冠心病患者中医证型与冠脉病变特点的相关性研究

发布时间：2018-11-09 12:24

【摘要】：目的:冠心病作为临床常见疾病,近发病率也越来越高。冠脉造影作为诊断的“金标准”,在本病的诊断及治疗过程中具有重要作用。此次研究主要通过收集患者临床资料,以了解冠心病中医证型的分布;同时对冠脉造影的结果进行统计及分析,以希望能进一步分析各中医证型和冠脉病变特点之间的关系。希望今后能为本病的辨证及治疗提供一些参考。资料与方法:收集大连医科大学附属第二医院心内科100例患者资料,在术前收集患者信息,及相关实验室检查结果,并根据《中药新药治疗胸痹(冠心病、心绞痛)的临床研究指导原则》对患者进行中医证型分型,术后根据患者冠脉造影结果,并依据病例纳入和排除标准对患者进行进一步筛选,对符合标准的患者详细记录病变血管及病变程度,并对冠脉病变进行评分。然后对所有患者的具体中医辨证分型及所记录的各项结果进行统计学分析。结果:1.此次收集的100名患者中:男性65例,女性35例,男性发病率明显高于女性,所有患者的年龄具体分布于44-84岁之间,收集的患者平均年龄64.28±9.16岁。2.100名病例中,对所有患者进行辨证分型:气滞血瘀证的患者共31人,痰阻心脉证的患者共35名,阴寒凝滞证的患者共8人,气阴两虚证的患者共11人,心肾阴虚证的患者共9人,阳气虚衰证的患者共6人,冠心病中医证型分布的主要证型为气滞血瘀证及痰浊阻滞证。3.在各中医证型的病变范围的分析,气滞血瘀证的患者中单支病变者共16人,双支病变者8人,多支病变者6人,痰阻心脉证的患者单支病变者2人,双支病变者8人,多支病变者25人。各中医证型之间进行Fisher检验,P=0.0000.01。气滞血瘀证的患者多以单支病变为主,痰阻心脉证的患者病变则更加弥漫。4.各中医证型的病变严重程度分析,可以看出气滞血瘀证的患者各个程度的狭窄分布比较均匀,而痰阻心脉证的患者重度狭窄的患者比较多,但不同证型之间的病变狭窄程度的差异并不具有显著的统计学意义(P=0.234)。5.各中医证型与冠脉积分之间的分析,各中医证型与冠脉积分之间进行方差分析具有显著意义(F=4.151,P0.01),其中积分最高的为痰阻心脉证的患者,其次为气滞血瘀证、阳气虚衰证、心肾阴虚证、气阴两虚证及阴寒凝滞证。各证型之间的两两对比,与气滞血瘀证对比痰阻心脉证有显著差异(P0.01),与痰阻心脉证比,气滞血瘀证、阴寒凝滞证、气阴两虚证、心肾阴虚证、阳气虚衰证均有显著差异,但其余各证型之间的对比并无显著意义。结论:1.冠心病的中医证型主要以气滞血瘀证及痰阻心脉证为主;2.冠心病的中医病机为本虚标实,大部分患者多以标实为主要表现,而病理要素主要为痰浊及血瘀,痰浊较血瘀病变更加弥漫。3.在中医对冠心病的治疗中应该更加注意痰浊与瘀血并重。
[Abstract]:Objective: coronary heart disease as a common clinical disease, the near-incidence is also increasing. Coronary angiography, as the golden standard of diagnosis, plays an important role in the diagnosis and treatment of this disease. In this study, the clinical data of patients were collected to understand the distribution of TCM syndromes of coronary heart disease. At the same time, the results of coronary angiography were statistically analyzed in order to further analyze the relationship between TCM syndromes and the characteristics of coronary lesions. Hope to provide some reference for the diagnosis and treatment of this disease in the future. Materials and methods: data of 100 patients in Department of Cardiology, second affiliated Hospital of Dalian Medical University were collected, patient information was collected before operation, and related laboratory results were collected. According to the results of coronary angiography, and according to the criteria of inclusion and exclusion of cases, the patients were further screened. Patients who met the criteria were given detailed records of the diseased vessels and severity, and the coronary artery lesions were graded. Then all the patients of specific TCM syndrome differentiation and recorded results were statistically analyzed. The result is 1: 1. Of the 100 patients collected, 65 were males and 35 were females. The incidence rate of males was significantly higher than that of females. The age of all patients was between 44 and 84 years old. The average age of the patients collected was 64.28 卤9.16 years old. 2.100 cases. There were 31 patients with Qi stagnation and blood stasis syndrome, 35 patients with phlegm blocking heart pulse syndrome, 8 patients with Yin cold stagnation syndrome, 11 patients with deficiency of qi and yin syndrome, 9 patients with heart and kidney yin deficiency syndrome, 31 patients with Qi stagnation and blood stasis syndrome, 35 patients with phlegm blocking heart pulse syndrome, 8 patients with Yin cold stagnation syndrome, 11 patients with deficiency of qi and yin syndrome and 9 patients with deficiency of heart and kidney yin syndrome. There were 6 patients with yang qi deficiency and failure syndrome. The main syndromes of TCM syndromes of coronary heart disease were qi stagnation and blood stasis syndrome and phlegm stagnation syndrome. 