qi stagnation and blood stasis syndrome of coronary heart disease angina is closely related to cardiac indexes LVRT、SV, when the LVRT、SV value are smaller, the possibility of the diagnosis of patients with Qi stagnation and blood stasis syndrome is greater. Phlegm-stasis blocking collateral syndrome of coronary heart disease angina is closely related to cardiac indexes LVPWT、 E、CO、 FS、LVEDd、LVRT, when the LVPWT、E、 CO、FS value are higer, the LVEDd. LVRT value are lower, the possibility of the diagnosis of patients with Phlegm-stasis blocking collateral syndrome is higer. Qi-deficiency and blood-stasis syndrome of coronary heart disease angina is closely related to cardiac indexes LVESd、E/A、LVPWT、LVRT,when the LVESd、E/A value are larger, the LVPWT、LVRT value are smaller, the possibility of the diagnosis of patients with qi-deficiency and blood-stasis syndrome is greater. Qi deficiency and phlegm stasis syndrome of coronary heart disease angina is Closely related to cardiac indexes LVRT、E/A, when the LVRT value is larger, the E/A value is smaller, the possibility of the diagnosis of patients with qi deficiency and phlegm stasis syndrome is higer. Therefore, We can draw a conclusion that there is obvious correlation between the common syndromes of coronary heart disease angina and cardiac ultrasonography detection indexes. These cardiac structure and function indexes can provide objective basis for clinical differentiation of coronary heart disease angina, became a basis of differentiation beside the four methods of diagnosis of TCM, and make for better treatment according to syndrome differentiation in TCM of coronary heart disease angina.
探索冠心病心绞痛患者中医证型分布特点,并通过对冠心病心绞痛中医分型与心脏结构及功能指标之间的相关性研究,探索能指导临床辨证分型的特异的指标,使冠心病心绞痛中医辨证分型更为客观,有利于辨证标准的统一,为临床论治提供可靠依据。
方法：
本研究共收集广州中医药大学第二临床医学院2012年3月—2013年2月住院及门诊的冠心病心绞痛患者281例,以患者的临床症状、舌象、脉象作为辨证依据,对病例进行中医辨证分型,明确冠心病心绞痛的中医证型分布特征。在纳入的病例中,每种辨证分型均选取一定数目的病例作为相关性研究对象,另选取健康体检人员20名作为健康对照组,在治疗前1周内对研究对象以及健康对照组进行心脏超声检查,检测心脏结构以及功能的相关指标并记录,分析证型与左心结构和功能指标的相关性,探索能指导临床辨证分型的特异的指标。
结果：
本研究结果显示,入选的281例冠心病心绞痛患者的中医证型的分布规律为：气虚痰瘀型103例,痰瘀阻络型39例,气虚血瘀型38例,气滞痰阻型28例,气虚痰阻型25例,气滞血瘀型24例,心阳虚衰型13例,气阴两虚型11例。心阳虚衰型以及气虚血瘀型患者的平均年龄明显偏大,而且病程也较长。
