冠脉血运重建术后患者中医证候特征及伴焦虑抑郁状态的危险因素分析  

Analysis of TCM syndromes and risk factors of anxiety and depression after coronary revascularization

作　　者：王帅[1,2] 何璠玙 李秋冶 宋筱靓[2] 郝文君[3] 王凤荣[2] Wang Shuai;He Fanyu;Li Qiuye;Song Xiaoliang;Hao Wenjun;Wang Fengrong(First Clinical College,Liaoning University of Traditional Chinese Medicine,Shenyang 110032,China;Department of Cardiovascular Medicine,Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Branch of National Clinical Research Center for Chinese Medicine Cardiology,Shenyang 110032,China;Department of Cardiovascular Medicine,the People's Hospital of Liaoning Province,Shenyang 110032,China)

机构地区：[1]辽宁中医药大学第一临床学院,沈阳110032 [2]辽宁中医药大学附属医院心血管科,国家中医心血管病临床医学研究中心分中心,沈阳110032 [3]辽宁省人民医院心血管科,沈阳110000

出　　处：《国际中医中药杂志》2023年第12期1490-1495,共6页International Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81874415);辽宁省中医药临床重点学(专)科服务能力建设项目(LNZYXZK201908);全国老中医药专家传承工作室建设项目(2022);国家中医药传承创新平台项目(2020);辽宁省自然科学基金项目(2023-MS-230);沈阳市科学技术计划项目(21-174-9-15)。

摘　　要：目的通过真实世界数据挖掘,分析探讨冠脉血运重建术后伴焦虑抑郁状态患者的中医证治规律及危险因素。方法多中心回顾性临床研究。利用冠脉病中西医诊疗随访协作平台系统,采集2018年9月-2019年12月辽宁中医药大学附属医院心血管科、辽宁省人民医院心血管科577例成功行经皮冠状动脉介入术患者的基线资料、中医证型及证素、冠脉造影及支架植入情况、相关疾病史、汉密尔顿焦虑及抑郁量表评分等数据,建立临床资料数据库。以电话与门诊访视相结合的方式进行随访,每3个月随访1次,共随访1年。结果入组577例患者,最终完成随访561例。①年龄分布:男性患者年龄为(61.80±11.00)岁、女性为(68.37±10.13)岁,两者比较差异无统计学意义(P>0.05),但男性发病年龄有早于女性的趋势。②中医证素分布:虚性证素中占比最高的为气虚(61.75%,176/285),其次为阴虚(28.77%,82/285);实性证素中占比最高的为血瘀(39.13%,108/276),其余依次有痰浊(36.23%,100/276)、气郁(20.29%,56/276)等。③中医证型分布:伴焦虑抑郁状态的患者中,频率高于10%的中医证型依次为痰瘀互结伴忧郁气结证、气虚血瘀证、心胆气虚证、气阴两虚兼血瘀证;不伴焦虑抑郁状态的患者中,频率高于10%的中医证型为心血瘀阻证、气虚血瘀证,其中伴焦虑抑郁状态的痰瘀互结伴忧郁气结证、心血瘀阻证患者与不伴有焦虑抑郁状态的患者比较,差异有统计学意义(χ2=12.07,P<0.01)。④相关性分析:支架植入数、LDL-C与焦虑抑郁状态呈正相关(r分别为0.107、0.118,P<0.05),尿酸呈负相关(r=-0.127,P=0.011)。多因素Cox比例风险回归分析显示,在治疗第6个月时,年龄[RR(95%CI)为1.052(1.012~1.094),P=0.010]、糖尿病[RR(95%CI)为4.561(1.028~20.238),P=0.046]是发生终点事件的独立危险因素。结论行冠脉血运重建术后患者年龄多集中在60~70岁,男性患者发病有早于女性趋�Objective To explore the TCM syndromes and risk factors of patients with anxiety and/or depression after coronary revascularization through real-world data mining based on the national pilot project of Chinese and Western medicine clinical collaboration for major difficult diseases;To provide clinical evidence and guide practice for the diagnosis and treatment of bicardiac diseases after coronary revascularization.Methods A retrospective multi-center clinical study was conducted.From September 2018 to December 2019,577 patients who underwent successful percutaneous coronary intervention in the Department of Cardiovascular Medicine of Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Department of Cardiovascular Medicine of the People's Hospital of Liaoning Province were enrolled using the collaborative platform system of TCM and Western Medicine Diagnosis and follow-up for coronary disease.Clinical data database was established.Baseline data,TCM syndrome types and elements,coronary angiography and stent implantation status,relevant disease history,Hamilton Anxiety and Depression Scale,etc.were collected.A combination of postoperative phone calls and outpatient visits was performed,with follow-up every 3 months for a total of 1 year.The TCM treatment patterns and risk factors of patients with anxiety and depression after coronary artery revascularization surgery were analyzed and explored.Results A total of 577 patients were enrolled and 561 patients were followed up.Age distribution:The age of males and females undergoing coronary revascularization due to ACS was(61.80±11.00)years and(68.37±10.13)years,with no statistical significance between groups(P>0.05),but the age of onset in males tended to be earlier than in females.The distribution pattern of TCM syndrome elements showed that the most deficiency syndrome elements were qi deficiency(61.75%,176/285),followed by yin deficiency(28.77%,82/285).The most common excessive symptom was blood stasis(39.13%,108/276),and the other syndromes

关 键 词：心脏病 冠脉血运重建术后 焦虑抑郁状态 证候特征 危险因素 

分 类 号：R259[医药卫生—中西医结合]