冠脈CTA斑塊辨識與胸痹中醫(yī)證型相關性研究
發(fā)布時間：2019-06-25 15:26
【摘要】：冠狀動脈粥樣硬化性心臟病(coronary atherosclerotic heart disease,CHD)又稱冠心病,屬中醫(yī)“胸痹”、“胸痹心痛”范疇。近年心血管病患病率、死亡率持續(xù)上升,成為居民首位死因,報告顯示,2014年估計全國已有心血管患者2.9億。CHD又分為急性冠脈綜合征(acute coronary syndrome,ACS)和慢性冠脈病(chronic coronary artery disease, CAD),其中ACS是發(fā)生急性心血管事件的主要原因。現(xiàn)代研究發(fā)現(xiàn),ACS的發(fā)生與動脈粥樣硬化(atherosclerotic, AS)斑塊性質(zhì)有密切相關性,即ACS的發(fā)生主要取決于斑塊的穩(wěn)定性及血流動力學因素,故斑塊辨識對預防ACS發(fā)生的診療具有重大意義,對CHD(尤其是ACS)的風險評估有極高價值,應該納入診斷及評估體系。目的本研究結(jié)合目前中西醫(yī)對冠心病及冠狀動脈粥樣硬化的認識,對斑塊辨識與中醫(yī)證型的關系進行探求,以期為中西醫(yī)對冠脈斑塊的診斷尋找新的切入點,為其治療提供新思路及更多的理論指導。材料與方法回顧分析2013年10月-2015年10月在北京中醫(yī)藥大學東直門醫(yī)院放射科行冠脈CTA檢查,并且由副主任醫(yī)師及以上級別醫(yī)師主診,有造成冠脈輕度及以上程度狹窄斑塊存在的患者,131例為研究對象,收集患者冠脈CTA檢查結(jié)果中的斑塊數(shù)量、斑塊性質(zhì)、狹窄程度、鈣化積分,收集患者病歷資料,根據(jù)中醫(yī)四診信息進行辨證分型,探討冠脈CTA斑塊辨識與胸痹中醫(yī)證型的相關性。使用SPSS18.0統(tǒng)計軟件進行醫(yī)學統(tǒng)計學分析。結(jié)果1.本研究共納入131例患者,其中男性61例,占46.6%,女性70例,占53.4%,中醫(yī)證型分布：氣虛血瘀氣滯血瘀痰瘀阻絡心腎陰虛氣陰兩虛陽氣虛衰,納入分析斑塊斑塊497個,鈣化斑塊345個,混合斑75個,軟斑塊77個；2.病程與年齡呈正相關關系；3.痰瘀阻絡證斑塊,尤其鈣化斑塊的發(fā)生率高于其他證型；4.中度狹窄-鈣化斑塊及重度狹窄-鈣化斑塊在痰瘀阻絡證發(fā)生率高于其他證型；痰瘀阻絡證的輕、中、重度狹窄均主要由鈣化斑塊引起；痰瘀阻絡、氣虛血瘀、氣滯血瘀及心腎陰虛證引起輕度狹窄的斑塊中,鈣化斑塊發(fā)生率高于混合及軟斑；氣陰兩虛、陽氣虛衰證各斑塊分布沒有差異；5.輕、中度狹窄主要由鈣化斑塊引起；6.病程與總斑塊數(shù)、鈣化斑塊及混合斑塊的發(fā)生呈正相關關系；7.鈣化程度與斑塊發(fā)生呈正相關關系。結(jié)論1.中醫(yī)證型分布：氣虛血瘀氣滯血瘀痰瘀阻絡心腎陰虛氣陰兩虛陽氣虛衰；2.冠心病及冠狀動脈粥樣硬化患者發(fā)病年齡相對穩(wěn)定；3.輕、中度狹窄主要由鈣化斑塊引起；4.病程與總斑塊數(shù)、鈣化斑塊及混合斑塊的發(fā)生呈正相關關系；5.鈣化程度與斑塊發(fā)生呈正相關關系；6.冠脈CTA的斑塊辨識與胸痹的中醫(yī)證型有一定的相關性,具體表現(xiàn)為痰瘀阻絡證斑塊(尤其是鈣化斑塊)發(fā)生率較高,相對來講,陰兩虛、陽氣虛衰證輕度狹窄中軟斑及混合斑的發(fā)生率高于其他組；對中西醫(yī)結(jié)合對冠脈斑塊的認識有一定指導意義。
[Abstract]:Coronary atherosclerotic heart disease (coronary atherosclerotic heart disease,CHD), also known as coronary heart disease, belongs to the category of "chest arthralgia" and "chest arthralgia" in traditional Chinese medicine. In recent years, the prevalence and mortality of cardiovascular diseases have continued to rise, becoming the first cause of death among residents. The report shows that 290m cardiovascular patients have been estimated in 2014 as acute coronary syndrome (acute coronary syndrome,ACS) and chronic coronary artery disease (chronic coronary artery disease, CAD),). ACS is the main cause of acute cardiovascular events. Modern studies have found that the occurrence of ACS is closely related to the nature of atherosclerotic (atherosclerotic, AS) plaques, that is, the occurrence of ACS mainly depends on the stability of plaques and hemodynamic factors. Therefore, plaque identification is of great significance to the diagnosis and treatment of ACS. It is of great value to the risk assessment of CHD (especially ACS), and should be included in the diagnosis and evaluation system. Objective to explore the relationship between plaque identification and TCM syndrome types based on the current understanding of coronary heart disease and coronary atherosclerosis in traditional Chinese and western medicine, in order to find a new entry point for the diagnosis of coronary plaques by traditional Chinese and western medicine, and to provide new ideas and more theoretical guidance for its treatment. Materials and methods Coronary artery CTA was performed in the Department of Radiology, Dongzhimen Hospital of Beijing University of traditional Chinese Medicine from October 2013 to October 2015. 