冠心病心絞痛中醫(yī)證型與心沖擊圖及冠脈狹窄程度的相關(guān)性研究
發(fā)布時間：2019-07-08 14:13
【摘要】：冠心病是冠狀動脈粥樣硬化改變導致血管管腔狹窄、阻塞和(或)因冠狀動脈功能性改變(痙攣)導致心肌缺血缺氧或壞死而引起的心臟疾病,是多種動脈粥樣硬化疾病常見疾病。因其高患病率、反復頻繁的再住院率,為家庭和社會帶來沉重的負擔,已成為重大的公共衛(wèi)生問題。隨著近年來醫(yī)學研究的不斷深入,中醫(yī)藥防治冠心病心絞痛能夠改善癥狀,提高運動耐量和生存質(zhì)量,降低病死率,體現(xiàn)出了明顯的優(yōu)勢。辨證論治是中醫(yī)的核心思想,準確的辨證方能施行有效的治療。因此,為冠心病心絞痛的中醫(yī)辨證提供客觀的量化指標逐漸成為研究的熱點。心沖擊圖是醫(yī)學物理學領(lǐng)域的心血管監(jiān)測儀器,有望成為評價血管狹窄的手段。基于此,筆者將心沖擊圖技術(shù)引入臨床研究,試圖評價冠心病心絞痛不同中醫(yī)證型與心沖擊圖及冠脈狹窄程度的相關(guān)性,為中醫(yī)辨證分型探索客觀的量化依據(jù),提高冠心病心絞痛的中醫(yī)辨證水平與臨床療效。研究目的:(1)研究冠心病心絞痛組與非冠心病心絞痛組在心沖擊圖主要指標(IJ、JK間期)及冠脈狹窄程度方面的差異。(2)評價冠心病心絞痛組不同中醫(yī)辨證分型與心沖擊圖主要指標(IJ、JK間期)及冠脈狹窄程度的相關(guān)性。研究方法:以2016年11月到2017年3月在北京中醫(yī)藥大學東方醫(yī)院心血管內(nèi)科病房住院疑診為冠心病心絞痛的139例患者為研究對象。本研究分為冠心病心絞痛組和非冠心病心絞痛組,冠心病心絞痛的西醫(yī)診斷標準參照1979年國際心臟病學會及WHO制定的《缺血性心臟病的命名及診斷標準》,以冠脈造影檢查結(jié)果作為診斷金標準。中醫(yī)辨證分型依據(jù)2002年國家藥品監(jiān)督管理局《中藥新藥臨床研究指導原則》分為心血瘀阻證、氣虛血瘀證、氣滯血瘀證、痰阻心脈證、氣陰兩虛證5個常見證型。由本人對139例入組患者行造影術(shù)前采集心電圖一心沖擊圖資料,后期測定所需的心沖擊圖主要指標IJ、JK間期。冠狀動脈造影結(jié)果分析由有經(jīng)驗的心內(nèi)科導管室醫(yī)生完成,結(jié)果由有經(jīng)驗的心內(nèi)科醫(yī)師2人以上共同閱片出具報告。符合冠心病診斷標準的納入冠心病心絞痛組,排除冠心病診斷的患者的納入非冠心病心絞痛組。將數(shù)據(jù)采用SPSS20.0對數(shù)據(jù)進行統(tǒng)計分析。計量資料采用t檢驗及方差分析或非參數(shù)檢驗,計數(shù)資料采用卡方檢驗,等級資料采用秩和檢驗,相關(guān)性分析采用Spearman相關(guān)分析,入選與剔除值為P0.05。研究結(jié)果:1.冠心病心絞痛組患者的IJ、JK間期及Gensini積分明顯高于非冠心病心絞痛患者,差異具有統(tǒng)計學意義(P0.05)。2.冠心病心絞痛組部分中醫(yī)證型與IJ、JK間期均有一定的相關(guān)性(P0.05),隨著(心血瘀阻證、氣虛血瘀證)/氣滯血瘀、(痰阻心脈證/氣陰兩虛證)中醫(yī)證型的轉(zhuǎn)變,IJ、JK間期呈逐漸增大趨勢。3.冠心病心絞痛組部分中醫(yī)證型與Gensini積分有一定的相關(guān)性(P0.05),隨著證型依次從心血瘀阻證到氣虛血瘀證、氣滯血瘀證,再到痰阻心脈證、氣陰兩虛證,冠脈狹窄程度加重。4.冠心病心絞痛組部分中醫(yī)證型與病變血管支數(shù)有一定的相關(guān)性(P0.05),單純血瘀者多為單支局部病變,病變程度輕,多種病因夾雜和虛證者常見多支病變,病變程度也相對較重。5.冠心病心絞痛組和非冠心病心絞痛組患者的IJ間期與冠脈狹窄程度、JK間期與冠脈狹窄程度間均存在相關(guān)性(P0.05),IJ、JK間期值與Gensini積分成正相關(guān)性,隨著冠脈狹窄程度的加重,IJ、JK間期值均有增大趨勢。研究結(jié)論:1.tIJ、tJK、Gensini積分在冠心病心絞痛組與非冠心病心絞痛組間存在顯著性差異。應用IJ、JK間期評價冠狀動脈狹窄程度具有一定的可行性。2.tIJ、tJK、Gensini積分均與冠心病心絞痛中醫(yī)證型存在相關(guān)性,可為中醫(yī)辨證分型提供客觀量化依據(jù)。3.tIJ和tJK與Gensini積分存在正相關(guān)性,可以為評價冠狀動脈狹窄程度提供參考。
[Abstract]:Coronary heart disease is a heart disease caused by coronary artery stenosis, obstruction, and/ or a change in coronary function (spasm) resulting in myocardial ischemia/ hypoxia or necrosis, which is a disease of various atherosclerotic disease. Due to its high prevalence, repeated frequent rehospitalization rates have a heavy burden on the family and society and have become a major public health problem. With the development of medical research in recent years, the prevention and treatment of coronary heart disease and angina pectoris can improve the symptoms, improve the exercise tolerance and the quality of life, and reduce the case fatality rate. The differentiation and treatment is the core thought of the traditional Chinese medicine, and the effective treatment can only be carried out by the exact differentiation of the syndrome. Therefore, it is a hot topic to provide objective quantitative index for TCM syndrome differentiation of coronary heart disease and angina pectoris. The cardiograph is a cardiovascular monitoring instrument in the field of medical physics and is expected to be a means of evaluating vascular stenosis. On the basis of this, the author introduced the cardiograph technique into the clinical study, and tried to evaluate the correlation between the different TCM syndrome types of the coronary heart disease and the degree of cardiac shock and the degree of coronary stenosis, and to explore the objective quantitative basis for the syndrome differentiation of TCM. To improve the syndrome differentiation and clinical curative effect of the patients with coronary heart disease and angina pectoris. Objective: (1) To study the difference of the main index (IJ, JK interval) and the degree of coronary stenosis in the patients with coronary heart disease and non-coronary heart disease. (2) To evaluate the correlation between the TCM syndrome differentiation and the main index (IJ, JK interval) and the degree of coronary stenosis in the patients with coronary heart disease and angina pectoris. Methods:139 patients with coronary heart disease and angina pectoris were studied in the cardiovascular system of the East Hospital of Beijing University of Traditional Chinese Medicine from November 2016 to March 2017. This study is divided into the coronary heart disease and the non-coronary heart disease group. The diagnostic criteria of the western medicine in the patients with coronary heart disease and angina pectoris are referred to in the 1979 International Heart Association and the WHO Standard for Naming