基于真实世界的颈动脉粥样硬化症患者中医辨证分布及疗效研究  

Clinical Study of Traditional Chinese Medicine Syndrome Type Distribution and Efficacy of Carotid Atherosclerosis in The Real World

作　　者：周倩 马静 汤茜 徐苏昊 乔学山 ZHOU Qian;MA Jing;TANG Qian;XU Suhao;QIAO Xueshan(Department of Traditional Chinese Medicine,Xijing Hospital,Air Force Medical University,Xi'an 710032,Shaanxi,China;Department of Traditional Chinese Medicine,Tianjin University of Traditional Chinese Medicine,Tianjin 300193,China;Cadets Brigade,Basic Medicine College,Air Force Medical University,Xizan 710032,Shaanxi,China)

机构地区：[1]空军军医大学西京医院中医科,陕西西安710032 [2]天津中医药大学中医学院,天津300193 [3]空军军医大学基础医学院学员旅,陕西西安710032

出　　处：《辽宁中医杂志》2020年第6期123-126,共4页Liaoning Journal of Traditional Chinese Medicine

基　　金：陕西省中医药管理局10个病种中医药创新计划项目(2015-JDM)。

摘　　要：目的探讨真实世界颈动脉粥样硬化症患者的中医证型分布特点及临床用药的疗效。方法 628例颈动脉粥样硬化症患者参照中医证候诊断标准进行辨证分型,分为气虚痰浊、肾虚血瘀、肾虚痰浊、肾阴亏虚、肝肾阴虚、肾虚气滞6大证型,按临床实际用药的真实情况非随机分为中药+中成药+西药、中药+西药、中成药+西药、中药+中成药、中药、中成药、西药等7种治疗方案辨证施治,采用颈动脉B超为药效监测手段,比较治疗前和治疗6个月后颈动脉粥样硬化斑块Crouse积分和斑块数目。结果 (1) 628例颈动脉粥样硬化症患者中以气虚痰浊型最多(34.2%,215/358),然后依次为肾虚血瘀型(22.0%,138/628)、肾虚痰浊型(15.3%,96/628)、肾阴亏虚型(10.7%,67/328)、肝肾阴虚型(9.7%,215/628)和肾虚气滞型(8.1%,51/628);(2)各证型间治疗前颈动脉粥样硬化斑块Crouse积分和斑块数目差异无统计学意义(P>0.05);(3) 7种治疗方案经6个月治疗后均能有效降低斑块Crouse积分和斑块数目,且中药+中成药+西药、中药+西药、中成药+西药的疗效优于单纯西药(P<0.05),中药+中成药、中药、中成药的治疗与西药的治疗效果差异没有统计学意义(P>0.05)。结论 (1)颈动脉粥样硬化症患者以气虚痰浊型最多见、肾虚血瘀型次之;(2)中药+中成药+西药、中药+西药、中成药+西药的疗效优于单纯西药,且7种治疗方案均能有效降低斑块Crouse积分和斑块数目。Objective To explore the traditional Chinese medicine syndrome type distribution of carotid atherosclerosis(CAS)and the curative effect of clinical medication in the real world.Methods A total of 628 cases of CAS were divided into six types of syndrome: Qi deficiency and phlegm turbidity,kidney deficiency and blood stasis,kidney deficiency and phlegm turbidity,deficiency of kidney-Yin,deficiency of liver-Yin and kidney-Yin,kidney deficiency and Qi stagnation.According to the real situation of clinical practice,628 cases were randomly divided into traditional Chinese medicine(TCM) and Proprietary Chinese Medicine(PCM) plus western medicine(WM) group,TCM plus WM group,PCM plus WM group,TCM plus PCM group,TCM group,PCM group,WM group.Carotid artery ultrasound examination was used to detect the Crouse score and number of carotid atherosclerotic plaque and assess the therapeutic effect.Results(1) Among 628 cases,the percent of patients with Qi deficiency and phlegm turbidity was 34.2%(215/328),followed by kidney deficiency and blood stasis(20.0%,138/628),kidney deficiency and phlegm turbidity(15.3%,96/628),deficiency of kidney-Yin(10.7%,67/628),deficiency of liver-Yin and kidney-Yin(9.7%,61/628),kidney deficiency and Qi stagnation(8.1%,51/628).(2) There was no significant differences in baseline crouse score or numbers of carotid atherosclerotic plaque among different syndromes before treatment(P>0.05).(3) After treatments with these seven regimens for six months,the Crouse score and numbers of carotid atherosclerotic plaque were significantly reduced.The TCM and PCM plus WM group,TCM plus WM group,and PCM plus WM group were significantly better than WM group in the clinical curative effect(P<0.05).There was no significant difference in the clinical curative effect among TCM plus PCM group,TCM group,PCM group,and WM group(P>0.05).Conclusion CAS patients with Qi deficiency and phlegm turbidity was the most common,the followed syndrome was kidney deficiency and blood stasis.TCM and PCM plus WM,TCM plus WM,and PCM plus W

关 键 词：颈动脉粥样硬化 中医证型 辨证论治 真实世界研究 

分 类 号：R543.5[医药卫生—心血管疾病]