131 patients with mild or above coronary stenosis plaques were examined by deputy chief physician and above. The number of plaques, plaque nature, stenosis degree, calcification score and patient medical records were collected. According to the four diagnosis information of traditional Chinese medicine (TCM), the correlation between coronary artery CTA plaque identification and TCM syndrome type of chest arthralgia was discussed. SPSS18.0 statistical software was used for medical statistical analysis. Result 1. A total of 131 patients were included in this study, including 61 males (46.6%) and 70 females (53.4%). The distribution of TCM syndromes was qi deficiency and blood stasis, stagnation of blood stasis, phlegm and blood stasis blocking collaterals deficiency of yin and kidney, deficiency of yin and yin, deficiency of yang and qi, including 497 plaques, 345 calcified plaques, 75 mixed plaques and 77 soft plaques. There was a positive correlation between the course of disease and age; 3. The incidence of plaques with phlegm and blood stasis blocking collaterals, especially calcified plaques, was higher than that of other syndromes. The incidence of moderate stenosis-calcification plaque and severe stenosis-calcification plaque in phlegm and blood stasis syndrome was higher than that in other syndromes; the mild, moderate and severe stenosis of phlegm and blood stasis syndrome was mainly caused by calcified plaque; among the plaques caused by phlegm and blood stasis, qi deficiency and blood stasis, qi stagnation and blood stasis and heart and kidney yin deficiency syndrome, the incidence of calcified plaques was higher than that of mixed and soft plaques; there was no difference in the distribution of plaques between qi and yin deficiency and yang qi deficiency syndrome. Mild to moderate stenosis was mainly caused by calcified plaques. The course of disease was positively correlated with the total number of plaques, calcified plaques and mixed plaques. There was a positive correlation between the degree of calcification and the occurrence of plaques. Conclusion 1. Distribution of TCM syndrome types: qi deficiency, blood stasis, phlegm and blood stasis, blocking collaterals, heart and kidney yin deficiency, qi deficiency, yang deficiency and failure; 2. The age of onset of coronary heart disease and coronary atherosclerosis was relatively stable. Mild to moderate stenosis was mainly caused by calcified plaques. The course of disease was positively correlated with the total number of plaques, calcified plaques and mixed plaques. There was a positive correlation between the degree of calcification and the occurrence of plaques. There is a certain correlation between plaque identification of coronary artery CTA and TCM syndrome types of chest arthralgia, which is manifested in the high incidence of plaques (especially calcified plaques) in phlegm and blood stasis syndrome. Relatively speaking, the incidence of soft plaques and mixed plaques in mild stenosis of yin deficiency and yang qi deficiency syndrome is higher than that of other groups, which has certain guiding significance for the understanding of coronary plaques by combination of traditional Chinese and western medicine.