and Diagnosis of the Ischemic Heart Disease. The results of the coronary angiography are used as the criteria for the diagnosis of coronary heart disease. The syndrome differentiation of Chinese medicine is divided into five common types of syndromes, such as heart blood stasis syndrome, qi deficiency and blood stasis syndrome, qi stagnation and blood stasis syndrome, phlegm-resistance heart-vein syndrome, and qi-yin deficiency-deficiency syndrome, according to the guidelines for clinical study of the Chinese medicine and drug administration in 2002. The main indexes of cardiac impact map (IJ) and JK interval (JK), which were required for later measurement, were collected from 139 patients who were enrolled in the group. The results of the coronary angiography were performed by an experienced cardiologist, and the results were reported by the experienced cardiologist at more than 2 co-readers. The coronary heart disease and angina pectoris group is included in the coronary heart disease and angina pectoris group, and the patients who are diagnosed with the coronary heart disease are excluded from the non-coronary heart disease and angina pectoris group. The data was statistically analyzed using the SPSS10.0. The measurement data is t-test and analysis of variance or non-quantitative test. The data of the count is chi-square test, and the rank data is rank and tested. The correlation analysis adopts the Spearman correlation analysis, and the inclusion and elimination value is P0.5.05. Study results:1. The IJ, JK interval and Gensini score in patients with coronary heart disease and angina pectoris were significantly higher than those in non-coronary heart disease and angina pectoris (P0.05). There was a certain correlation between the TCM syndrome type and the IJ and JK interval in the patients with coronary heart disease (P0.05). With the change of the syndrome of TCM, the interval of IJ and JK gradually increased with the change of TCM syndrome of (heart blood stasis syndrome, Qi deficiency and blood stasis syndrome)/ qi stagnation and blood stasis. There was a certain correlation between the TCM syndrome type and Gensini score in the patients with coronary heart disease (P0.05). In the patients with coronary heart disease and angina pectoris, there was a certain correlation between the number of TCM syndromes and the number of vessels in the lesion (P0.05). There was a correlation between the IJ interval and the degree of coronary stenosis, the degree of JK interval and the degree of coronary stenosis (P0.05), and the value of the IJ and JK interval was positively correlated with that of Gensini, and with the increase of the degree of coronary stenosis, IJ, There was an increase in the value of the JK interval. The results showed that 1. tIJ, tJK and Gensini had significant differences between the patients with coronary heart disease and non-coronary heart disease. 2. There is a positive correlation between tIJ, tJK and Gensini integral with the traditional Chinese medicine syndrome of the patients with coronary heart disease. A reference may be provided to evaluate the degree of coronary stenosis.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259
本文編號：2511644
[Abstract]:Coronary heart disease is a heart disease caused by coronary artery stenosis, obstruction, and/ or a change in coronary function (spasm) resulting in myocardial ischemia/ hypoxia or necrosis, which is a disease of various atherosclerotic disease. Due to its high prevalence, repeated frequent rehospitalization rates have a heavy burden on the family and society and have become a major public health problem. With the development of medical research in recent years, the prevention and treatment of coronary heart disease and angina pectoris can improve the symptoms, improve the exercise tolerance and the quality of life, and reduce the case fatality rate. The differentiation and treatment is the core thought of the traditional Chinese medicine, and the effective treatment can only be carried out by the exact differentiation of the syndrome. Therefore, it is a hot topic to provide objective quantitative index for TCM syndrome differentiation of coronary heart disease and angina pectoris. The cardiograph is a cardiovascular monitoring instrument in the field of medical physics and is expected to be a means of evaluating vascular stenosis. On the basis of this, the author introduced the cardiograph technique into the clinical study, and tried to evaluate the correlation between the