急性心肌梗死患者中医证型与客观化指标的相关性研究

发布时间：2018-01-12 10:09

本文关键词：急性心肌梗死患者中医证型与客观化指标的相关性研究　出处：《辽宁中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:将传统医学的标准化内容与现代医学的客观化指标相结合,探讨急性心肌梗死(Acute Myocardial Infarction,AMI)各中医证型与客观化指标之间的内在联系与外在差异,以检出AMI患者的高危人群,了解各项客观化指标对于AMI各中医证型的预测意义,从而推进AMI中医证型研究的科学性与客观化。尽早采取有效的临床措施,预防与治疗AMI,为临床应用提供切实的科学依据,以提高救治率。资料与方法:回顾性总结2012年3月至2015年11月,就诊于辽宁中医药大学附属医院420例AMI患者的性别、年龄、吸烟史、高血压病史、糖尿病病史、血脂异常症、外周血炎性指标、血脂指标、心肌酶谱指标等临床资料。将入选患者分为痰浊闭塞组、气滞血瘀组、阴血亏虚组、阳气亏虚组。将AMI患者的中医证型作为因变量,以各项客观指标作为自变量,进行统计描述、单因素分析及多因素分析。结果:1.420例AMI患者中医证型分布情况:痰浊闭塞证(31.19%),气滞血瘀证(33.33%),阴血亏虚证(15.00%),阳气亏虚证(20.48%)。2.四组中医证型在性别、年龄分段、吸烟史、高血压病史、糖尿病病史、血脂异常症、白细胞计数(White blood cell,WBC)、中性粒细胞计数(Neutrophil,NEU)、甘油三酯(Triglyceride,TG)、总胆固醇(Total cholesterol,TC)、低密度脂蛋白胆固醇(Low density lipoprotein cholesterol,LDL-C)、乳酸脱氢酶(Lactate dehydrogenase,LDH)、肌酸激酶同工酶(Creatine kinase MB,CK-MB)、羟丁酸脱氢酶(Hydroxybutyrate dehydrogenase,HBDH)的卡方检验中,组间差异均有统计学意义(P0.05)。3.四组中医证型在WBC、NEU、TG、TC、LDL-C、LDH、肌酸激酶(Creatine kinase,CK)、CK-MB、HBDH的单因素方差分析中,组间差异均有统计学意义(P0.05)。4.经过多因素分析,发现AMI患者痰浊闭塞证与年龄、吸烟史、TC、CK-MB有关;气滞血瘀证与高血压病史、糖尿病病史、WBC、TC、LDL-C有关;阴血亏虚证与年龄、高血压病史、糖尿病病史、血脂异常症有关;阳气亏虚证与年龄、高血压病史、TC、LDH有关。结论:1.AMI各中医证型中,气滞血瘀证、痰浊闭塞证、阳气亏虚证、阴血亏虚证所占比例依次减少。2.AMI中医证型与WBC、NEU、TG、TC、LDL-C、LDH、CK、CK-MB、HBDH之间存在相关性,可作为AMI中医证型的客观指标依据。3.年龄、吸烟史、高血压病史、糖尿病病史、血脂异常症、WBC、TC、LDL-C、LDH、CK-MB对AMI中医证型有一定的预测意义。
[Abstract]:Objective: to study acute Myocardial Infarction in acute myocardial infarction (AMI) by combining the standardized content of traditional medicine with the objective index of modern medicine. In order to detect the high-risk group of AMI patients and understand the predictive significance of each objective index for TCM syndromes of AMI, the internal relationship and external difference between TCM syndrome types and objective indexes were analyzed. In order to promote the scientific and objective study of TCM syndromes of AMI, to take effective clinical measures as soon as possible, to prevent and treat AMI, and to provide practical scientific basis for clinical application. Data and methods: from March 2012 to November 2015, 420 patients with AMI in affiliated hospital of Liaoning University of traditional Chinese Medicine were reviewed retrospectively. Hypertension history, diabetes history, dyslipidemia, peripheral blood inflammatory index, blood lipid index, myocardial enzyme index and other clinical data. Selected patients were divided into phlegm-turbid occlusion group, Qi stagnation and blood stasis group, Yin and blood deficiency group. Yang Qi deficiency group. The TCM syndrome type of AMI patients as dependent variables, with the objective indicators as independent variables, statistical description. Results the distribution of TCM syndromes in 1.420 cases of AMI were as follows: phlegm-turbid occlusion syndrome 31.1919, Qi stagnation and blood stasis syndrome 33.33). Yin-blood deficiency syndrome was 15.00 and Yang Qi deficiency syndrome was 20.480.2.The four TCM syndromes were gender, age, smoking, hypertension, diabetes and dyslipidemia. White blood cell count (WBC), neutrophil count (neutrophila), triglyceride (TG). TGG, Total cholesterol cholesterol (TC). Low density lipoprotein cholesterol (LDL-C). Lactic dehydrogenate dehydrogenase (Lactate dehydrogenase), creatine kinase isoenzyme (Creatine kinase). Hydroxybutyrate dehydrogenase (HBDH). There were significant differences among the four groups (P 0.05, P 0.05, P < 0.05). The four groups of TCM syndromes were in WBCU, TGV, TGN, LDL-CU, LDH. Single factor analysis of variance of Creatine kinase CK-MBN HBDH. There was a significant difference between the two groups (P 0.05). By multivariate analysis, it was found that the type of phlegm turbid obliteration in AMI patients was related to age, smoking history and CK-MB. The syndrome of qi stagnation and blood stasis was related to the history of hypertension and diabetes mellitus. The deficiency of yin and blood was related to age, history of hypertension, history of diabetes and dyslipidemia. Conclusion 1. Among the TCM syndromes of AMI, qi stagnation and blood stasis syndrome, phlegm turbid occlusion syndrome and yang qi deficiency syndrome are related to age and hypertension history. The proportion of yin and blood deficiency syndrome decreased in turn. 2. There was a correlation between the TCM syndrome type of AMI and the HBDH of WBCU Neiu TGN TGN LDL-CU LDHN CKK MBN and HBDH. It can be used as the objective index of TCM syndrome type of AMI. Age, smoking history, hypertension history, diabetes history and dyslipidemia. CK-MB has certain predictive significance for TCM syndrome type of AMI.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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