冠脉CTA斑块辨识与胸痹中医证型相关性研究
发布时间：2019-06-25 15:26
【摘要】：冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease,CHD)又称冠心病,属中医“胸痹”、“胸痹心痛”范畴。近年心血管病患病率、死亡率持续上升,成为居民首位死因,报告显示,2014年估计全国已有心血管患者2.9亿。CHD又分为急性冠脉综合征(acute coronary syndrome,ACS)和慢性冠脉病(chronic coronary artery disease, CAD),其中ACS是发生急性心血管事件的主要原因。现代研究发现,ACS的发生与动脉粥样硬化(atherosclerotic, AS)斑块性质有密切相关性,即ACS的发生主要取决于斑块的稳定性及血流动力学因素,故斑块辨识对预防ACS发生的诊疗具有重大意义,对CHD(尤其是ACS)的风险评估有极高价值,应该纳入诊断及评估体系。目的本研究结合目前中西医对冠心病及冠状动脉粥样硬化的认识,对斑块辨识与中医证型的关系进行探求,以期为中西医对冠脉斑块的诊断寻找新的切入点,为其治疗提供新思路及更多的理论指导。材料与方法回顾分析2013年10月-2015年10月在北京中医药大学东直门医院放射科行冠脉CTA检查,并且由副主任医师及以上级别医师主诊,有造成冠脉轻度及以上程度狭窄斑块存在的患者,131例为研究对象,收集患者冠脉CTA检查结果中的斑块数量、斑块性质、狭窄程度、钙化积分,收集患者病历资料,根据中医四诊信息进行辨证分型,探讨冠脉CTA斑块辨识与胸痹中医证型的相关性。使用SPSS18.0统计软件进行医学统计学分析。结果1.本研究共纳入131例患者,其中男性61例,占46.6%,女性70例,占53.4%,中医证型分布：气虚血瘀气滞血瘀痰瘀阻络心肾阴虚气阴两虚阳气虚衰,纳入分析斑块斑块497个,钙化斑块345个,混合斑75个,软斑块77个；2.病程与年龄呈正相关关系；3.痰瘀阻络证斑块,尤其钙化斑块的发生率高于其他证型；4.中度狭窄-钙化斑块及重度狭窄-钙化斑块在痰瘀阻络证发生率高于其他证型；痰瘀阻络证的轻、中、重度狭窄均主要由钙化斑块引起；痰瘀阻络、气虚血瘀、气滞血瘀及心肾阴虚证引起轻度狭窄的斑块中,钙化斑块发生率高于混合及软斑；气阴两虚、阳气虚衰证各斑块分布没有差异；5.轻、中度狭窄主要由钙化斑块引起；6.病程与总斑块数、钙化斑块及混合斑块的发生呈正相关关系；7.钙化程度与斑块发生呈正相关关系。结论1.中医证型分布：气虚血瘀气滞血瘀痰瘀阻络心肾阴虚气阴两虚阳气虚衰；2.冠心病及冠状动脉粥样硬化患者发病年龄相对稳定；3.轻、中度狭窄主要由钙化斑块引起；4.病程与总斑块数、钙化斑块及混合斑块的发生呈正相关关系；5.钙化程度与斑块发生呈正相关关系；6.冠脉CTA的斑块辨识与胸痹的中医证型有一定的相关性,具体表现为痰瘀阻络证斑块(尤其是钙化斑块)发生率较高,相对来讲,阴两虚、阳气虚衰证轻度狭窄中软斑及混合斑的发生率高于其他组；对中西医结合对冠脉斑块的认识有一定指导意义。
[Abstract]:Coronary atherosclerotic heart disease (coronary atherosclerotic heart disease,CHD), also known as coronary heart disease, belongs to the category of "chest arthralgia" and "chest arthralgia" in traditional Chinese medicine. In recent years, the prevalence and mortality of cardiovascular diseases have continued to rise, becoming the first cause of death among residents. The report shows that 290m cardiovascular patients have been estimated in 2014 as acute coronary syndrome (acute coronary syndrome,ACS) and chronic coronary artery disease (chronic coronary artery disease, CAD),). ACS is the main cause of acute cardiovascular events. Modern studies have found that the occurrence of ACS is closely related to the nature of atherosclerotic (atherosclerotic, AS) plaques, that is, the occurrence of ACS mainly depends on the stability of plaques and hemodynamic factors. Therefore, plaque identification is of great significance to the diagnosis and treatment of ACS. It is of great value to the risk assessment of CHD (especially ACS), and should be included in the diagnosis and evaluation system. Objective to explore the relationship between plaque identification and TCM syndrome types based on the current understanding of coronary heart disease and coronary atherosclerosis in traditional Chinese and western medicine, in order to find a new entry point for the diagnosis of coronary plaques by traditional Chinese and western medicine, and to provide new ideas and more theoretical guidance for its treatment. Materials and methods Coronary artery CTA was performed in the Department of Radiology, Dongzhimen Hospital of Beijing University of traditional Chinese Medicine from October 2013 to October 2015. 