冠心病胸痹发病相关因素与五脏关系初探

发布时间：2018-04-01 11:14

本文选题：冠心病　切入点：五脏　出处：《北京中医药大学》2016年硕士论文

【摘要】：目的：通过流行病学调查问卷,对冠心病的中医证素、涉及脏腑进行研究,探索冠心病胸痹心痛发病相关因素与五脏之间的相关性。方法：采取横断面调查模式,对2013年05月至2014年05月之间,就诊于东直门医院、安贞医院、中日友好医院三家三级甲等医院,通过冠脉造影或冠脉CT确诊为冠心病的患者,共400例进行调查,建立数据库分析冠心病胸痹发病相关因素与五脏之间的关系。结果：本研究共纳入400例病例,对其进行分析后得出结果如下：1.性别年龄五脏分布差异：①冠心病患者性别分布在各涉及脏腑之间存在差异,主要差异脏腑在脾,男性冠心病患者较女性患者更易出现脾失健运的问题。②冠心病患者年龄分布在各涉及脏腑之间存在差异,主要差异脏腑在肝,随着年龄增长,病位涉及肝的可能性越大。2.冠心病危险因素在五脏分布差异：①腹型肥胖与肝、脾两脏关系密切。即冠心病胸痹患者中病位涉及到肝和脾的患者较其他患者更容易出现腹型肥胖。②高血压与脾关系密切。可以推测冠心病胸痹患者中病位涉及到脾的患者较其他患者合并高血压的概率更小。③糖尿病与肺关系密切。可以推测冠心病胸痹患者中病位涉及肺的患者较其他患者合并糖尿病的概率更高。④与高脂血症相关性较大脏腑是心、肾。可以推测冠心病胸痹患者中病位涉及到心、肾的患者较其他患者合并高脂血症的概率更高。3.冠心病各证素在五脏间分布差异：①病位涉及到心的证素有：阳虚、水饮；②病位涉及到肝的证素主要有：阴虚、气滞、痰浊、水饮：③病位涉及到脾的证素主要有痰浊、水饮；④病位涉及到肺的证素主要有：痰浊、水饮；⑤病位涉及到肾的证素主要有：阴虚、阳虚、水饮。4.冠心病中医证型与五脏相关性：本研究共纳入研究病例400份,按照证素组合可分为26个中医证型。对冠心病胸痹中医证型与五脏相关性进行多项logistics回归分析,得出结果如下：①气虚血瘀型与脾关系密切。冠心病胸痹患者中病位涉及到脾的患者较其他患者出现气虚血瘀的可能性更高。②气虚痰瘀型与肾关系密切。冠心病胸痹患者中病位涉及到肾的患者较其他患者出现气虚痰瘀的可能性更高。③气阴两虚血瘀型与脾关系密切。冠心病胸痹患者中病位涉及到脾的患者更容易出现气阴两虚痰瘀。④气滞血瘀型与肝、脾关系密切。冠心病胸痹患者中病位涉及肝、脾两脏的患者较其他患者出现气滞血瘀的可能性更高。⑤气阳两虚型与脾、肾关系密切。冠心病胸痹患者中病位涉及脾、肾两脏的患者较其他患者出现气阳两虚的可能性更高。⑥气虚血瘀水停与肾关系密切。冠心病胸痹患者中病位涉及到肾的患者较其他患者出现气虚血瘀水停的可能性更大。5.冠心病冠状动脉病变在五脏分布差异：本研究共纳入研究病例400份,对冠心病冠状动脉病变状况与五脏进行逐一相关性分析,得出结果如下：①前降支病变与脾存在密切的联系,可以推测冠心病胸痹患者中病位涉及到脾的患者更容易出现前降支的病变。②冠心病劳累性心绞痛分级与肝、脾具有明显的相关性,冠心病胸痹患者中病位涉及到肝、脾的患者与其他患者相比心绞痛分级较低。③急性心肌梗死的发生在五脏分布存在差异：急性下壁心肌梗死与心具有明显相关性,急性前壁心肌梗死与肝具有明显相关性,急性ST段抬高型心肌梗死与脾具有明显的相关性。可以推测,冠心病胸痹患者中病位涉及到心的患者较其他患者出现急性下壁心肌梗死的概率更高,病位涉及到肝的患者较其他患者出现急性前壁心肌梗死的概率更高,病位涉及到脾的患者较其他患者出现急性ST段抬高型心肌梗死的概率更高。结论：本研究共纳入400份冠心病病例,其中病位涉及到心的病例有395例(98.75%),病位涉及到肝的病例有101例(25.25%),病位涉及到脾的病例有203例(50.75%),病位涉及到肺的病例有12例(3%),病位涉及到肾的病例有117例(29.3%)。五脏与冠心病胸痹心痛发病关系密切程度依次是心脾肾肝肺。1.冠心病胸痹患者中病位涉及到心的患者与其他患者相比①更容易合并高脂血症；②出现急性下壁心肌梗死的概率更高；③常伴有阳虚和水饮内停的症状。2.冠心病胸痹患者中病位涉及到肝的患者①更容易合并腹型肥胖；②出现急性前壁心肌梗死的概率更高；③冠心病劳累性心绞痛分级往往较低；④常伴有阴虚、气滞、痰浊阻滞和水饮内停的症状。3.冠心病胸痹患者中病位涉及到脾的患者①更容易合并腹型肥胖,而合并高血压病的可能性较小：②其前降支发生病变的可能性较大；③出现急性ST段抬高型心肌梗死的概率更高；④冠心病劳累性心绞痛分级往往较低；⑤常见中医证型有气虚血瘀型、气阴两虚血瘀型、气滞血瘀型、气阳两虚型；⑥常伴有痰浊阻滞、水饮内停的症状。4.冠心病胸痹患者中病位涉及到肺的患者①合并糖尿病的可能性更大；②常伴有水饮内停的症状。5.冠心病胸痹患者中病位涉及到肾的患者①更容易合并高脂血症的可能性较大；②常见中医证型有气虚痰瘀型、气阳两虚型、气虚血瘀水停型；③常伴有阴虚、阳虚、阴寒凝滞和水饮内停的症状。
[Abstract]:Objective: through epidemiological survey, TCM syndrome of coronary heart disease, involving viscera research, explore the correlation between the related factors of coronary heart disease angina onset and five organs. Methods: a cross-sectional survey of 05, between 2013 to 2014 05 months, was diagnosed at Dongzhimen hospital, An Zhen Hospital, China-Japan Friendship Hospital, three three level of first-class hospital, by coronary angiography or coronary CT diagnosed as coronary heart disease, 400 cases were investigated to establish a database to analyze the relationship between risk factors of coronary heart disease and the incidence of chest organs. Results: 400 cases were included in this study were obtained on the analysis results are as follows: 1. the differences of gender and age distribution of five: the gender distribution in patients with coronary heart disease the differences between the organs involved, the main differences between the viscera in the spleen, male patients with coronary heart disease than female patients more prone to splenism The problem of the aged patients with coronary heart disease. The distribution in each relates to differences between the internal organs, the main differences between the organs in the liver, with the increase of age, the risk of disease involving the liver more likely.2. factors of coronary heart disease in five: the distribution of abdominal obesity and