不稳定型心绞痛中医证型与冠脉病变程度及心率变异性关系的研究

发布时间：2018-05-20 11:13

本文选题：不稳定型心绞痛 + 中医证型　；参考：《辽宁中医药大学》2017年硕士论文

【摘要】：目的:通过分析不稳定型心绞痛(unstable angina pectoris,UA)中医证型与冠状动脉病变程度和心率变异性(heart rate variability,HRV)三者之间的关系,为UA患者冠状动脉病变程度的预判及自主神经功能受损情况的判断提供参考。方法:收集2015年3月至2016年12月在辽宁中医药大学附属医院心血管科住院并行冠状动脉造影(coronary angiography,CAG)检查确诊为UA的患者,在入选的168例患者中,按中医证型分为气滞血瘀证组(43例),气虚血瘀证组(57例),痰瘀互结证组(68例);按冠状动脉病变支数分为单支病变组(53例),双支病变组(60例),多支病变组(55例);按冠状动脉狭窄程度分为:轻度狭窄组(27例),中度狭窄组(79例),重度狭窄组(62例)。冠状动脉造影结果检查正常且行24小时动态心电图者54例为对照组。在入院72小时内采用12导动态心电图仪(型号:BI9800)记录所有受试者HRV时域指标,NN间期标准差(standard deviation of all normal intervals,SDNN)、NN间期平均值的标准差(standard deviation of the average values of NN intervals,SDANN)、NN间期标准差的均值(mean value of the standard deviations of all NN intervals,SDNN INDEX)、相邻NN间期差值的均方根(the square root of the mean of sum of the squares of differences between adjacent R-R intervals,RMSSD)、相邻NN间期的差值超过50ms的心搏数占NN间期总搏数的百分比(the percentage of adjacent NN intervals differing by more than 50ms,PNN50)、相邻NN间期的差值超过50ms的心搏数(the adjacent NN intervals differing by more than 50ms,NN50)、HRV三角指数,记录24小时。结果:1.把单支、双支、多支病变分三个等级,进行秩和检验,气滞血瘀证组,气虚血瘀证组,痰瘀互结证组的病变支数等级分布有统计学差异(p0.01),UA病变支数在各组间有痰瘀互结证组气虚血瘀证组气滞血瘀证组的趋势。2.按冠状动脉狭窄程度分轻度、中度、重度病变分三个等级,经秩和检验得出气滞血瘀证组,气虚血瘀证组,痰瘀互结证组,病变狭窄程度无统计学差异(P0.05);但UA狭窄程度有痰瘀互结证组气虚血瘀证组气滞血瘀证组的趋势。3.其中气滞血瘀证组、气虚血瘀证组和痰瘀互结证组的HRV时域指标SDNN、SDANN、SDNN INDEX均明显低于对照组(P0.05);痰瘀互结证组SDNN明显低于气滞血瘀证组和气虚血瘀证组(P0.05);相邻NN间期差值的均方根RMSSD在痰瘀互结证组和气滞血瘀证组也明显低于对照组(P0.05);HRV三角指数在痰瘀互结证组与气虚血瘀证组明显低于对照组(P0.05),且痰瘀互结证组明显低于气滞血瘀证组(P0.05)。4.单支病变组、双支病变组与多支病变组SDNN、SDANN、SDNN INDEX均低于对照组(P0.05),且多支病变组SDNN、SDANN低于单支病变组和双支病变组(P0.05);RMSSD、相邻NN间期的差值超过50ms的心搏数占NN间期总搏数的百分比PNN50、三角指数在多支病变组和双支病变组低于对照组(P0.05),且三角指数在多支病变组和双支病变组低于单支病变组(P0.05)。5.SDNN在轻度狭窄组、中度狭窄组、重度狭窄组均明显低于对照组(P0.05),且重度狭窄组明显低于轻度狭窄组和中度狭窄组(p0.05);SDANN在各组间有对照组轻度狭窄组中度狭窄组重度狭窄组(p0.05);SDNN INDEX在重度狭窄组和中度狭窄组明显低于对照组和轻度狭窄组(p0.05);三角指数在中度狭窄组与重度狭窄组明显低于对照组(p0.05),且重度狭窄组明显低于轻度狭窄组(p0.05)。结论:1.UA中医证型与冠状动脉病变程度有相关性,气滞血瘀证、气虚血瘀证和痰瘀互结证三组中,痰瘀互结证病变程度最重,其次为气虚血瘀证,气滞血瘀证的病变程度最轻。2.UA患者HRV降低,存在着自主神经功能受损;中医证型与HRV存在相关性,痰瘀互结证组HRV明显低于气虚血瘀证组和气滞血瘀证组;HRV随着冠状动脉病变程度的加重而降低。
[Abstract]:Objective: to analyze the relationship between the TCM syndrome types of unstable angina pectoris (UA) and the degree of coronary artery disease and heart rate variability (heart rate variability, HRV) three, and to provide a reference for the prediction of the degree of coronary artery disease and the judgment of the damage of autonomic nerve function in the patients of UA. Method: collect March 2015 By December 2016 at the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, coronary angiography (CAG) was used to check the patients with UA. Among the 168 patients selected, they were divided into qi stagnation and blood stasis syndrome group (43 cases), Qi deficiency and blood stasis syndrome group (57 cases), phlegm stasis syndrome group (68 cases), and the coronary artery lesion branch. The number was divided into single branch lesion group (53 cases), double branch lesion group (60 cases) and multiple branch lesion group (55 cases). The degree of coronary artery stenosis was divided into mild stenosis group (27 cases), moderate stenosis group (79 cases), severe stenosis group (62 cases). Coronary angiography results were normal and 24 hour dynamic electrocardiogram (54 cases) were used as control group. 12 guide was used within 72 hours of admission. The dynamic electrocardiograph (model: BI9800) records all the subjects' HRV time domain index, the standard deviation of the NN interval standard (standard deviation of all normal intervals, SDNN), the standard deviation of the NN interval value. All NN intervals, SDNN INDEX), the root mean square root of the difference value of the adjacent NN interval (the square root of the mean) E than 50ms, PNN50), the difference of the adjacent NN interval exceeded 50ms's heart beat number (the adjacent NN intervals differing by), recorded for 24 hours. Results: 1. single branch, double branch and multi branch lesion