1990~2020年我国冠心病中医证的流行病学调查研究概况  

Research Situation of Traditional Chinese Medicine Clinical Epidemiological Investigation of Coronary Heart Disease in China from 1990 to 2020

作　　者：王传池 吴珊 江丽杰[1] 许伟明[1] 佟旭[1] 蔡嫣然 周聪慧 童新元[3] 胡镜清[1] WANG Chuan-chi;WU Shan;JIANG Li-jie;XU Wei-ming;TONG Xu;CAI Yan-ran;ZHOU Cong-hui;TONG Xin-yuan;HU Jing-qing(Institute of Basic Theory for Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China;School of Medicine&Holistic Integrative Medicine,Nanjing University of Chinese Medicine,Nanjing 210023,China;Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]中国中医科学院中医基础理论研究所,北京100700 [2]南京中医药大学医学院整合医学学院,南京210023 [3]中国人民解放军总医院,北京100039

出　　处：《中国中医基础医学杂志》2020年第12期1883-1893,共11页JOURNAL OF BASIC CHINESE MEDICINE

基　　金：国家重点基础研究计划(973计划)(2014CB542903)-“基于冠心病痰瘀互结证辨证方法的创新研究”;国家重点研发计划(2019YFC1708501)-“冠心病痰瘀互结病因病机与诊治方案创新研究”;中国中医科学院院级基本科研业务费育苗基金培育专项(zz11-104)-“基于S-T-IM模型的冠心病病机量化辨识方法研究”。

摘　　要：目的:了解1990~2020年近30年来我国冠心病中医证的流行病学调查研究概况。方法:系统检索CNKI、VIP、WANFANG DATA、PubMed等数据库,纳入我国冠心病中医证的流行病学调查研究文献,对其调查目的、调查对象、调查方法及主要调查结果等进行描述统计。根据NICE推荐的研究质量评价标准以及STROBE声明第四版对纳入文献的方法学质量和报告质量进行评价。结果:①最终纳入139篇目标文献,最早发表于1992年,2007~2020年之间发表130篇(93.5%);调查地区涵盖全国28个省市自治区,主要集中在华北(44.6%)、中南(44.6%)、华东(33.8%)共纳入100546例冠心病患者,累计覆盖707个研究中心,住院或门诊患者占91.0%;②61.9%的调查采用横断面调查研究方法,其余分别采用队列研究方法(28.0%)、病例对照研究方法(10.1%);77.7%的调查主要研究证的分布特征,其余分别为研究证或临床表征的演变规律(28.8%),研究证与理化指标的关系(15.8%),明确辨证依据(10.8%)以及研究证对心血管事件的影响(5%);③主要调查结果显示,频数排名前四位的证为血瘀证(64.2%)、气虚证(57.3%)、痰浊(湿)证(37.8%)、阴虚证(26.7%),呈血瘀证>气虚证>痰浊(湿)证>阴虚证>阳虚证>气滞证>热证>水饮证>寒凝证>血虚证的趋势。不同阶段冠心病患者中医证分布结果显示,稳定性冠心病患者痰浊(湿)证(58.6%)和阳虚证(26.8%)比例高于其他阶段;至急性冠脉综合征阶段开始出现热证(2.8%);冠心病心力衰竭患者气虚证比例最高(81.2%),且近1/3(33.1%)患者出现水饮证。介入术后3个月内,血瘀证比例显著下降(术前68.3%→术后1 d 46.7%→术后1周44.7%→术后1个月35.1%→术后3个月26.2%),但术后6个月又升至42.6%,总体呈先降后升趋势。此外,气虚证成为介入术后各时间点最主要的单元证,且术后6个月比例最高达64.4%;气滞证比例于术后3个月、术后6个月呈上升趋势,热证、血虚证比例�Objective:To understand the general situation of traditional Chinese medicine(TCM)clinical epidemiological investigation of coronary heart disease(CHD)in China from 1990 to 2020,the distribution characteristics of TCM syndromes of CHD,and the methodological problems affecting the research quality.Methods:CNKI,VIP,Wanfang,PubMed and other databases were searched systematically,and the literature of clinical epidemiological investigation of CHD in China was included.The investigation purpose,object,method and the main findings were described and counted.According to the research quality evaluation standard recommended by NICE and the STROBE statement,the methodological quality and report quality of the included literature were evaluated.Results:①139 target literatures were finally included,which were first published in 1992 and 130(93.5%)were published between 2007 and 2020.The survey area covers 28 provinces in China,mainly concentrated in North China(44.6%),Central South China(44.6%)and East China(33.8%).A total of 707 research centers were covered.A total of 10546 patients with CHD were included,of which 91.0%were hospitalized or outpatient.②61.9%of the investigations were conducted by cross-sectional investigation,while others were conducted by cohort study(28.0%)and case-control study(10.1%).77.7%of the investigations aim to explore the distribution characteristics of syndrome,28.8%to reveal the evolution law of syndrome or clinical representation,15.8%to explore the biological basis of syndrome,10.8%to clarify the basis of syndrome differentiation,and 5.0%to explore the influence of syndrome on cardiovascular events.③The main investigation results show that the top four frequency of unit syndrome of CHD are blood stasis(64.2%),Qi deficiency(57.3%),phlegm turbidity(dampness)(37.8%)and yin deficiency(26.7%),and the order is blood stasis>Qi deficiency>phlegm turbidity(dampness)>Yin deficiency>yang deficiency>Qi stagnation>heat syndrome>fluid retention>cold coagulation>blood deficiency.The analysis results

关 键 词：冠心病 中医 证候 临床流行病学 横断面调查 演变规律 质量评价 

分 类 号：R541.4[医药卫生—心血管疾病]