131 patients with mild or above coronary stenosis plaques were examined by deputy chief physician and above. The number of plaques, plaque nature, stenosis degree, calcification score and patient medical records were collected. According to the four diagnosis information of traditional Chinese medicine (TCM), the correlation between coronary artery CTA plaque identification and TCM syndrome type of chest arthralgia was discussed. SPSS18.0 statistical software was used for medical statistical analysis. Result 1. A total of 131 patients were included in this study, including 61 males (46.6%) and 70 females (53.4%). The distribution of TCM syndromes was qi deficiency and blood stasis, stagnation of blood stasis, phlegm and blood stasis blocking collaterals deficiency of yin and kidney, deficiency of yin and yin, deficiency of yang and qi, including 497 plaques, 345 calcified plaques, 75 mixed plaques and 77 soft plaques. There was a positive correlation between the course of disease and age; 3. The incidence of plaques with phlegm and blood stasis blocking collaterals, especially calcified plaques, was higher than that of other syndromes. The incidence of moderate stenosis-calcification plaque and severe stenosis-calcification plaque in phlegm and blood stasis syndrome was higher than that in other syndromes; the mild, moderate and severe stenosis of phlegm and blood stasis syndrome was mainly caused by calcified plaque; among the plaques caused by phlegm and blood stasis, qi deficiency and blood stasis, qi stagnation and blood stasis and heart and kidney yin deficiency syndrome, the incidence of calcified plaques was higher than that of mixed and soft plaques; there was no difference in the distribution of plaques between qi and yin deficiency and yang qi deficiency syndrome. Mild to moderate stenosis was mainly caused by calcified plaques. The course of disease was positively correlated with the total number of plaques, calcified plaques and mixed plaques. There was a positive correlation between the degree of calcification and the occurrence of plaques. Conclusion 1. Distribution of TCM syndrome types: qi deficiency, blood stasis, phlegm and blood stasis, blocking collaterals, heart and kidney yin deficiency, qi deficiency, yang deficiency and failure; 2. The age of onset of coronary heart disease and coronary atherosclerosis was relatively stable. Mild to moderate stenosis was mainly caused by calcified plaques. The course of disease was positively correlated with the total number of plaques, calcified plaques and mixed plaques. There was a positive correlation between the degree of calcification and the occurrence of plaques. There is a certain correlation between plaque identification of coronary artery CTA and TCM syndrome types of chest arthralgia, which is manifested in the high incidence of plaques (especially calcified plaques) in phlegm and blood stasis syndrome. Relatively speaking, the incidence of soft plaques and mixed plaques in mild stenosis of yin deficiency and yang qi deficiency syndrome is higher than that of other groups, which has certain guiding significance for the understanding of coronary plaques by combination of traditional Chinese and western medicine.
