急性冠脉综合征血瘀证与痰湿证临床特征比较研究
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摘要
目的探讨急性冠脉综合征(ACS)病人血瘀证与痰湿证临床特征及冠状动脉影像学的差异性。方法选取2017年6月—2017年12月胸痛中心收治的拟行冠状动脉造影的80例ACS病人作为研究对象,分为血瘀组及痰湿组,比较分析两组生物信息学、中医证候结果和冠状动脉影像结果,探讨两组临床特征及客观性指标的差异。结果痰湿组合并糖尿病病人高于血瘀组,其体质指数(BMI)高于血瘀组(P<0.05)。痰湿组肾小球滤过率、血清直接胆红素均高于血瘀组(P<0.05);血瘀组血清尿素氮高于痰湿组(P<0.05)。结论痰湿、血瘀均是冠心病的危险证候,糖尿病、高BMI、血清胆红素可能与痰湿证的形成相关,血清尿素氮与血瘀证具有相关性,血瘀证与痰湿证客观指标上具有一定差异。
Objective To investigate the differentiation of clinical characteristics and coronary angiography between blood stasis syndrome and phlegm-damp syndrome in patients with acute coronary syndrome(ACS).Methods From June 2017 to December 2017,80 ACS patients in chest pain center scheduled to undergo coronary angiography were enrolled.Dividing into blood stasis syndrome group and phlegm-damp syndrome group,comparative analysis of bioinformatics,syndrome of Chinese medicine and coronary imageology were performed to study difference of clinical characteristics and objective index between two groups.Results For phlegm-damp syndrome,more individuals had diabetes mellitus and the body mass index(BMI) was higher(P<0.05).The glomerular filtration rate and direct bilirubin(DBIL) of phlegm-damp syndrome were higher than blood stasis syndrome(P<0.05).The serum urea nitrogen(BUN) of blood stasis syndrome group was higher than that of phlegm-damp syndrome group(P<0.05).Conclusion Phlegm-damp and blood stasis are two major risk syndromes of coronary heart disease.Diabetes mellitus,high level of BMI and DBIL may associate with the formation of phlegm-damp syndrome.The level of serum BUN is associated with blood stasis syndrome.And there were differences of objective indexes between blood stasis syndrome and phlegm-damp syndrome.
Objective To investigate the differentiation of clinical characteristics and coronary angiography between blood stasis syndrome and phlegm-damp syndrome in patients with acute coronary syndrome(ACS).Methods From June 2017 to December 2017,80 ACS patients in chest pain center scheduled to undergo coronary angiography were enrolled.Dividing into blood stasis syndrome group and phlegm-damp syndrome group,comparative analysis of bioinformatics,syndrome of Chinese medicine and coronary imageology were performed to study difference of clinical characteristics and objective index between two groups.Results For phlegm-damp syndrome,more individuals had diabetes mellitus and the body mass index(BMI) was higher(P<0.05).The glomerular filtration rate and direct bilirubin(DBIL) of phlegm-damp syndrome were higher than blood stasis syndrome(P<0.05).The serum urea nitrogen(BUN) of blood stasis syndrome group was higher than that of phlegm-damp syndrome group(P<0.05).Conclusion Phlegm-damp and blood stasis are two major risk syndromes of coronary heart disease.Diabetes mellitus,high level of BMI and DBIL may associate with the formation of phlegm-damp syndrome.The level of serum BUN is associated with blood stasis syndrome.And there were differences of objective indexes between blood stasis syndrome and phlegm-damp syndrome.
引文
[1] 中国医师协会急诊医师分会,中华医学会心血管病学分会,中华医学会检验医学分会.急性冠脉综合征急诊快速诊疗指南[J].中华急诊医学杂志,2016,25(4):397-404.
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[4] 中国中西医结合学会活血化瘀专业委员会.冠心病血瘀证诊断标准[J].中国中西医结合杂志,2016,36(10):1162.
[5] 胡镜清,许伟明,王传池,等.冠心病痰湿证临床诊断标准解读[J].中国中医基础医学杂志,2017,23(9):1247-1250.
[6] ELLIS S G,VANDORMAEL M G,COWLEY M J,et al.Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease.Implications for patient selection.Multivessel Angioplasty Prognosis Study Group[J].Circulation,1990,82(4):1193-1202.
[7] GENSINI G G.A more meaningful scoring system for determining the severity of coronary heart disease[J].American Journal of Cardiology,1983,51(3):606.
[8] 徐达,吴颢昕.从痰瘀互结论治冠心病的研究进展[J].中华中医药杂志,2018,33(6):2503-2506.
[9] REN Y,ZHANG M,CHEN K,et al.Clinical and epidemiological investigation of TCM syndromes of patients with coronary heart disease in China[J].Evidence-based Complementary and Alternative Medicine,2012(2):714517.
[10] 吴光哲,王岩,钟丹,等.有关血尿素氮评价急性冠脉综合征预后的临床研究[J].心血管康复医学杂志,2011,20(4):345-347.
[11] ADAM A M,NASIR S A R,MERCHANT A Z,et al .Efficacy of serum blood urea nitrogen,creatinine and electrolytes in the diagnosis and mortality risk assessment of patients with acute coronary syndrome[J].Indian Heart Journal,2018,70(3):353-359.