3. According to the analysis of the pathological range of TCM syndromes, there were 16 patients with single vessel disease, 8 patients with double vessel disease, 6 patients with multiple vessel disease, 2 patients with phlegm blocking heart and pulse syndrome, and 8 patients with double vessel disease, among whom there were 16 patients with Qi stagnation and blood stasis syndrome, 8 patients with double vessel disease, 6 patients with multiple vessel disease, 2 patients with phlegm blocking heart and pulse syndrome, 8 patients with double vessel disease. There were 25 patients with multiple vessel disease. Fisher test was carried out among all TCM syndromes, P0. 0000. 01. The patients with Qi stagnation and Blood stasis syndrome were mainly single vessel disease, and those with phlegm blocking heart and pulse syndrome were more diffuse. 4. 4. By analyzing the severity of various TCM syndromes, we can see that the patients with Qi stagnation and Blood stasis syndrome have more narrow distribution, while the patients with phlegm blocking heart and pulse syndrome have more severe stenosis. However, there was no significant difference in the degree of stenosis between different syndromes (P < 0. 234). The analysis of each TCM syndrome type and coronary artery integral, each TCM syndrome type and coronary artery integral carries on the variance analysis to have the significance (FP0.01), among them the highest integral is the phlegm block the heart pulse syndrome patient, the next is the qi stagnation blood stasis syndrome, the second is the qi stagnation and blood stasis syndrome. Yang qi deficiency syndrome, heart-kidney yin deficiency syndrome, qi-yin deficiency syndrome and Yin cold stagnation syndrome. Compared with Qi stagnation and blood stasis syndrome, there was significant difference in phlegm blocking heart and pulse syndrome (P0.01), compared with phlegm blocking heart vein syndrome, Qi stagnation and blood stasis syndrome, Yin cold stagnation syndrome, qi and yin deficiency syndrome, heart kidney yin deficiency syndrome, There were significant differences in Yang Qi deficiency and failure syndrome, but there was no significant difference between the other syndromes. Conclusion: 1. TCM syndromes of coronary heart disease are mainly qi stagnation and blood stasis syndrome and phlegm blocking heart vein syndrome; 2. The pathogenesis of coronary heart disease is based on deficiency and solid, most of the patients are mainly characterized by standard, while pathological elements are phlegm turbidity and blood stasis, phlegm turbidity is more diffuse than blood stasis disease. We should pay more attention to both phlegm and blood stasis in the treatment of coronary heart disease.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

【参考文献】