冠心病患者中醫(yī)證型與冠脈病變特點的相關(guān)性研究
發(fā)布時間：2018-11-09 12:24
【摘要】：目的:冠心病作為臨床常見疾病,近發(fā)病率也越來越高。冠脈造影作為診斷的“金標準”,在本病的診斷及治療過程中具有重要作用。此次研究主要通過收集患者臨床資料,以了解冠心病中醫(yī)證型的分布;同時對冠脈造影的結(jié)果進行統(tǒng)計及分析,以希望能進一步分析各中醫(yī)證型和冠脈病變特點之間的關(guān)系。希望今后能為本病的辨證及治療提供一些參考。資料與方法:收集大連醫(yī)科大學附屬第二醫(yī)院心內(nèi)科100例患者資料,在術(shù)前收集患者信息,及相關(guān)實驗室檢查結(jié)果,并根據(jù)《中藥新藥治療胸痹(冠心病、心絞痛)的臨床研究指導原則》對患者進行中醫(yī)證型分型,術(shù)后根據(jù)患者冠脈造影結(jié)果,并依據(jù)病例納入和排除標準對患者進行進一步篩選,對符合標準的患者詳細記錄病變血管及病變程度,并對冠脈病變進行評分。然后對所有患者的具體中醫(yī)辨證分型及所記錄的各項結(jié)果進行統(tǒng)計學分析。結(jié)果:1.此次收集的100名患者中:男性65例,女性35例,男性發(fā)病率明顯高于女性,所有患者的年齡具體分布于44-84歲之間,收集的患者平均年齡64.28±9.16歲。2.100名病例中,對所有患者進行辨證分型:氣滯血瘀證的患者共31人,痰阻心脈證的患者共35名,陰寒凝滯證的患者共8人,氣陰兩虛證的患者共11人,心腎陰虛證的患者共9人,陽氣虛衰證的患者共6人,冠心病中醫(yī)證型分布的主要證型為氣滯血瘀證及痰濁阻滯證。3.在各中醫(yī)證型的病變范圍的分析,氣滯血瘀證的患者中單支病變者共16人,雙支病變者8人,多支病變者6人,痰阻心脈證的患者單支病變者2人,雙支病變者8人,多支病變者25人。各中醫(yī)證型之間進行Fisher檢驗,P=0.0000.01。氣滯血瘀證的患者多以單支病變?yōu)橹?痰阻心脈證的患者病變則更加彌漫。4.各中醫(yī)證型的病變嚴重程度分析,可以看出氣滯血瘀證的患者各個程度的狹窄分布比較均勻,而痰阻心脈證的患者重度狹窄的患者比較多,但不同證型之間的病變狹窄程度的差異并不具有顯著的統(tǒng)計學意義(P=0.234)。5.各中醫(yī)證型與冠脈積分之間的分析,各中醫(yī)證型與冠脈積分之間進行方差分析具有顯著意義(F=4.151,P0.01),其中積分最高的為痰阻心脈證的患者,其次為氣滯血瘀證、陽氣虛衰證、心腎陰虛證、氣陰兩虛證及陰寒凝滯證。各證型之間的兩兩對比,與氣滯血瘀證對比痰阻心脈證有顯著差異(P0.01),與痰阻心脈證比,氣滯血瘀證、陰寒凝滯證、氣陰兩虛證、心腎陰虛證、陽氣虛衰證均有顯著差異,但其余各證型之間的對比并無顯著意義。結(jié)論:1.冠心病的中醫(yī)證型主要以氣滯血瘀證及痰阻心脈證為主;2.冠心病的中醫(yī)病機為本虛標實,大部分患者多以標實為主要表現(xiàn),而病理要素主要為痰濁及血瘀,痰濁較血瘀病變更加彌漫。3.在中醫(yī)對冠心病的治療中應(yīng)該更加注意痰濁與瘀血并重。
[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 鹵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.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259
本文編號：2320403
[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 鹵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.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259
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