冠心病心绞痛患者与健康对照组之间心脏彩超指标比较结果显示,冠心病心绞痛患者的12项心脏结构及功能指标均要劣于健康对照组,差异均有统计学意义。冠心病心绞痛不同证型心脏结构及功能指标的组间两两比较结果显示,气滞痰阻型和痰瘀阻络型患者的心脏指标IST以及LVPWT均要大于其他证型的冠心病患者；心阳虚衰型和气虚血瘀型患者的LVEDd以及LVESd较其他证型的冠心病患者要大；心阳虚衰型以及气虚痰阻型患者的E以及E/A值小于其他证型的冠心病患者,这两型患者的A值要大于其他证型的冠心病患者；气滞痰阻型以及气虚痰阻型患者的LVRT值要高于其他证型的冠心病患者；与气阴两虚型、气滞痰阻型、痰瘀阻络以及气虚痰瘀型患者相比,心阳虚衰型患者FS值较低；气虚血瘀型患者的FS值低于气阴两虚型、气滞痰阻型、气滞血瘀型、痰瘀阻络型以及气虚痰瘀型患者；痰瘀阻络型患者的FS值高于气滞痰阻型、气滞血瘀型、以及气虚痰阻型患者；与气阴两虚型、气滞痰阻型、痰瘀阻络以及气虚痰瘀型患者相比,心阳虚衰型患者LVEF值较低；气虚血瘀型患者的LVEF值低于气阴两虚型、气滞痰阻型、气滞血瘀型、痰瘀阻络型以及气虚痰瘀型患者；痰瘀阻络型患者的LVEF值高于气滞痰阻型、气滞血瘀型、以及气虚痰阻型患者。
冠心病心绞痛常见证型与心脏彩超检测指标相关性分析结果显示,与气虚痰瘀呈正相关关系的心脏彩超指标有SV,呈负相关关系的指标有IST、A指标；与气滞痰阻证呈正相关关系的心脏彩超指标有E、LVRT,呈负相关关系的指标有A、SV；与气滞血瘀证呈负相关关系的指标有LVRT、SV;与痰瘀阻络证呈正相关关系的心脏彩超指标有LVPWT、E、CO、 FS,而呈负相关关系的指标有LVEDd、LVRT;与气虚血瘀证呈正相关关系的心脏彩超指标有LVESd、E/A,而呈负相关关系的指标有LVPWT、LVRT;与气虚痰阻证呈正相关关系的心脏彩超指标有LVRT,而呈负相关关系的指标有E/A。
结论：
中医学认为,冠心病包括本虚和标实两个方面,本虚即气虚、阴虚和阳虚,标实即气滞、痰浊和血瘀。本研究显示,气虚痰瘀型患者所占比例最多,这与气虚痰瘀构成了冠心病最基本的病机特点相符,此外,由于久病伤阳,久病成瘀,因此,研究中,心阳虚衰型、气虚血瘀型患者的平均年龄明显偏大,而且病程也较长。
本研究冠心病心绞痛患者与健康对照组之间心脏指标的比较结果显示,冠心病心绞痛患者12项心脏的结构和功能指标均劣于健康对照组,这说明冠心病心绞痛患者均不同程度存在左室重构现象。冠心病心绞痛不同证型的心脏指标的组间两两比较结果我们可以发现,不同中医证型的冠心病心绞痛患者可以出现不同的心血管重构征象和表现,其中气滞痰阻型以及痰瘀阻络型患者要比其他证型患者的左室壁增厚更加明显,心阳虚衰型和气虚血瘀型患者的左室内径扩大程度比其他证型严重。心阳虚衰型以及气虚痰阻型患者的左室舒张功能要明显劣于其他证型患者。此外,与冠心病心绞痛其余大部分中医证型患者相比,心阳虚衰型以及气虚血瘀型患者的收缩功能减退的情况更为显著。已有研究表明,心脏结构以及功能的改变与病程及疾病的严重程度相关,综合研究结果,我们可以看出心阳虚衰型以及气虚血瘀型患者较其它证型相比有更为明显的心血管重构的表现,因此,我们认为这两型患者的冠脉病变较为显著,病情较重,为冠心病中、晚期患者。
冠心病心绞痛常见证型与心脏彩超客观指标相关性分析结果表明,冠心病心绞痛气虚痰瘀证与心脏指标SV、IST、A密切相关,当SV数值越大,IST、A数值越小时,患者诊断为气虚痰瘀证的可能性愈大；冠心病心绞痛气滞痰阻证与心脏指标E、LVRT、A、SV明显相关,当E、LVRT的数值越高,而A、SV数值越低时,患者的证型就越倾向于气滞痰阻证；冠心病心绞痛气滞血瘀证与心脏指标LVRT、SV密切相关,LVRT、SV的数值越小时,患者诊断为气滞血瘀证的可能性就越大；痰瘀阻络证与心脏指标LVPWT、E、CO、FS、LVEDd、LVRT显著相关,LVPWT、E、CO、FS的数值越高,LVEDd、 LVRT数值越低时,患者的中医证型就越倾向于痰瘀阻络证；冠心病心绞痛气虚血瘀证与心脏指标LVESd、E/A、LVPWT、LVRT显著相关,LVESd、E/A的数值越大,LVPWT、 LVRT数值越小时,患者辨证为气虚血瘀证的可能性越大；冠心病心绞痛气虚痰阻证与心脏指标LVRT、E/A明显相关,LVRT的数值越大,E/A数值越小时,则患者诊断为气虚痰阻证的可能性也愈大。由此,我们可以得出结论,冠心病心绞痛常见中医证型与心脏彩超客观指标有着明显的相关性,这些特异性的指标可为冠心病心绞痛临床辨证分型提供客观依据,成为中医四诊范围外的一种中医辨证依据的拓展,有利于更好地进行冠心病心绞痛中医临床辨证论治。
Objective
The aim of the study is to explore the syndrome distribution of coronary heart disease angina. And through relative researches of heart structure, heart function and the TCM syndrome patterns of coronary heart disease angina, trying to find some peculiar indexs and leading them to the TCM differentiation of coronary heart disease angina. These indexes which make the differentiation more practical can help unify the differentiation standard and provide reliable basis for clinical trearment.