were divided into three grades, rank sum test, qi stagnation and blood stasis syndrome group, Qi deficiency and blood stasis syndrome group, phlegm stasis syndrome group's pathological branch There were statistical differences (P0.01), and the number of UA lesions in each group had phlegm and blood stasis syndrome group. The trend.2. of qi stagnation and blood stasis syndrome group was divided into three grades according to the degree of coronary stenosis, which were divided into mild, moderate and severe pathological changes. There was no statistical difference in degree (P0.05), but the degree of UA stenosis was in the group of qi stagnation and blood stasis syndrome group of qi deficiency and blood stasis syndrome group.3. in which qi stagnation and blood stasis syndrome group, Qi deficiency and blood stasis syndrome group and phlegm stasis syndrome group HRV time domain index SDNN, SDANN, SDNN INDEX were significantly lower than the control group (P0.05); SDNN of phlegm stasis syndrome group was obviously lower than qi stagnation and blood stasis syndrome group. Syndrome group and Qi deficiency and blood stasis syndrome group (P0.05); the root mean square root RMSSD of adjacent NN interval in phlegm and stasis syndrome group and qi stagnation and blood stasis syndrome group was also significantly lower than the control group (P0.05); HRV triangle index in the phlegm stasis syndrome group and Qi deficiency and blood stasis syndrome group was significantly lower than the control group (P0.05), and the phlegm stasis syndrome group was significantly lower than the qi stagnation and blood stasis syndrome group (P0.05).4. single branch The SDNN, SDANN, and SDNN INDEX in the double branch group and the multiple branch lesion group were lower than the control group (P0.05), and the multiple branch lesion group was SDNN, SDANN was lower than the single branch and the double branch lesion group (P0.05); RMSSD, the difference of the adjacent NN interval exceeded the 50ms number in the percentage of the total NN interval, and the trigonometric index was in the multiple lesion group and the double branch lesion. The group was lower than the control group (P0.05), and the trigonometric index was lower than the single branch lesion group (P0.05) in the mild stenosis group, the moderate stenosis group and the severe stenosis group were significantly lower than the control group (P0.05), and the severe stenosis group was significantly lower than the mild narrow group and the moderate stenosis group (P0.05), and the SDANN in the control group was lighter than the control group (P0.05). Severe stenosis group (P0.05) in moderate stenosis group, SDNN INDEX in severe stenosis group and moderate stenosis group was significantly lower than control group and mild stenosis group (P0.05); trigonometric index in moderate stenosis group and severe stenosis group was significantly lower than that of control group (P0.05), and severe stenosis group was significantly lower than that of mild stenosis group (P0.05). Conclusion: 1.UA TCM syndrome type and the group of severe stenosis (P0.05). Among the three groups, the degree of coronary artery disease was related, qi stagnation and blood stasis syndrome, Qi deficiency and blood stasis syndrome and phlegm stasis syndrome were the most serious, followed by qi deficiency and blood stasis syndrome,.2.UA patients with the lightest degree of qi stagnation and blood stasis syndrome HRV decreased, there was a loss of autonomic nerve function, the TCM syndrome type was correlated with HRV, and the syndrome group of phlegm and blood stasis syndrome was H RV was significantly lower than that of qi deficiency and blood stasis syndrome group and qi stagnation and blood stasis syndrome group; HRV decreased with the aggravation of coronary artery lesion.
【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】：2017
【分类号】：R259

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