liver, spleen two dirty close. The chest disease involving in patients with coronary heart disease the liver and spleen of patients compared with other patients more prone to abdominal obesity and hypertension. The spleen is closely related to that in patients with coronary heart disease. Chest disease involving the spleen of patients compared with other patients with hypertension. The close relationship between the smaller probability of diabetes and lung in patients with coronary heart disease in the chest. Presumably probability than other patients with diabetes mellitus the disease involved lung were higher. The correlation between hyperlipidemia and larger organs is the heart, kidney. Presumably in patients with coronary heart disease in chest disease related to heart, kidney patients than in the The probability of patients with hyperlipidemia had higher.3. coronary heart disease syndromes in five variation: the disease related to heart yang deficiency syndrome known as: drinking water; the disease involving the liver syndrome are: Yin deficiency, qi stagnation, phlegm, drinking water: the disease involving the spleen the main syndromes of phlegm, drinking water; the disease related to lung thesyndrome are: phlegm, drinking water; the disease related to renal syndromes are: Yin deficiency, Yang deficiency, drinking water, the correlation between.4. TCM Syndromes of coronary heart disease and five: This study included 400 cases of a, according to syndrome combination can be divided into 26 TCM Syndromes of coronary heart disease. Chest pain syndromes and viscera of multinomial logistics regression analysis, the results are as follows: 1 and spleen qi deficiency and blood stasis in patients with coronary heart disease are closely related. In chest disease involving the spleen of patients compared with other patients with Qi deficiency and blood stasis may More. The Qi deficiency and phlegm stasis type and kidney are closely related. In patients with coronary heart disease in chest disease involves the possibility of renal patients compared with other patients with Qi deficiency phlegm and blood stasis. The higher the Qi blood stasis and spleen closely. In patients with coronary heart disease in chest disease involving the spleen is more common in patients with Qi and yin deficiency phlegm and blood stasis. The qi stagnation and blood stasis and liver, spleen is closely related to disease involving the liver in patients with coronary heart disease. Chest, spleen two dirty patients than the other patients had a higher possibility of qi stagnation and blood stasis. The two Qi and yang deficiency type and spleen and kidney are closely related. The disease involves the spleen in patients with coronary heart disease in the chest, the possibility of kidney two dirty patients compared with other patients with Qi and yang two higher. The relationship between the deficiency of qi deficiency and blood stasis and kidney water stop close. In patients with coronary heart disease in chest disease related to kidney patients compared with other patients the possibility of qi deficiency and blood stasis water stop more.5. coronary heart disease coronary artery In the five distribution: vein lesions were enrolled in the study in 400 cases, by correlation analysis of coronary artery lesions in coronary heart disease and five organs, the results are as follows: 1 anterior descending artery and spleen are closely related, presumably in patients with coronary heart disease in chest disease involving the spleen