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  

Effect of Coronary Artery Disease Degree and Traditional Chinese Medicine Syndrome on Left Ventricular Remodeling in Patients with Coronary Heart Disease

作　　者：林侃[1] 郑关毅[1] 熊尚全 傅开龙[1] 李楠[1] 陈小英[1] 李金国[1] LIN Kan1, ZHENG Guanyi1, XIONG Shangquan2, FU Kailong1, LI Nan1, CHEN Xiaoying1, LI Jinguo1(1. Fujian Medical University Union Hospital, Fuzhou, 350001; 2. Affiliated People＇s Hospital of Fujian University of Traditional Chinese Medicin)

机构地区：[1]福建医科大学附属协和医院 [2]福建中医药大学附属人民医院

出　　处：《中医杂志》2018年第10期851-856,共6页Journal of Traditional Chinese Medicine

基　　金：2016-2019年度福建省中医药科研项目(2017FJZYLC205)

摘　　要：目的探讨冠心病患者冠状动脉狭窄程度、病变支数、中医证型与左室重构的关系。方法收集261例疑似冠心病患者的冠状动脉造影和超声心动图检查结果,根据冠状动脉造影结果分为冠心病组231例,非冠心病组30例。冠心病组按狭窄程度分为完全闭塞组、重度狭窄组、中度狭窄组和轻度狭窄组;按病变支数分为3支病变组、2支病变组和单支病变组;根据中医证型分为气虚血瘀组、痰阻心脉组、阴寒凝滞组、心肾阴虚组、阳气虚衰组。比较不同狭窄程度、病变支数、中医证型患者左室形态学指标[左室舒张末期内径(LVED)、左室收缩末期内径(LVES)、左心房内径(LAD)、左室后壁厚度(LVPW)、室间隔厚度(IVST)、左室重量指数(LVMI)]和左室收缩功能指标[左室短轴缩短率(LVFS)、射血分数(EF)、每搏输出量(SV)]、左室舒张功能指标[舒张早期最大流速/舒张晚期最大流速(E/A)]的差异。结果与非冠心病组比较,完全闭塞组、3支病变组、2支病变组及阳气虚衰组患者LVED、LVES、LAD、LVPW、IVST、LVMI、SV升高,LVFS、EF、E/A下降(P<0.05或P<0.01);重度狭窄组患者LVED、LVES、LAD、LVPW、LVMI、SV升高;中度狭窄组患者LVPW、LVMI升高(P<0.05或P<0.01)。与单支病变组比较,3支病变组和2支病变组LVFS、EF降低(P<0.05)。气虚血瘀组患者LVED、LVES、LAD、LVMI高于非冠心病组(P<0.05)。阳气虚衰组患者LVMI高于其他证型组(P<0.05),LVED、LVES高于心肾阴虚组(P<0.05)。结论冠心病不同病变程度、病变支数、中医证型影响左室重构程度,特别是完全闭塞、3支病变、阳气虚衰证的患者左室重构明显,并且左室形态结构改变早于左室功能改变。Objective To investigate the relationship between degree of coronary artery stenosis,number of lesions,traditional Chinese medicine syndrome and left ventricular remodeling in patients with coronary heart disease（ CHD）. Methods The coronary angiography and echocardiography results of 261 patients with suspected coronary heart disease were collected and divided into CHD group（ 231 patients） and non-CHD group（ 30 patients） according to coronary angiographic results. The coronary heart disease group was divided into complete occlusion group,severe stenosis group,moderate stenosis group and mild stenosis group according to the degree of stenosis. They were divided into three lesions group,two lesions group and single lesion group according to the number of lesions. They were divided into qi deficiency and blood stasis group,phlegm blocking heart vessel group,yin cold stagnation group,heart and kidney yin deficiency group,yang qi deficiency group. The differences of left ventricular morphological index（ left ventricular end diastolic diameter（ LVED）,left ventricular end-systolic diameter（ LVES）,left atrial diameter（ LAD）,left ventricular posterior wall thickness（ LVPW）,interventricular septal thickness（ IVST）,left ventricular mass index（ LVMI））,left ventricular systolic function index（ left ventricular fractional shortening（ LVFS）,ejection fraction（ EF）,stroke volume（ SV））,left ventricular diastolic function index（ peak velocity flow in early diastole/peak velocity flow in late diastole（ E/A）） of patients with different degree of stenosis,number of lesions and Chinese medicine symptom integral were compared. Results Compared with non-CHD group,LVED,LVES,LAD,LVPW,IVST,LVMI,and SV of patient in complete occlusion group,three lesions group,two lesions group,yang qi deficiency group were increased,and LVFS,EF,E/A were decreased（ P〈0. 05 or P〈0. 01）. LVED,LVES,LAD,LVPW,LVMI,SV of patient with server stenosis were increased. LVPW and LVMI of patients wi

关 键 词：冠心病 左室重构 中医证型 超声心动图 冠状动脉造影 

分 类 号：R259[医药卫生—中西医结合]