胸痹心痛热毒血瘀证血管病变及相关特征分析  

Analysis of Vascular Lesions and Related Characteristics in Patients with Chest Qi-Blockage and Heart Pain of Heat-Toxin and Blood-Stasis Syndrome

作　　者：姚美丹 李雨 黄尉威 冼绍祥[2] 王卢曦 陈洁[2] YAO Mei-Dan;LI Yu;HUANG Wei-Wei;XIAN Shao-Xiang;WANG Lu-Xi;CHEN Jie(Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Huazhong University of Science and Technology Union Shenzhen Hospital,Shenzhen 518000 Guangdong,China)

机构地区：[1]广州中医药大学,广东广州510405 [2]广州中医药大学第一附属医院,广东广州510405 [3]华中科技大学协和深圳医院,广东深圳518000

出　　处：《广州中医药大学学报》2024年第2期263-271,共9页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:81973776);广州市市校(院)联合资助项目基础与应用基础研究项目(编号:202201020342);广州市科技局2022年重点研发项目(编号:2060404);深圳市医疗卫生三名工程项目(编号:SZZYSM202106006);国家中医临床研究基地建设项目(编号:国中医药科技函[2018]131号);冼绍祥全国名老中医药专家传承工作室项目[国中医药人教函(2022)75号]。

摘　　要：【目的】基于冠状动脉(简称冠脉)、颈动脉、心脏病变及其相关指标回顾性研究胸痹心痛患者热毒血瘀证血管及其相关因素的辨证特征。【方法】回顾性收集221例胸痹心痛患者,根据中医辨证分型情况将患者分为热毒血瘀证154例和非热毒血瘀证67例,进行人口学特征、心血管危险因素相关疾病、理化指标、冠脉Gensini评分、颈动脉超声、心脏超声等指标的采集。比较热毒血瘀证与非热毒血瘀证患者各项指标的差异,并采用Spearman或Pearson分析探讨胸痹心痛热毒血瘀证与冠脉、颈动脉病变及其相关指标的相关性。【结果】(1)人口学特征及相关疾病分析结果提示,与非热毒血瘀证相比,胸痹心痛热毒血瘀证患者以男性发病为主(P=0.001),吸烟史及不稳定型心绞痛(UA)、急性非ST段抬高型心肌梗死(NSTEMI)、急性ST段抬高型心肌梗死(STEMI)等冠心病类型的比例较高,且多合并血脂异常(P<0.01或P<0.001),而热毒血瘀证与非热毒血瘀证在合并其他疾病方面比较,差异均无统计学意义(P>0.05)。(2)理化指标分析结果提示,胸痹心痛热毒血瘀证患者的甘油三酯(TG)及肌酸激酶同工酶MB(CK-MB)较高,高密度脂蛋白胆固醇(HDL-C)较低,与非热毒血瘀证比较,差异均有统计学意义(P<0.01),而2组的糖化血红蛋白(HbA1c)、空腹血糖(FBG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、血清尿酸(UA)、同型半胱氨酸(Hcy)、B型钠尿肽(BNP)、体质量指数(BMI)比较,差异均无统计学意义(P>0.05)。(3)冠脉狭窄Gensini评分分析结果提示,热毒血瘀证患者的冠脉狭窄Gensini评分较非热毒血瘀证显著升高(P<0.01);且热毒血瘀证患者的冠脉狭窄以中重度为主,占54.55%(84/154),非热毒血瘀证患者以正常或轻度狭窄为主,占76.12%(51/67),差异有统计学意义(P<0.01)。(4)颈动脉斑块分析结果提示,与非热毒血瘀证比较,热毒血瘀证患者的左、右侧颈动脉内�Objective To retrospectively investigate the syndrome-identification characteristics of vascular lesions and related factors in patients with chest qi-blockage and heart pain of heat-toxin and blood-stasis syndrome based on the pathological changes in the coronary artery,carotid artery,and heart.Methods The clinical information of 221 patients with chest qi-blockage and heart pain was retrospectively collected.The patients were divided into Redu Xueyu group(154 cases with heat-toxin and blood-stasis syndrome)and non-Redu Xueyu group(67 cases without heat-toxin and blood-stasis syndrome).The clinical information included the demographic characteristics,cardiovascular risk factor-related diseases,physiochemical parameters,coronary artery Gensini scores,carotid ultrasonography,and cardiac ultrasonography.Differences of the indicators in patients with or without heat-toxin and blood-stasis syndrome were compared,and the correlation of chest qi-blockage and heart pain of heat-toxin and blood-stasis syndrome with the pathological changes in the coronary artery and carotid artery were analyzed by Spearman’s or Pearson’s analysis.Results(1)The analysis results for demographic characteristics and cardiovascular risk factor-related diseases suggested that compared with non-Redu Xueyu group,Redu Xueyu group were predominated by the male patients(P=0.001),with higher percentages of smoking history and coronary heart diseases such as unstable angina pectoris(UA),acute non-ST-segment elevation myocardial infarction(NSTEMI),and acute ST-segment elevation myocardial infarction(STEMI),and with a high incidence of the complication of dyslipidemia(P<0.01 or P<0.001).However,no statistically significant difference was found in the incidence of other diseases between Redu Xueyu group and non-Redu Xueyu group(P>0.05).(2)The analysis results for physicochemical indexes suggested that patients with chest qi-blockage and heart pain in Redu Xueyu group had higher triglyceride(TG)and creatine kinase MB isoenzyme(CK-MB)levels and lower

关 键 词：胸痹心痛 冠心病 热毒血瘀证 颈动脉斑块 GENSINI评分 相关性 

分 类 号：R256.22[医药卫生—中医内科学]