急诊胸痛的中医证型与D-二聚体水平相关性研究

发布时间：2018-02-26 11:14

本文关键词： 胸痛中医证型 D-二聚体相关性研究　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：通过详细整理分析急诊胸痛中医证型分布及其血浆D-二聚体的升高水平情况,研究其不同中医证型与D-二聚体水平的相关性,探讨D-二聚体升高与相关证型在疾病发生发展过程中的共性,为今后中西医结合防治急诊胸痛提供客观的、简单的临床参考依据。方法：采用回顾性调查研究的方法,分析2015年1月至2015年12月广东省中医院急诊科从症状学角度确诊为胸痛的139病例,采集患者的一般资料、主诉、临床症状、既往史及D-二聚体指标结果,采用excel进行数据录入,数据分析采用spss19.0软件进行统计分析胸痛各证型分布频数及常见证型与D-二聚体结果的相关性。统计描述计量资料采用均值±标准差或中位数(四分位数间距)表示,计数资料采用率或构成比表示；统计推断计量资料采用秩和检验或方差分析,计数资料采用X2检验,影响因素分析采用多重线性回归分析进行,相关性采用spearman进行分析。结果：1、急诊胸痛的中医证型以实证分布最多,其次为虚实夹杂证,最少的为虚证；具体的辨证分型从多到少依次为痰阻型(31.0%)、血瘀型(28.9%)、气滞型(15.8%)、气虚型(15.7%)、寒凝型(5.10%)、阳虚型(2.50%)、阴虚型(1.0%)。2、急诊胸痛的D-二聚体升高水平大于截点值(500 μ g/L)的中医证型有血瘀型和痰阻型,而且血瘀型明显多于痰阻型。而D-二聚体升高水平低于截点值的中医证型以痰阻型、气滞型、气虚型为主。3、急诊胸痛混合证型的D-二聚体升高水平明显高于单一证型的D-二聚体升高水平(P0.05)。4、急诊胸痛以虚证、实证、虚实夹杂证分类,三组的D-二聚体升高水平存在统计学差异(P0.001),表现为虚证组的D-二聚体水平明显低于实证组和虚实夹杂证组。5、急诊胸痛不同单一证型的D-二聚体升高水平存在统计学差异,表现为血瘀型的D-二聚体升高水平明显高于其他证型,其他证型间无差异(P0.001)。结论：本研究在某个层面上总结了急诊胸痛的中医证型分布情况：急诊胸痛以实证分布最多,其次为虚实夹杂证,最少的为虚证；其辨证分型从多到少依次为痰阻型、血瘀型、气滞型、气虚型、寒凝型、阳虚型、阴虚型。其中,急诊胸痛的实证组和虚实夹杂证组的D-二聚体升高水平明显高于虚证组的升高水平。血瘀型的急诊胸痛与反映纤溶活性的D-二聚体存在一定的相关性,痰阻型、气滞型、气虚型等其他6种胸痛证型与D-二聚体升高水平没有明显联系。D-二聚体升高数值大于截点值的胸痛证型以血瘀型为主,其次为痰阻证。故急诊胸痛患者体内凝血、纤溶系统异常与中医学的实证、血瘀证存在相关性。
[Abstract]:Objective: to analyze the distribution of TCM syndromes in emergency chest pain and the elevated level of plasma D-dimer, and to study the correlation between different TCM syndromes and D-dimer level. To explore the commonness of Ddimer elevation and related syndromes in the course of disease occurrence and development, to provide objective and simple clinical reference for the prevention and treatment of emergency chest pain by integrated Chinese and western medicine. Methods: retrospective investigation was used. From January 2015 to December 2015, the emergency department of Guangdong traditional Chinese Medicine Hospital diagnosed 139 cases of chest pain from the point of view of symptom, collected the general information, main complaint, clinical symptoms, past history and the results of D-dimer index, and used excel to input the data. Spss19.0 software was used to analyze the distribution frequency of each syndrome type of chest pain and the correlation between the common syndromes and the results of D-dimer. The statistical description and measurement data were expressed as mean 卤standard deviation or median (quartile spacing). The counting data were expressed by rate or composition ratio, the statistical inferences were measured by rank sum test or variance analysis, the count data were analyzed by X2 test, and the influencing factors were analyzed by multiple linear regression analysis. The correlation was analyzed by spearman. Results: one of the types of TCM syndromes of emergency chest pain was empirical distribution, followed by deficiency syndrome and deficiency syndrome. The specific syndrome types from more to less were phlegm obstruction (31.0), blood stasis (28.9m), Qi stagnation (15.8), Qi deficiency (15.7m), cold coagulation (5.1010), Yang deficiency (2.50), Yin deficiency (1.0) and emergency chest pain (> 500 渭 g / L). There were blood stasis type and phlegm obstruction type in emergency chest pain. Moreover, the blood stasis type was obviously more than the phlegm blocking type, while the traditional Chinese medicine syndrome type with D- dimer elevation level lower than the cut-off value was phlegm obstruction type, qi stagnation type, and D- dimer elevation level was lower than the cut-off value. The elevation level of D-dimer in emergency chest pain mixed syndrome was significantly higher than that in single syndrome type (P0.05N. 4). The emergency chest pain was classified as deficiency syndrome, empirical evidence, and mixed syndrome of deficiency and deficiency. There was significant difference in the level of D-dimer elevation among the three groups (P 0.001), which showed that the level of D-dimer in the deficiency syndrome group was significantly lower than that in the deficiency syndrome group and the deficiency and deficiency syndrome group. There was a statistical difference in the level of D-dimer elevation among different single syndrome types in emergency chest pain. The elevation level of Ddimer in blood stasis type was significantly higher than that in other syndromes, and there was no difference between other syndrome types (P 0.001). Conclusion: this study summarized the distribution of TCM syndromes of emergency chest pain on a certain level: the empirical distribution of emergency chest pain was the most. The second is deficiency syndrome, the least is deficiency syndrome, and the syndrome differentiation is phlegm obstruction type, blood stasis type, qi stagnation type, qi deficiency type, cold coagulation type, yang deficiency type and yin deficiency type. The elevated level of D-dimer in the empirical group of emergency chest pain and the group with deficiency and solid inclusion syndrome was significantly higher than that in the deficiency syndrome group. There was a certain correlation between the emergency chest pain of blood stasis type and the D-dimer, which reflected fibrinolytic activity, phlegm blocking type, Qi stagnation type, and so on. Other 6 types of chest pain syndrome, such as Qi deficiency type, had no obvious relationship with the level of D-dimer elevation. The blood stasis type was the main type of chest pain syndrome, and the second was phlegm blocking syndrome. Therefore, the patients with chest pain in emergency department had blood clotting in the body. The abnormality of fibrinolytic system is correlated with the evidence of traditional Chinese medicine and blood stasis syndrome.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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