Methods
Collecting281patients with coronary heart disease angina in Guangzhou University of Chinese Medicine Second School of Clinic Medicine from March2012to February2013. Taking the clinical symptoms, tongue Picture, pulse condition of these patients with coronary heart disease angina as the dialectical basis, dividing the patients by differentiation standard, comfirming the syndrome distribution of coronary heart disease angina. Selecting randomly some patients from each syndrome pattern as the study group, in addition, selecting20healthy Persons as control group, all subjects received cardiac structral and functional examination with Doppler ultrasonic cardiogram a week before the treatment. Analyzing the relationship of heart structure, heart function and the TCM syndrome patterns of coronary heart disease angina.
ResuIts
This study shows that The TCM dialectical types of281patients with coronary heart disease angina were distributed as follow:103patients with qi deficiency and phlegm and blood stasis syndrome,39patients with phlegm-stasis blocking collateral syndrome,38patients with qi-deficiency and blood-stasis syndrome,28patients with phlegm stagnation of qi stagnation syndrome,25patients with qi deficiency and phlegm stasis syndrome,24patients with qi stagnation and blood stasis syndrome,13patients with heart yang deficiency syndrome,11patients with qi and yin deficiency syndrome. The patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome are older than the other patients, and disease course of the patients with the two syndromes are also longer than that of the other patients.
The results of comparison of echocardiography index between patients with coronary heart disease angina group and healthy control group show that, the12cardiac structure and function indexes of the patients with coronary heart disease angina are all inferior to the healthy control group, and the difference has statistical significance. The results of comparison of cardiac structure and function indexes between patients with different syndromes of coronary heart disease angina shows that, the data of cardiac indexes of IST and LVPWT in patients with phlegm stagnation of qi stagnation syndrome and phlegm-stasis blocking collateral syndrome are higher than the patients of other syndromes with coronary heart disease angina. The data of cardiac indexes of LVEDd and LVESd in patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome are higher than the patients of other syndromes with coronary heart disease angina. The data of cardiac indexes of E and E/A in patients with heart yang deficiency syndrome and qi deficiency and phlegm stasis syndrome are lower than the patients of other syndromes with coronary heart disease angina, the data of cardiac indexes of A in patients with heart yang deficiency syndrome and qi deficiency and phlegm stasis syndrome are higer than the patients of other syndromes with coronary heart disease angina. The data of cardiac indexes of LVRT in patients with phlegm stagnation of qi stagnation syndrome and qi deficiency and phlegm stasis syndrome are higer than the patients of other syndromes with coronary heart disease angina. Compared with patients with qi and yin deficiency syndrome、phlegm stagnation of qi stagnation syndrome、phlegm-stasis blocking collateral syndrome and qi deficiency and phlegm and blood stasis syndrome, patients with heart yang deficiency syndrome has lower FS. The data of cardiac index of FS in patients with qi-def iciency and blood-stasis syndrome is lower than that of patients with qi and yin deficiency syndrome、phlegm stagnation of qi stagnation syndrome、qi stagnation and blood stasis syndrome、 phlegm-stasis blocking collateral syndrome and qi deficiency and phlegm and blood stasis syndrome. The data of cardiac index of FS in patients with phlegm-stasis blocking collateral syndrome is higer than that of patients with phlegm stagnation of qi stagnation syndrome、qi stagnation and blood stasis syndrome and qi deficiency and phlegm stasis syndrome. Compared with patients with qi and yin deficiency syndrome、phlegm stagnation of qi stagnation syndrome、phlegm-stasis blocking collateral syndrome and qi deficiency and phlegm and blood stasis syndrome, patients with heart yang deficiency syndrome has lower LVEF. The data of cardiac index of LVEF in patients with qi-def iciency and blood-stasis syndrome is lower than that of patients with qi and yin deficiency syndrome、phlegm stagnation of qi stagnation syndrome、qi stagnation and blood stasis syndrome、phlegm-stasis blocking collateral syndrome and qi deficiency and phlegm and blood stasis syndrome. The data of cardiac index of LVEF in patients with phlegm-stasis blocking collateral syndrome is higer than that of patients with phlegm stagnation of qi stagnation syndrome、qi stagnation and blood stasis syndrome and qi deficiency and phlegm stasis syndrome.
The results of correlation analysis between the common syndromes of coronary heart disease angina and cardiac ultrasonography detection indexes show that, qi deficiency and phlegm and blood stasis syndrome has positive relationship with echocardiography index SV, and shows negative correlation with IST, A. Phlegm stagnation of qi stagnation syndrome has positive relationship with echocardiography indexes E、LVRT, and shows negative correlation with A、SV. Qi stagnation and blood stasis syndrome has negative correlation with LVRT、SV. Phlegm-stasis blocking collateral syndrome has positive relationship with echocardiography indexes LVPWT、E、CO、FS, and shows negative correlation with LVEDd、LVRT. Qi-deficiency and blood-stasis syndrome has positive relationship with echocardiography indexes LVESd、E/A, and shows negative correlation with LVPWT、LVRT. Qi deficiency and phlegm stasis syndrome has positive relationship with echocardiography index LVRT,and shows negative correlation with E/A.