[12] 李静,张继东,刘同涛.血清胆红素与冠脉病变程度、血脂及冠心病中医证型关系[J].南京中医药大学学报,2006,22(2):77-79.
[13] 林灵丹,冯国勤,孟春,等.急性冠脉综合征患者血清胆红素水平的相关研究[J].现代诊断与治疗,2008,19(6):330-332.
[14] FU R,SONG X,SU D,et al.Serum STLT-1 and bilirubin levels in patients with acute coronary syndrome and correlation with prognosis[J].Experimental & Therapeutic Medicine,2018,16(1):241-245.
[15] 单艳梅,周华,戎靖枫,等.冠心病病人中医体质类型特点研究[J].中西医结合心脑血管病杂志,2016,14(6):561-564.
[16] 周菁,罗海明.42例痰湿体质病人胰岛素抵抗指数临床研究报告[J].辽宁中医杂志,2010,37(5):822-823.
[17] 罗广波,唐爱华,周燕,等.不同体质的糖调节受损患者与胰岛素抵抗相关性研究[J].新中医,2008,40(9):44-45.
[18] 杜毅,杨关林,陈旭,等.基于文献的冠心病中医证候与冠脉造影结果的研究[J].辽宁中医杂志,2012,39(6):1034-1035.
[19] 任毅,陈可冀,张敏州,等. 405例冠心病患者冠状动脉造影结果与中医证型的相关性[J].中医杂志,2010,51(8):725-728.
[20] CHEN K J,SHI D Z,XU H,et al.XS0601 reduces the incidence of restenosis:a prospective study of 335 patients undergoing percutaneous coronary intervention in China[J].Chinese Medical Journal (Engl),2006,119(1):6-13.
[2] MORAN A,GU D,ZHAO D,et al.Future cardiovascular disease in China Markov model and risk factor scenario projections from the coronary heart disease policy model-China[J].Circulation,2010,3(3):243-252.
[3] 牛子长,付姝菲,毛浩萍.急性冠脉综合征的中医证候分布规律研究[J].辽宁中医杂志,2016,43(12):2488-2491.
[4] 中国中西医结合学会活血化瘀专业委员会.冠心病血瘀证诊断标准[J].中国中西医结合杂志,2016,36(10):1162.
[5] 胡镜清,许伟明,王传池,等.冠心病痰湿证临床诊断标准解读[J].中国中医基础医学杂志,2017,23(9):1247-1250.
[6] ELLIS S G,VANDORMAEL M G,COWLEY M J,et al.Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease.Implications for patient selection.Multivessel Angioplasty Prognosis Study Group[J].Circulation,1990,82(4):1193-1202.
[7] GENSINI G G.A more meaningful scoring system for determining the severity of coronary heart disease[J].American Journal of Cardiology,1983,51(3):606.
[8] 徐达,吴颢昕.从痰瘀互结论治冠心病的研究进展[J].中华中医药杂志,2018,33(6):2503-2506.
[9] REN Y,ZHANG M,CHEN K,et al.Clinical and epidemiological investigation of TCM syndromes of patients with coronary heart disease in China[J].Evidence-based Complementary and Alternative Medicine,2012(2):714517.
[10] 吴光哲,王岩,钟丹,等.有关血尿素氮评价急性冠脉综合征预后的临床研究[J].心血管康复医学杂志,2011,20(4):345-347.
[11] ADAM A M,NASIR S A R,MERCHANT A Z,et al .Efficacy of serum blood urea nitrogen,creatinine and electrolytes in the diagnosis and mortality risk assessment of patients with acute coronary syndrome[J].Indian Heart Journal,2018,70(3):353-359.
[12] 李静,张继东,刘同涛.血清胆红素与冠脉病变程度、血脂及冠心病中医证型关系[J].南京中医药大学学报,2006,22(2):77-79.
[13] 林灵丹,冯国勤,孟春,等.急性冠脉综合征患者血清胆红素水平的相关研究[J].现代诊断与治疗,2008,19(6):330-332.
[14] FU R,SONG X,SU D,et al.Serum STLT-1 and bilirubin levels in patients with acute coronary syndrome and correlation with prognosis[J].Experimental & Therapeutic Medicine,2018,16(1):241-245.
[15] 单艳梅,周华,戎靖枫,等.冠心病病人中医体质类型特点研究[J].中西医结合心脑血管病杂志,2016,14(6):561-564.
[16] 周菁,罗海明.42例痰湿体质病人胰岛素抵抗指数临床研究报告[J].辽宁中医杂志,2010,37(5):822-823.
[17] 罗广波,唐爱华,周燕,等.不同体质的糖调节受损患者与胰岛素抵抗相关性研究[J].新中医,2008,40(9):44-45.
[18] 杜毅,杨关林,陈旭,等.基于文献的冠心病中医证候与冠脉造影结果的研究[J].辽宁中医杂志,2012,39(6):1034-1035.
[19] 任毅,陈可冀,张敏州,等. 405例冠心病患者冠状动脉造影结果与中医证型的相关性[J].中医杂志,2010,51(8):725-728.
[20] CHEN K J,SHI D Z,XU H,et al.XS0601 reduces the incidence of restenosis:a prospective study of 335 patients undergoing percutaneous coronary intervention in China[J].Chinese Medical Journal (Engl),2006,119(1):6-13.