冠心病左室重构患者中医证素、危险因素与左室重构的关联规则分析
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摘要
目的探讨冠心病左室重构与证素、危险因素的关系。方法运用临床流行病学调查方法,对261例疑似冠心病患者进行冠状动脉造影和心脏彩超检查,对确诊为冠心病左室重构患者的中医证素和危险因素进行横断面调查,运用频数分析和关联规则方法进行数据统计。结果 261例疑似患者最终确诊为冠心病左室重构病例为231例。231例患者中病位证素以心(226例)、肺(116例)、肾(69例)为主;病性证素以血瘀(221例)、气虚(77例)、阴虚(72例)、阳虚(58例)为主。关联规则提示冠心病左室重构与心、肺、肾、血瘀、气虚、阳虚、阴虚等证素有关,在吸烟、年龄、男性、心、血瘀条件下出现左心室重构概率为98. 49%;冠心病左室重构患者2个证素以心与阳虚、心与气虚等组合多见,3个证素以心与阳虚、肾,心与阳虚、肺等组合多见。4个证素以心与阳虚、肾、血瘀,心与阳虚、肺、血瘀等组合多见。结论冠心病左室重构患者多见本虚标实,病位多与心、肺、肾相关,气虚、阴虚、阳虚等虚证是发病之本,血瘀、痰是发病之标,危险因素是发作的重要因素。
Objective To investigate the relationship between left ventricular remodeling and syndrome elements and risk factors. Methods Using clinical epidemiological investigation methods,261 patients with suspected coronary heart disease underwent coronary angiography and echocardiography,and cross-sectional survey was conducted for traditional Chinese medicine( TCM) syndromes and risk factors in patients with left ventricular remodeling diagnosed as coronary heart disease. The frequency analysis and the association rule method were used for data statistics.Results Totally 231 cases were final diagnosed of left ventricular remodeling in 261 suspected patients. Among the231 patients,the main pathogenic factors were heart( 226 cases),lung( 116 cases),and kidney( 69 cases); the main pathogenic factors were blood stasis( 221 cases),qi deficiency( 77 cases),yin deficiency( 72 cases),and yang deficiency( 58 cases). The association rule suggested that left ventricular remodeling was related to heart,lung,kidney,blood stasis,qi deficiency,yang deficiency,yin deficiency. The probability of left ventricular remodeling was 98. 49% under smoking,age,male,heart,and blood stasis conditions. For two syndrome elements,the combination of heart and yang deficiency,heart and qi deficiency were more common in patients with left ventricular remodeling of coronary heart disease. For three syndrome elements,the combination of heart,yang deficiency and kidney,heart,yang deficiency and lung were more common. For four syndromes,the combination of the heart,yang deficiency,kidney and blood stasis,heart,yang deficiency,lung and blood stasis were more common. Conclusion Patients with left ventricular remodeling in coronary heart disease are more likely to have root deficiency and manifestation excess,and the disease location is mostly related to heart,lung and kidney. Deficiency of qi,yin deficiency and yang deficiency were the causes of the disease. Blood stasis and phlegm are the targets of the disease,and risk factors are important factors for the onset of the disease.
Objective To investigate the relationship between left ventricular remodeling and syndrome elements and risk factors. Methods Using clinical epidemiological investigation methods,261 patients with suspected coronary heart disease underwent coronary angiography and echocardiography,and cross-sectional survey was conducted for traditional Chinese medicine( TCM) syndromes and risk factors in patients with left ventricular remodeling diagnosed as coronary heart disease. The frequency analysis and the association rule method were used for data statistics.Results Totally 231 cases were final diagnosed of left ventricular remodeling in 261 suspected patients. Among the231 patients,the main pathogenic factors were heart( 226 cases),lung( 116 cases),and kidney( 69 cases); the main pathogenic factors were blood stasis( 221 cases),qi deficiency( 77 cases),yin deficiency( 72 cases),and yang deficiency( 58 cases). The association rule suggested that left ventricular remodeling was related to heart,lung,kidney,blood stasis,qi deficiency,yang deficiency,yin deficiency. The probability of left ventricular remodeling was 98. 49% under smoking,age,male,heart,and blood stasis conditions. For two syndrome elements,the combination of heart and yang deficiency,heart and qi deficiency were more common in patients with left ventricular remodeling of coronary heart disease. For three syndrome elements,the combination of heart,yang deficiency and kidney,heart,yang deficiency and lung were more common. For four syndromes,the combination of the heart,yang deficiency,kidney and blood stasis,heart,yang deficiency,lung and blood stasis were more common. Conclusion Patients with left ventricular remodeling in coronary heart disease are more likely to have root deficiency and manifestation excess,and the disease location is mostly related to heart,lung and kidney. Deficiency of qi,yin deficiency and yang deficiency were the causes of the disease. Blood stasis and phlegm are the targets of the disease,and risk factors are important factors for the onset of the disease.
引文
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[2]朱文锋,张华敏.“证素”的基本特征[J].中国中医基础医学杂志,2005,11(1):17-18.
[3]FIHN SD,GARDIN JM,ABRAMS J,et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemicheart disease:A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines,and the American College of Physicians,American Association for Thoracic Surgery,reventive Cardiovascular Nurses Association,Society for Cardiovascular Angiography and Interventions and Society of Thoracic Surgeons[J]. Circulation,2012,126(25):e354-e471.
[4]GANAU A,DEVEREUX RB,ROMAN MJ,et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension[J]. J Am Coll Cardiol,1992,19(7):1550-1558.
[5]诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-953.
[6]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[7]SMITH SC JR,DOVE JT,JACOBS AK,et al. ACC/AHA guidelines for percutaneous coronary intervention(revision of the 1993 PTCA guidelines)-executive summary:a report of the American College of Cardiology/American Heart Association task force on practice guidelines(Committee to revise the 1993 guidelines for percutaneous transluminalcoronary angioplasty)endorsed by the Society for Cardiac Angiography and Interventions[J]. Circulation,2001,103(24):3019-3041.
[8]周永昌,郭万学.超声医学[M]. 4版.北京:科学技术文献出版社,2006:680-712.
[9]朱文锋.中医主症鉴别诊疗学[M].长沙:湖南科学技术出版社,2000:316.
[10]朱文锋.证素辨证学[M].北京:人民卫生出版社,2008:90-290.
[11]葛均波,徐永健.内科学[M].北京:人民卫生出版社,2013:220-227.
[12]王绿娅.冠状动脉粥样硬化性心脏病相关临床脂质研究新亮点[J].心肺血管病杂志,2017,36(10):797-799.
[13]林侃,郑关毅,熊尚全,等.冠状动脉病变程度及中医证型对冠心病患者左室重构的影响[J].中医杂志,2018,59(10):851-856.
[14]王永刚,齐婧,钟伟,等.冠心病中医病因病机的认识与探索[J].中医杂志,2015,56(17):1449-1452.
[15]葛永彬,毛静远. 6155例冠心病患者中医证型分布规律分析[J].北京中医药,2014,33(7):533-534.
[16]赵振凯,王永刚,郑刚,等.冠心病患者中医证型与脑钠肽、左室射血分数及E/A的相关性分析[J].长春中医药大学学报,2015,31(3):525-528.
[17]王东海,董波.冠心病心绞痛证型分布的回顾性分析[J].世界中西医结合杂志,2015,10(3):387-389.