本文選題：冠心病　切入點(diǎn)：五臟　出處：《北京中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：通過(guò)流行病學(xué)調(diào)查問(wèn)卷,對(duì)冠心病的中醫(yī)證素、涉及臟腑進(jìn)行研究,探索冠心病胸痹心痛發(fā)病相關(guān)因素與五臟之間的相關(guān)性。方法：采取橫斷面調(diào)查模式,對(duì)2013年05月至2014年05月之間,就診于東直門醫(yī)院、安貞醫(yī)院、中日友好醫(yī)院三家三級(jí)甲等醫(yī)院,通過(guò)冠脈造影或冠脈CT確診為冠心病的患者,共400例進(jìn)行調(diào)查,建立數(shù)據(jù)庫(kù)分析冠心病胸痹發(fā)病相關(guān)因素與五臟之間的關(guān)系。結(jié)果：本研究共納入400例病例,對(duì)其進(jìn)行分析后得出結(jié)果如下：1.性別年齡五臟分布差異：①冠心病患者性別分布在各涉及臟腑之間存在差異,主要差異臟腑在脾,男性冠心病患者較女性患者更易出現(xiàn)脾失健運(yùn)的問(wèn)題。②冠心病患者年齡分布在各涉及臟腑之間存在差異,主要差異臟腑在肝,隨著年齡增長(zhǎng),病位涉及肝的可能性越大。2.冠心病危險(xiǎn)因素在五臟分布差異：①腹型肥胖與肝、脾兩臟關(guān)系密切。即冠心病胸痹患者中病位涉及到肝和脾的患者較其他患者更容易出現(xiàn)腹型肥胖。②高血壓與脾關(guān)系密切�？梢酝茰y(cè)冠心病胸痹患者中病位涉及到脾的患者較其他患者合并高血壓的概率更小。③糖尿病與肺關(guān)系密切�？梢酝茰y(cè)冠心病胸痹患者中病位涉及肺的患者較其他患者合并糖尿病的概率更高。④與高脂血癥相關(guān)性較大臟腑是心、腎。可以推測(cè)冠心病胸痹患者中病位涉及到心、腎的患者較其他患者合并高脂血癥的概率更高。3.冠心病各證素在五臟間分布差異：①病位涉及到心的證素有：陽(yáng)虛、水飲；②病位涉及到肝的證素主要有：陰虛、氣滯、痰濁、水飲：③病位涉及到脾的證素主要有痰濁、水飲；④病位涉及到肺的證素主要有：痰濁、水飲；⑤病位涉及到腎的證素主要有：陰虛、陽(yáng)虛、水飲。4.冠心病中醫(yī)證型與五臟相關(guān)性：本研究共納入研究病例400份,按照證素組合可分為26個(gè)中醫(yī)證型。對(duì)冠心病胸痹中醫(yī)證型與五臟相關(guān)性進(jìn)行多項(xiàng)logistics回歸分析,得出結(jié)果如下：①氣虛血瘀型與脾關(guān)系密切。冠心病胸痹患者中病位涉及到脾的患者較其他患者出現(xiàn)氣虛血瘀的可能性更高。②氣虛痰瘀型與腎關(guān)系密切。冠心病胸痹患者中病位涉及到腎的患者較其他患者出現(xiàn)氣虛痰瘀的可能性更高。③氣陰兩虛血瘀型與脾關(guān)系密切。冠心病胸痹患者中病位涉及到脾的患者更容易出現(xiàn)氣陰兩虛痰瘀。④氣滯血瘀型與肝、脾關(guān)系密切。冠心病胸痹患者中病位涉及肝、脾兩臟的患者較其他患者出現(xiàn)氣滯血瘀的可能性更高。⑤氣陽(yáng)兩虛型與脾、腎關(guān)系密切。冠心病胸痹患者中病位涉及脾、腎兩臟的患者較其他患者出現(xiàn)氣陽(yáng)兩虛的可能性更高。⑥氣虛血瘀水停與腎關(guān)系密切。冠心病胸痹患者中病位涉及到腎的患者較其他患者出現(xiàn)氣虛血瘀水停的可能性更大。5.冠心病冠狀動(dòng)脈病變?cè)谖迮K分布差異：本研究共納入研究病例400份,對(duì)冠心病冠狀動(dòng)脈病變狀況與五臟進(jìn)行逐一相關(guān)性分析,得出結(jié)果如下：①前降支病變與脾存在密切的聯(lián)系,可以推測(cè)冠心病胸痹患者中病位涉及到脾的患者更容易出現(xiàn)前降支的病變。②冠心病勞累性心絞痛分級(jí)與肝、脾具有明顯的相關(guān)性,冠心病胸痹患者中病位涉及到肝、脾的患者與其他患者相比心絞痛分級(jí)較低。③急性心肌梗死的發(fā)生在五臟分布存在差異：急性下壁心肌梗死與心具有明顯相關(guān)性,急性前壁心肌梗死與肝具有明顯相關(guān)性,急性ST段抬高型心肌梗死與脾具有明顯的相關(guān)性�？梢酝茰y(cè),冠心病胸痹患者中病位涉及到心的患者較其他患者出現(xiàn)急性下壁心肌梗死的概率更高,病位涉及到肝的患者較其他患者出現(xiàn)急性前壁心肌梗死的概率更高,病位涉及到脾的患者較其他患者出現(xiàn)急性ST段抬高型心肌梗死的概率更高。結(jié)論：本研究共納入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%),病位涉及到腎的病例有117例(29.3%)。五臟與冠心病胸痹心痛發(fā)病關(guān)系密切程度依次是心脾腎肝肺。1.冠心病胸痹患者中病位涉及到心的患者與其他患者相比①更容易合并高脂血癥；②出現(xiàn)急性下壁心肌梗死的概率更高；③常伴有陽(yáng)虛和水飲內(nèi)停的癥狀。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出現(xiàn)急性前壁心肌梗死的概率更高；③冠心病勞累性心絞痛分級(jí)往往較低；④常伴有陰虛、氣滯、痰濁阻滯和水飲內(nèi)停的癥狀。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,而合并高血壓病的可能性較�。孩谄淝敖抵Оl(fā)生病變的可能性較大；③出現(xiàn)急性ST段抬高型心肌梗死的概率更高；④冠心病勞累性心絞痛分級(jí)往往較低；⑤常見(jiàn)中醫(yī)證型有氣虛血瘀型、氣陰兩虛血瘀型、氣滯血瘀型、氣陽(yáng)兩虛型；⑥常伴有痰濁阻滯、水飲內(nèi)停的癥狀。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常伴有水飲內(nèi)停的癥狀。5.冠心病胸痹患者中病位涉及到腎的患者①更容易合并高脂血癥的可能性較大；②常見(jiàn)中醫(yī)證型有氣虛痰瘀型、氣陽(yáng)兩虛型、氣虛血瘀水停型；③常伴有陰虛、陽(yáng)虛、陰寒凝滯和水飲內(nèi)停的癥狀。
[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.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R256.22