is more common in patients with lesions of anterior descending branch. The coronary heart disease angina pectoris grade with liver and spleen has obvious relevance, chest disease in patients with coronary heart disease related to liver, spleen patients compared with other patients with angina pectoris grade is lower. The incidence of acute myocardial infarction in the five distribution differences: acute inferior myocardial infarction and angina was significantly correlated with the, anterior wall acute myocardial infarction was significantly correlated with the liver and spleen, elevation myocardial infarction and acute ST segment has obvious relevance. Presumably, chest disease involving in patients with coronary heart disease And to the probability of heart patients compared with other patients with acute inferior myocardial infarction is higher, the disease related to the probability of liver patients compared with other patients with acute anterior myocardial infarction is higher, the disease related to the patients with spleen probability than other patients with acute ST elevation myocardial infarction is higher. Conclusion this study included 400 cases of coronary heart disease, the disease related to heart 395 cases (98.75%), a disease related to liver in 101 cases (25.25%), a disease involving the spleen 203 cases (50.75%), a disease related to lung in 12 cases (3%), a disease related to kidney 117 cases (29.3%). Five viscera and chest pain is closely related to coronary heart disease incidence degree followed by spleen and kidney liver and lung disease in patients with coronary heart disease.1. syndrome related to heart patients and other patients compared to patients with hyperlipidemia; the present acute under wall heart The probability of myocardial infarction is higher; and often accompanied with Yang deficiency and water retention symptoms in patients with coronary heart disease.2. chest disease related to patients with hepatic easier with abdominal obesity; the probability of occurrence of acute anterior wall myocardial infarction is higher; the classification of coronary heart disease angina fatigue is often low; it is often accompanied by Yin deficiency, qi stagnation, phlegm and fluid retention symptoms in patients with coronary heart disease.3. chest disease involving the spleen were more easily combined with abdominal obesity, but less likely complicated with hypertension: the anterior descending lesions occur more likely; the probability of occurrence of acute ST elevation myocardial infarction the higher the grade of coronary heart disease; tired angina is often low; the common TCM Syndromes of qi deficiency and blood stasis, yin deficiency and blood stasis, qi stagnation and blood stasis, Qi and yang deficiency type two; and often accompanied by phlegm, symptoms of water retention of.4 In patients with coronary heart disease. Chest disease involves the possibility of lung patients with diabetes more; the water retention is often accompanied by symptoms of coronary heart disease in patients with chest.5. disease related to patients with renal easier possibility of hyperlipidemia with larger; the common TCM syndrome type of qi deficiency and phlegm stasis type, gas two yang deficiency, Qi deficiency and blood stasis type water stop; it is often accompanied by Yin deficiency, Yang deficiency, stagnation of Yin cold and water retention symptoms.

【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】：R256.22

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