【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】：2016
【分类号】：R541.4
[Abstract]:Coronary atherosclerotic heart disease (coronary atherosclerotic heart disease,CHD), also known as coronary heart disease, belongs to the category of "chest arthralgia" and "chest arthralgia" in traditional Chinese medicine. In recent years, the prevalence and mortality of cardiovascular diseases have continued to rise, becoming the first cause of death among residents. The report shows that 290m cardiovascular patients have been estimated in 2014 as acute coronary syndrome (acute coronary syndrome,ACS) and chronic coronary artery disease (chronic coronary artery disease, CAD),). ACS is the main cause of acute cardiovascular events. Modern studies have found that the occurrence of ACS is closely related to the nature of atherosclerotic (atherosclerotic, AS) plaques, that is, the occurrence of ACS mainly depends on the stability of plaques and hemodynamic factors. Therefore, plaque identification is of great significance to the diagnosis and treatment of ACS. It is of great value to the risk assessment of CHD (especially ACS), and should be included in the diagnosis and evaluation system. Objective to explore the relationship between plaque identification and TCM syndrome types based on the current understanding of coronary heart disease and coronary atherosclerosis in traditional Chinese and western medicine, in order to find a new entry point for the diagnosis of coronary plaques by traditional Chinese and western medicine, and to provide new ideas and more theoretical guidance for its treatment. Materials and methods Coronary artery CTA was performed in the Department of Radiology, Dongzhimen Hospital of Beijing University of traditional Chinese Medicine from October 2013 to October 2015. 131 patients with mild or above coronary stenosis plaques were examined by deputy chief physician and above. The number of plaques, plaque nature, stenosis degree, calcification score and patient medical records were collected. According to the four diagnosis information of traditional Chinese medicine (TCM), the correlation between coronary artery CTA plaque identification and TCM syndrome type of chest arthralgia was discussed. SPSS18.0 statistical software was used for medical statistical analysis. Result 1. A total of 131 patients were included in this study, including 61 males (46.6%) and 70 females (53.4%). The distribution of TCM syndromes was qi deficiency and blood stasis, stagnation of blood stasis, phlegm and blood stasis blocking collaterals deficiency of yin and kidney, deficiency of yin and yin, deficiency of yang and qi, including 497 plaques, 345 calcified plaques, 75 mixed plaques and 77 soft plaques. There was a positive correlation between the course of disease and age; 3. The incidence of plaques with phlegm and blood stasis blocking collaterals, especially calcified plaques, was higher than that of other syndromes. The incidence of moderate stenosis-calcification plaque and severe stenosis-calcification plaque in phlegm and blood stasis syndrome was higher than that in other syndromes; the mild, moderate and severe stenosis of phlegm and blood stasis syndrome was mainly caused by calcified plaque; among the plaques caused by phlegm and blood stasis, qi deficiency and blood stasis, qi stagnation and blood stasis and heart and kidney yin deficiency syndrome, the incidence of calcified plaques was higher than that of mixed and soft plaques; there was no difference in the distribution of plaques between qi and yin deficiency and yang qi deficiency syndrome. Mild to moderate stenosis was mainly caused by calcified plaques. The course of disease was positively correlated with the total number of plaques, calcified plaques and mixed plaques. There was a positive correlation between the degree of calcification and the occurrence of plaques. Conclusion 1. Distribution of TCM syndrome types: qi deficiency, blood stasis, phlegm and blood stasis, blocking collaterals, heart and kidney yin deficiency, qi deficiency, yang deficiency and failure; 2. The age of onset of coronary heart disease and coronary atherosclerosis was relatively stable. Mild to moderate stenosis was mainly caused by calcified plaques. The course of disease was positively correlated with the total number of plaques, calcified plaques and mixed plaques. There was a positive correlation between the degree of calcification and the occurrence of plaques. There is a certain correlation between plaque identification of coronary artery CTA and TCM syndrome types of chest arthralgia, which is manifested in the high incidence of plaques (especially calcified plaques) in phlegm and blood stasis syndrome. Relatively speaking, the incidence of soft plaques and mixed plaques in mild stenosis of yin deficiency and yang qi deficiency syndrome is higher than that of other groups, which has certain guiding significance for the understanding of coronary plaques by combination of traditional Chinese and western medicine.
【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】：2016
【分类号】：R541.4
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