江门地区中青年男性急性冠脉综合征证候分布与相关危险因素Logistic回归分析  

Logistic Regressive Analysis of Syndrome Distribution and Related Risk Factors in Young and Middleaged Male ACS Patients in Jiangmen Area

作　　者：唐品升 杨海玉 束明慧 于涛 刘冠英 Tang Pinsheng;Yang Haiyu;Shu Minghui;Yu Tao;Liu Guanying(Hunan University of Traditional Chinese Medicine,Hunan,Changsha 410000,China)

机构地区：[1]湖南中医药大学,湖南长沙410000 [2]广东省江门市五邑中医院,广东江门529000

出　　处：《中国中医急症》2020年第6期982-985,1039,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：广东省中医药局科研项目(20161272);江门市医疗卫生领域科技计划项目(2018c017)。

摘　　要：目的分析江门地区中青年男性急性冠脉综合征(ACS)患者的中医证候分布以及其与危险因素和冠脉病变的相关性。方法收集2017年3月至2019年2月在江门市五邑中医院确诊的166例ACS患者的病例资料进行回顾性分析,主要内容包括年龄、家族史、吸烟史、饮酒史、熬夜史、高血压病史、中医证型、冠脉造影结果、体质量指数(BMI)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TAG)、糖化血红蛋白(HbA1c)、颈动脉内中膜厚度(cIMT)等。分析相关危险因素以及冠脉病变与中医证候的相关性。结果本组患者中痰瘀互阻证86例,占比最高,为51.81%。不同证型患者之间年龄、HbA1c、TAG、吸烟史、高血压病史以及家族史之间无明显统计学差异(P>0.05)。不同证型患者BMI、LDL-C、cIMT、饮酒史、熬夜史之间有统计学差异(P<0.05),其中BMI与气虚血瘀证、痰瘀互阻证相关,LDL-C与气虚血瘀证、痰瘀互阻证、寒凝心脉证相关,cIMT与4个证型均有相关性,饮酒史与痰瘀互阻证相关,熬夜史与气虚血瘀证和寒凝心脉证相关,均具有统计学意义(P<0.05)。不同冠脉病变支数的证型分布有统计学差异(P<0.05)。痰瘀互阻证、寒凝心脉证与单支病变显著相关,气虚血瘀证、痰瘀互阻证、正虚阳脱证与双支病变显著相关,气虚血瘀证、正虚阳脱证与3支病变显著相关,均具有统计学意义(P<0.05)。结论江门地区中青年男性ACS患者中医证素以痰为主,痰瘀互阻是主要证型,在辨证论治时应结合冠脉造影、BMI、LDL-C、cIMT等检查结果以及饮酒、熬夜等病史,治疗时应急治其标,采用介入方法开通血管,中医可根据冠脉病变程度选择通阳化浊、益气活血化瘀或回阳救逆的治法,同时注重健脾化痰通络,可能有助于提高临床疗效。Objective:To analyze the distribution of TCM syndrome and its correlation with risk factors and coronary lesions in young and middle-aged male ACS patients in Jiangmen area.Methods:166 cases of ACS from March 2017 to February 2019 were retrospectively analyzed.The main contents included age,family history of coronary heart disease,smoking,drinking,staying up late,history of hypertension,TCM syndromes,coronary angiography results,BMI,LDL-C,TAG,HbA1c and cIMT.And then,the risk factors were analyzed.The correlation was studied between these factors and TCM syndrome.Results:86 cases with phlegm and blood stasis syndrome were found in the group,accounting for 51.81%,the highest one.There were no significant differences in age,HbA1c,TG,smoking,family history of coronary heart disease and history of hypertension among patients with different syndromes(P>0.05).BMI,LDL-C,cIMT,drinking and staying up late were significantly different in different syndrome types(P<0.05).BMI was correlated with Qi deficiency and blood stasis syndrome and phlegm and blood stasis syndrome;LDL-C was correlated with Qi deficiency and blood stasis syndrome,phlegm and blood stasis syndrome and cold congestion and heart pulse syndrome;cIMT was correlated with 4 syndrome types(P<0.05).Drinking was related to phlegm and blood stasis syndrome;staying up late was related to Qi deficiency and blood stasis syndrome and cold congestion heart pulse syndrome,with significant difference(P<0.05).There were significant differences in the distribution of syndrome types of different coronary lesion branches(P<0.05).Phlegm and blood stasis syndrome,cold congealing heart pulse syndrome and single vessel disease were significantly correlated;Qi deficiency and blood stasis syndrome,phlegm and blood stasis syndrome,Zheng deficiency and Yang detachment syndrome were significantly correlated with double vessels disease;Qi deficiency and blood stasis syndrome,Zheng deficiency and Yang detachment syndrome were significantly correlated with three vessel disease,all of whi

关 键 词：急性冠脉综合征 中青年 中医证型 危险因素 冠脉造影 

分 类 号：R541.4[医药卫生—心血管疾病]