冠心病心绞痛中医证型与心冲击图及冠脉狭窄程度的相关性研究

发布时间：2019-07-08 14:13

【摘要】：冠心病是冠状动脉粥样硬化改变导致血管管腔狭窄、阻塞和(或)因冠状动脉功能性改变(痉挛)导致心肌缺血缺氧或坏死而引起的心脏疾病,是多种动脉粥样硬化疾病常见疾病。因其高患病率、反复频繁的再住院率,为家庭和社会带来沉重的负担,已成为重大的公共卫生问题。随着近年来医学研究的不断深入,中医药防治冠心病心绞痛能够改善症状,提高运动耐量和生存质量,降低病死率,体现出了明显的优势。辨证论治是中医的核心思想,准确的辨证方能施行有效的治疗。因此,为冠心病心绞痛的中医辨证提供客观的量化指标逐渐成为研究的热点。心冲击图是医学物理学领域的心血管监测仪器,有望成为评价血管狭窄的手段。基于此,笔者将心冲击图技术引入临床研究,试图评价冠心病心绞痛不同中医证型与心冲击图及冠脉狭窄程度的相关性,为中医辨证分型探索客观的量化依据,提高冠心病心绞痛的中医辨证水平与临床疗效。研究目的:(1)研究冠心病心绞痛组与非冠心病心绞痛组在心冲击图主要指标(IJ、JK间期)及冠脉狭窄程度方面的差异。(2)评价冠心病心绞痛组不同中医辨证分型与心冲击图主要指标(IJ、JK间期)及冠脉狭窄程度的相关性。研究方法:以2016年11月到2017年3月在北京中医药大学东方医院心血管内科病房住院疑诊为冠心病心绞痛的139例患者为研究对象。本研究分为冠心病心绞痛组和非冠心病心绞痛组,冠心病心绞痛的西医诊断标准参照1979年国际心脏病学会及WHO制定的《缺血性心脏病的命名及诊断标准》,以冠脉造影检查结果作为诊断金标准。中医辨证分型依据2002年国家药品监督管理局《中药新药临床研究指导原则》分为心血瘀阻证、气虚血瘀证、气滞血瘀证、痰阻心脉证、气阴两虚证5个常见证型。由本人对139例入组患者行造影术前采集心电图一心冲击图资料,后期测定所需的心冲击图主要指标IJ、JK间期。冠状动脉造影结果分析由有经验的心内科导管室医生完成,结果由有经验的心内科医师2人以上共同阅片出具报告。符合冠心病诊断标准的纳入冠心病心绞痛组,排除冠心病诊断的患者的纳入非冠心病心绞痛组。将数据采用SPSS20.0对数据进行统计分析。计量资料采用t检验及方差分析或非参数检验,计数资料采用卡方检验,等级资料采用秩和检验,相关性分析采用Spearman相关分析,入选与剔除值为P0.05。研究结果:1.冠心病心绞痛组患者的IJ、JK间期及Gensini积分明显高于非冠心病心绞痛患者,差异具有统计学意义(P0.05)。2.冠心病心绞痛组部分中医证型与IJ、JK间期均有一定的相关性(P0.05),随着(心血瘀阻证、气虚血瘀证)/气滞血瘀、(痰阻心脉证/气阴两虚证)中医证型的转变,IJ、JK间期呈逐渐增大趋势。3.冠心病心绞痛组部分中医证型与Gensini积分有一定的相关性(P0.05),随着证型依次从心血瘀阻证到气虚血瘀证、气滞血瘀证,再到痰阻心脉证、气阴两虚证,冠脉狭窄程度加重。4.冠心病心绞痛组部分中医证型与病变血管支数有一定的相关性(P0.05),单纯血瘀者多为单支局部病变,病变程度轻,多种病因夹杂和虚证者常见多支病变,病变程度也相对较重。5.冠心病心绞痛组和非冠心病心绞痛组患者的IJ间期与冠脉狭窄程度、JK间期与冠脉狭窄程度间均存在相关性(P0.05),IJ、JK间期值与Gensini积分成正相关性,随着冠脉狭窄程度的加重,IJ、JK间期值均有增大趋势。研究结论:1.tIJ、tJK、Gensini积分在冠心病心绞痛组与非冠心病心绞痛组间存在显著性差异。应用IJ、JK间期评价冠状动脉狭窄程度具有一定的可行性。2.tIJ、tJK、Gensini积分均与冠心病心绞痛中医证型存在相关性,可为中医辨证分型提供客观量化依据。3.tIJ和tJK与Gensini积分存在正相关性,可以为评价冠状动脉狭窄程度提供参考。
[Abstract]:Coronary heart disease is a heart disease caused by coronary artery stenosis, obstruction, and/ or a change in coronary function (spasm) resulting in myocardial ischemia/ hypoxia or necrosis, which is a disease of various atherosclerotic disease. Due to its high prevalence, repeated frequent rehospitalization rates have a heavy burden on the family and society and have become a major public health problem. With the development of medical research in recent years, the prevention and treatment of coronary heart disease and angina pectoris can improve the symptoms, improve the exercise tolerance and the quality of life, and reduce the case fatality rate. The differentiation and treatment is the core thought of the traditional Chinese medicine, and the effective treatment can only be carried out by the exact differentiation of the syndrome. Therefore, it is a hot topic to provide objective quantitative index for TCM syndrome differentiation of coronary heart disease and angina pectoris. The cardiograph is a cardiovascular monitoring instrument in the field of medical physics and is expected to be a means of evaluating vascular stenosis. On the basis of this, the author introduced the cardiograph technique into the clinical study, and tried to evaluate the correlation between the different TCM syndrome types of the coronary heart disease and the degree of cardiac shock and the degree of coronary stenosis, and to explore the objective quantitative basis for the syndrome differentiation of TCM. To improve the syndrome differentiation and clinical curative effect of the patients with coronary heart disease and angina pectoris. Objective: (1) To study the difference of the main index (IJ, JK interval) and the degree of coronary stenosis in the patients with coronary heart disease and non-coronary heart disease. (2) To evaluate the correlation between the TCM syndrome differentiation and the main index (IJ, JK interval) and the degree of coronary stenosis in the patients with coronary heart disease and angina pectoris. Methods:139 patients with coronary heart disease