【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】：2016
【分類號】：R541.4
[Abstract]:Coronary atherosclerotic heart disease (coronary atherosclerotic heart disease,CHD), also known as coronary heart disease, belongs to the category of "chest arthralgia" and "chest arthralgia" in traditional Chinese medicine. In recent years, the prevalence and mortality of cardiovascular diseases have continued to rise, becoming the first cause of death among residents. The report shows that 290m cardiovascular patients have been estimated in 2014 as acute coronary syndrome (acute coronary syndrome,ACS) and chronic coronary artery disease (chronic coronary artery disease, CAD),). ACS is the main cause of acute cardiovascular events. Modern studies have found that the occurrence of ACS is closely related to the nature of atherosclerotic (atherosclerotic, AS) plaques, that is, the occurrence of ACS mainly depends on the stability of plaques and hemodynamic factors. Therefore, plaque identification is of great significance to the diagnosis and treatment of ACS. It is of great value to the risk assessment of CHD (especially ACS), and should be included in the diagnosis and evaluation system. Objective to explore the relationship between plaque identification and TCM syndrome types based on the current understanding of coronary heart disease and coronary atherosclerosis in traditional Chinese and western medicine, in order to find a new entry point for the diagnosis of coronary plaques by traditional Chinese and western medicine, and to provide new ideas and more theoretical guidance for its treatment. Materials and methods Coronary artery CTA was performed in the Department of Radiology, Dongzhimen Hospital of Beijing University of traditional Chinese Medicine from October 2013 to October 2015. 131 patients with mild or above coronary stenosis plaques were examined by deputy chief physician and above. The number of plaques, plaque nature, stenosis degree, calcification score and patient medical records were collected. According to the four diagnosis information of traditional Chinese medicine (TCM), the correlation between coronary artery CTA plaque identification and TCM syndrome type of chest arthralgia was discussed. SPSS18.0 statistical software was used for medical statistical analysis. Result 1. A total of 131 patients were included in this study, including 61 males (46.6%) and 70 females (53.4%). The distribution of TCM syndromes was qi deficiency and blood stasis, stagnation of blood stasis, phlegm and blood stasis blocking collaterals deficiency of yin and kidney, deficiency of yin and yin, deficiency of yang and qi, including 497 plaques, 345 calcified plaques, 75 mixed plaques and 77 soft plaques. There was a positive correlation between the course of disease and age; 3. The incidence of plaques with phlegm and blood stasis blocking collaterals, especially calcified plaques, was higher than that of other syndromes. The incidence of moderate stenosis-calcification plaque and severe stenosis-calcification plaque in phlegm and blood stasis syndrome was higher than that in other syndromes; the mild, moderate and severe stenosis of phlegm and blood stasis syndrome was mainly caused by calcified plaque; among the plaques caused by phlegm and blood stasis, qi deficiency and blood stasis, qi stagnation and blood stasis and heart and kidney yin deficiency syndrome, the incidence of calcified plaques was higher than that of mixed and soft plaques; there was no difference in the distribution of plaques between qi and yin deficiency and yang qi deficiency syndrome. Mild to moderate stenosis was mainly caused by calcified plaques. The course of disease was positively correlated with the total number of plaques, calcified plaques and mixed plaques. There was a positive correlation between the degree of calcification and the occurrence of plaques. Conclusion 1. Distribution of TCM syndrome types: qi deficiency, blood stasis, phlegm and blood stasis, blocking collaterals, heart and kidney yin deficiency, qi deficiency, yang deficiency and failure; 2. The age of onset of coronary heart disease and coronary atherosclerosis was relatively stable. Mild to moderate stenosis was mainly caused by calcified plaques. The course of disease was positively correlated with the total number of plaques, calcified plaques and mixed plaques. There was a positive correlation between the degree of calcification and the occurrence of plaques. There is a certain correlation between plaque identification of coronary artery CTA and TCM syndrome types of chest arthralgia, which is manifested in the high incidence of plaques (especially calcified plaques) in phlegm and blood stasis syndrome. Relatively speaking, the incidence of soft plaques and mixed plaques in mild stenosis of yin deficiency and yang qi deficiency syndrome is higher than that of other groups, which has certain guiding significance for the understanding of coronary plaques by combination of traditional Chinese and western medicine.
【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】：2016
【分類號】：R541.4
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