different TCM syndrome types of the coronary heart disease and the degree of cardiac shock and the degree of coronary stenosis, and to explore the objective quantitative basis for the syndrome differentiation of TCM. To improve the syndrome differentiation and clinical curative effect of the patients with coronary heart disease and angina pectoris. Objective: (1) To study the difference of the main index (IJ, JK interval) and the degree of coronary stenosis in the patients with coronary heart disease and non-coronary heart disease. (2) To evaluate the correlation between the TCM syndrome differentiation and the main index (IJ, JK interval) and the degree of coronary stenosis in the patients with coronary heart disease and angina pectoris. Methods:139 patients with coronary heart disease and angina pectoris were studied in the cardiovascular system of the East Hospital of Beijing University of Traditional Chinese Medicine from November 2016 to March 2017. This study is divided into the coronary heart disease and the non-coronary heart disease group. The diagnostic criteria of the western medicine in the patients with coronary heart disease and angina pectoris are referred to in the 1979 International Heart Association and the WHO Standard for Naming and Diagnosis of the Ischemic Heart Disease. The results of the coronary angiography are used as the criteria for the diagnosis of coronary heart disease. The syndrome differentiation of Chinese medicine is divided into five common types of syndromes, such as heart blood stasis syndrome, qi deficiency and blood stasis syndrome, qi stagnation and blood stasis syndrome, phlegm-resistance heart-vein syndrome, and qi-yin deficiency-deficiency syndrome, according to the guidelines for clinical study of the Chinese medicine and drug administration in 2002. The main indexes of cardiac impact map (IJ) and JK interval (JK), which were required for later measurement, were collected from 139 patients who were enrolled in the group. The results of the coronary angiography were performed by an experienced cardiologist, and the results were reported by the experienced cardiologist at more than 2 co-readers. The coronary heart disease and angina pectoris group is included in the coronary heart disease and angina pectoris group, and the patients who are diagnosed with the coronary heart disease are excluded from the non-coronary heart disease and angina pectoris group. The data was statistically analyzed using the SPSS10.0. The measurement data is t-test and analysis of variance or non-quantitative test. The data of the count is chi-square test, and the rank data is rank and tested. The correlation analysis adopts the Spearman correlation analysis, and the inclusion and elimination value is P0.5.05. Study results:1. The IJ, JK interval and Gensini score in patients with coronary heart disease and angina pectoris were significantly higher than those in non-coronary heart disease and angina pectoris (P0.05). There was a certain correlation between the TCM syndrome type and the IJ and JK interval in the patients with coronary heart disease (P0.05). With the change of the syndrome of TCM, the interval of IJ and JK gradually increased with the change of TCM syndrome of (heart blood stasis syndrome, Qi deficiency and blood stasis syndrome)/ qi stagnation and blood stasis. There was a certain correlation between the TCM syndrome type and Gensini score in the patients with coronary heart disease (P0.05). In the patients with coronary heart disease and angina pectoris, there was a certain correlation between the number of TCM syndromes and the number of vessels in the lesion (P0.05). There was a correlation between the IJ interval and the degree of coronary stenosis, the degree of JK interval and the degree of coronary stenosis (P0.05), and the value of the IJ and JK interval was positively correlated with that of Gensini, and with the increase of the degree of coronary stenosis, IJ, There was an increase in the value of the JK interval. The results showed that 1. tIJ, tJK and Gensini had significant differences between the patients with coronary heart disease and non-coronary heart disease. 2. There is a positive correlation between tIJ, tJK and Gensini integral with the traditional Chinese medicine syndrome of the patients with coronary heart disease. A reference may be provided to evaluate the degree of coronary stenosis.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259
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