Conelusion
Traditional Chinese medicine believes that,pathogenesis of coronary heart disease angina contains two respects:deficiency in origin and excess in superficiality. Deficiency in origin contains qi deficiency, yin deficiency and yang deficiency. Excess in superficiality contains qi stagnation, phlegm stasis and blood stasis. This study shows the largest proportion of coronary heart disease angina patients is the patients with qi deficiency and phlegm and blood stasis syndrome. This result consistent with the basic characteristics of the pathogenesis of qi deficiency、phlegm and blood stasis. In addition, chronic diseases injury Yang and form blood stasis, the study also shows that patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome are older than the other patients, and disease course of the patients with the two syndromes are also longer than that of the other patients.
The results of comparison of echocardiography index between patients with coronary heart disease angina group and healthy control group show that, the12cardiac structure and function indexes of the patients with coronary heart disease angina are all inferior to the healthy control group, this means that all types of patients with coronary heart disease angina have phenomenon of cardiovascular remodeling. From the results of comparison of cardiac structure and function indexes between patients with different syndromes of coronary heart disease angina, we can find that, different TCM syndrome types in patients with coronary heart disease angina have different features and performance in cardiovascular remodeling.The left ventricular wall of patients with phlegm stagnation of qi stagnation syndrome and phlegm-stasis blocking collateral syndrome is more thick than patients with other ayndromes remarkably. The extent of left ventricular density of patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome is more evident than patients with other syndromes. The left ventricular diastolic function of the patients with heart yang deficiency syndrome and qi deficiency and phlegm stasis syndrome is inferior to the left ventricular diastolic function of patients with other syndromes evidently. In addition, compared with the patients with coronary heart disease angina of most of the other syndromes, the condition of systolic dysfunction of patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome is more obvious. Previous studies have suggested that, the change of cardiac structure and function is associated with the severity of disease and the course of disease. Comprehensive the results, we can find that the manifestation of cardiovascular remodeling of patients with heart yang deficiency syndrome and qi-def iciency and blood-stasis syndrome is more obvious than that of patients with other syndromes. Therefore, we believe that the patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome have more seriours coronary artery disease, the condition of the patients with these two syndromes is also seriours, the patients are in the advanced or erminal stage of coronary heart disease angina.
The results of correlation analysis between the common syndromes of coronary heart disease angina and cardiac ultrasonography detection indexes show that, qi deficiency and phlegm and blood stasis syndrome of coronary heart disease angina is closely related to cardiac indexes SV,IST, A, when the SV value is larger, the IST, A value are smaller, the possibility of the diagnosis of patients with Qi deficiency and blood stagnation syndrome is greater. Qi stagnation and blood stasis syndrome of coronary heart disease angina is closely related to cardiac indexes LVRT、SV, when the LVRT、SV value are smaller, the possibility of the diagnosis of patients with Qi stagnation and blood stasis syndrome is greater. Phlegm-stasis blocking collateral syndrome of coronary heart disease angina is closely related to cardiac indexes LVPWT、 E、CO、 FS、LVEDd、LVRT, when the LVPWT、E、 CO、FS value are higer, the LVEDd. LVRT value are lower, the possibility of the diagnosis of patients with Phlegm-stasis blocking collateral syndrome is higer. Qi-deficiency and blood-stasis syndrome of coronary heart disease angina is closely related to cardiac indexes LVESd、E/A、LVPWT、LVRT,when the LVESd、E/A value are larger, the LVPWT、LVRT value are smaller, the possibility of the diagnosis of patients with qi-deficiency and blood-stasis syndrome is greater. Qi deficiency and phlegm stasis syndrome of coronary heart disease angina is Closely related to cardiac indexes LVRT、E/A, when the LVRT value is larger, the E/A value is smaller, the possibility of the diagnosis of patients with qi deficiency and phlegm stasis syndrome is higer. Therefore, We can draw a conclusion that there is obvious correlation between the common syndromes of coronary heart disease angina and cardiac ultrasonography detection indexes. These cardiac structure and function indexes can provide objective basis for clinical differentiation of coronary heart disease angina, became a basis of differentiation beside the four methods of diagnosis of TCM, and make for better treatment according to syndrome differentiation in TCM of coronary heart disease angina.
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