基于真实世界的2型糖尿病合并稳定型心绞痛患者中医证候特征及其与预后结局的关系  

Characteristics of Chinese Medicine Syndromes and the Corerelation with Prognosis Outcome in Patients with Type 2 Diabetes Mellitus Complicated Stable Angina Pectoris:A Real World Study

作　　者：李蕾蕾 符宇 邵明义 燕树勋 张众 余海滨[1] 远佳瑶 王娴 吴明慧 赵瑞霞 崔伟锋[5] LI Leilei;FU Yu;SHAO Mingyi;YAN Shuxun;ZHANG Zhong;YU Haibin;YUAN Jiayao;WANG Xian;WU Minghui;ZHAO Ruixia;CUI Weifeng(Henan University of Chinese Medicine,Zhengzhou,450000;The First Affiliated Hospital of Henan University of Chinese Medicine;Shangqiu City Hospital of Traditional Chinese Medicine;Guangzhou University of Chinese Medicine;Henan Academy of Chinese Medicine)

机构地区：[1]河南中医药大学,河南郑州450000 [2]河南中医药大学第一附属医院 [3]河南省商丘市中医院 [4]广州中医药大学 [5]河南省中医药研究院

出　　处：《中医杂志》2021年第12期1052-1058,共7页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81704011);国家重点研发计划(2017YFC1703506);河南省重点研发与推广专项(192102310157);河南省中医药科学研究专项(2017JDZX034,2018Y2061,2019JDZX2026)。

摘　　要：目的探讨真实世界2型糖尿病合并稳定型心绞痛(T2DM-SAP)患者的中医证候特点及其与主要心脑血管不良事件发生的关系。方法回顾性分析965例T2DM-SAP患者临床资料,分别统计患者中医证型、证素及舌象、脉象分布情况,各证型不同病程、不同年龄分布情况,并采用Logistic回归分析法分析中医证候与主要心脑血管不良事件发生的关系。结果965例T2DM-SAP患者共有中医证型19种,其频次前3位分别为气虚血瘀(229)、气阴两虚兼血瘀(194)、痰瘀互结(119);共有病位证素8种,主要为心脉(485)、心(211)、脾(178),病性证素13种,主要为血瘀(649)、气虚(448)、痰浊(299);舌象多见舌质暗(598)、红(519),舌苔白(496)、腻(412);脉象多见弦(425)、细(354)、沉(294)。各证型不同病程分布虽有差异,但仍以气虚血瘀(24.2%,214/885)为主;各证型不同年龄分布中,以>60~74岁年龄段占比最高(46.1%,239/965)。发生主要心脑血管不良事件患者389例,Logistic回归分析结果显示:短暂性脑缺血发作、心绞痛再入院与湿热内蕴兼瘀血阻络(OR=5.39,P=0.04)呈正相关;心肌梗死再入院、冠状动脉血运重建术、再发脑卒中与年龄(OR=1.56,P=0.04)、风痰阻络(OR=2.07,P=0.02)、肝阳上亢(OR=5.07,P=0.02)呈正相关;全因死亡与年龄(OR=1.09,P<0.01)、心肾阳虚(OR=8.71,P=0.03)、阴阳两虚(OR=38.81,P<0.01)呈正相关。结论气虚血瘀、气阴两虚兼血瘀证是T2DM-SAP的主要证型,血瘀为最主要的病性证素;湿热内蕴兼瘀血阻络、风痰阻络、肝阳上亢、心肾阳虚、阴阳两虚证可能有发生主要心脑血管不良事件的危险。Objective To explore the characteristics of traditional Chinese medicine(TCM)syndromes in real-world patients with type 2 diabetes mellitus and stable angina pectoris(T2 DM-SAP)as well as the relationship between TCM syndromes and the occurrence of major adverse cardiovascular and cerebrovascular events(MACCE).Methods The clinical data of 965 patients with T2 DM-SAP were retrospectively analyzed;the TCM syndrome types,syndrome elements,tongue and pulse manifestations were assessed;and the syndrome distribution in different disease courses and ages was analyzed.Logistic regression analysis was used to analyze the correlation between TCM syndromes and MACCE.Results There were 19 TCM syndromes in 965 T2 DM-SAP patients,and the top three frequent syndromes were qi deficiency and blood stasis(n=229),qi and yin deficiency with blood stasis(n=194),and binding of phlegm and blood stasis(n=119).Eight shared disease location-related syndrome elements were remained,of which heart vessels(n=485),heart(n=211)and spleen(n=178)were in majority.There are 13 disease nature-related syndrome elements,mainly including blood stasis(n=649),qi deficiency(n=448)and phlegm turbid(n=299).The tongue body was often dusky(n=598)and red(n=519),and the tongue coating was white(n=496)and greasy(n=412);the pulse was often wiry(n=425),thready(n=354),and deep(n=294).Although there were differences between the patients with varied disease courses in the TCM syndrome distribution,the main symptoms of all disease courses were qi deficiency and blood stasis(24.2%,214/885).Regarding the TCM syndrome distributions in different ages,the group of patients aged>60 to 74 years accounted for the highest proportion(46.1%,239/965).There were 389 cases of MACCE.Logistic regression analysis showed that transient ischemic attack and re-admission due to angina pectoris were positively correlated to internal accumulation of damp-heat and blood stasis obstructing collaterals(OR=5.39,P=0.04);re-admission due to myocardial infarction,coronary revascularization,and rec

关 键 词：2型糖尿病 稳定型心绞痛 主要心脑血管不良事件 中医证候 真实世界研究 

分 类 号：R259[医药卫生—中西医结合]