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳偉偉;高潤(rùn)霖;劉力生;朱曼璐;王文;王擁軍;吳兆蘇;李惠君;鄭哲;蔣立新;胡盛壽;;《中國(guó)心血管病報(bào)告2014》概要[J];中國(guó)循環(huán)雜志;2015年07期

2 尹琳琳;劉如秀;;劉志明教授從心腎治療冠心病經(jīng)驗(yàn)[J];中西醫(yī)結(jié)合心腦血管病雜志;2015年03期

3 朱繼芳;李遠(yuǎn)瓊;陳朝蓉;劉莉;;冠心病患者焦慮抑郁現(xiàn)狀及影響因素調(diào)查[J];激光雜志;2014年09期

4 馮莉;趙耀;陳波;;淺談中西醫(yī)結(jié)合治療胃心綜合征[J];中醫(yī)臨床研究;2013年19期

5 張君毅;宋延彬;胡濤;王汝濤;夏陳海;黃衛(wèi)東;趙曉莉;陶凌;;冠心病患者腎功能減退與冠狀動(dòng)脈病變嚴(yán)重程度的相關(guān)性研究[J];中華臨床醫(yī)師雜志(電子版);2013年07期

6 韓翰;李佳;王嵐峰;;膽紅素在冠心病發(fā)病過(guò)程中的保護(hù)作用[J];中華老年心腦血管病雜志;2012年09期

7 汶麥霞;田華;張倩蓉;鄭小璞;饒坤睿;袁紅;;絕經(jīng)對(duì)女性冠心病患者臨床特征及危險(xiǎn)因素的影響[J];西安交通大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2012年03期

8 ;急性ST段抬高型心肌梗死診斷和治療指南[J];中華心血管病雜志;2010年08期

9 ;慢性心力衰竭診斷治療指南[J];中華心血管病雜志;2007年12期

10 譚成鋼;尹光玉;;論肝臟代謝與冠心病的關(guān)系兼談中醫(yī)辨治特點(diǎn)[J];中國(guó)現(xiàn)代醫(yī)生;2007年17期

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