and angina pectoris were studied in the cardiovascular system of the East Hospital of Beijing University of Traditional Chinese Medicine from November 2016 to March 2017. This study is divided into the coronary heart disease and the non-coronary heart disease group. The diagnostic criteria of the western medicine in the patients with coronary heart disease and angina pectoris are referred to in the 1979 International Heart Association and the WHO Standard for Naming and Diagnosis of the Ischemic Heart Disease. The results of the coronary angiography are used as the criteria for the diagnosis of coronary heart disease. The syndrome differentiation of Chinese medicine is divided into five common types of syndromes, such as heart blood stasis syndrome, qi deficiency and blood stasis syndrome, qi stagnation and blood stasis syndrome, phlegm-resistance heart-vein syndrome, and qi-yin deficiency-deficiency syndrome, according to the guidelines for clinical study of the Chinese medicine and drug administration in 2002. The main indexes of cardiac impact map (IJ) and JK interval (JK), which were required for later measurement, were collected from 139 patients who were enrolled in the group. The results of the coronary angiography were performed by an experienced cardiologist, and the results were reported by the experienced cardiologist at more than 2 co-readers. The coronary heart disease and angina pectoris group is included in the coronary heart disease and angina pectoris group, and the patients who are diagnosed with the coronary heart disease are excluded from the non-coronary heart disease and angina pectoris group. The data was statistically analyzed using the SPSS10.0. The measurement data is t-test and analysis of variance or non-quantitative test. The data of the count is chi-square test, and the rank data is rank and tested. The correlation analysis adopts the Spearman correlation analysis, and the inclusion and elimination value is P0.5.05. Study results:1. The IJ, JK interval and Gensini score in patients with coronary heart disease and angina pectoris were significantly higher than those in non-coronary heart disease and angina pectoris (P0.05). There was a certain correlation between the TCM syndrome type and the IJ and JK interval in the patients with coronary heart disease (P0.05). With the change of the syndrome of TCM, the interval of IJ and JK gradually increased with the change of TCM syndrome of (heart blood stasis syndrome, Qi deficiency and blood stasis syndrome)/ qi stagnation and blood stasis. There was a certain correlation between the TCM syndrome type and Gensini score in the patients with coronary heart disease (P0.05). In the patients with coronary heart disease and angina pectoris, there was a certain correlation between the number of TCM syndromes and the number of vessels in the lesion (P0.05). There was a correlation between the IJ interval and the degree of coronary stenosis, the degree of JK interval and the degree of coronary stenosis (P0.05), and the value of the IJ and JK interval was positively correlated with that of Gensini, and with the increase of the degree of coronary stenosis, IJ, There was an increase in the value of the JK interval. The results showed that 1. tIJ, tJK and Gensini had significant differences between the patients with coronary heart disease and non-coronary heart disease. 2. There is a positive correlation between tIJ, tJK and Gensini integral with the traditional Chinese medicine syndrome of the patients with coronary heart disease. A reference may be provided to evaluate the degree of coronary stenosis.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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