冠心病不同阶段临床特征与证素分布的回顾性横断面调查  

Retrospective cross-sectional survey of clinical characteristics and syndrome elements distribution at different stages of coronary heart disease

作　　者：钟森杰 赵新元 高翔 黄汝银 陈洁[1] 吴辉[1] 方红城 冼绍祥[1] ZHONG Sen-jie;ZHAO Xin-yuan;GAO Xiang;HUANG Ru-yin;CHEN Jie;WU Hui;FANG Hong-cheng;XIAN Shao-xiang(the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Postdoctoral Research Station of Guangzhou University of Chinese Medicine,Guangzhou 510006,China;Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine,Shenzhen 518104,China)

机构地区：[1]广州中医药大学第一附属医院,广东广州510405 [2]广州中医药大学博士后科研流动站,广东广州510006 [3]深圳市中西医结合医院,广东深圳518104

出　　处：《中国中药杂志》2024年第5期1406-1414,共9页China Journal of Chinese Materia Medica

基　　金：国家中医临床研究基地建设项目(国中医药科技函[2018]131号);冼绍祥岐黄学者工作室项目;广州市校(院)联合资助项目基础与应用基础研究项目(202201020342);广州市科技局2022年重点研发项目(2060404);深圳市“医疗卫生三名工程项目”(SZZYSM202106006)。

摘　　要：回顾性采集2022年1月—2023年3月在广州中医药大学第一附属医院、深圳市中西医结合医院诊疗的冠心病(CHD)患者临床资料,描述性分析人口学特征、临床症状与舌脉特征,χ2检验分析不同阶段的证素及证素组合分布差异,探讨CHD不同病理阶段的临床特征与证素规律。研究提取28条症状条目、10条舌象条目与7条脉象条目;归纳心、肺、肝、脾、肾5个主要病位,血瘀、痰湿、气滞、热(火)、水饮、气虚、阴虚、阳虚8个主要病性,凝练8种病性组合形式。证素分布的χ2检验结果示,肺、肝、脾、肾、血瘀、气滞、热(火)、水饮、气虚、阴虚、阳虚证素在CHD不同阶段的分布差异显著,肝、血瘀、热(火)、气滞证素在不稳定期占比最高,肺、脾、肾、水饮、气虚、阴虚、阳虚证素在终末期占比最高;气虚证素在经皮冠状动脉介入术(PCI)术后不同时间段的分布差异显著。证素组合的χ2检验结果示,单病位、多病位、单病性、双病性、多病性、单纯实证、虚实夹杂组合在CHD不同阶段的分布差异显著,单病位、单病性、单纯实证在稳定期占比最高,双病性在不稳定期占比最高,多病位、多病性、虚实夹杂在终末期占比最高。结果表明,稳定期痰瘀并重,不稳定期存在瘀毒致变的病理转折,PCI术后总体气虚加剧,终末期损及阴阳、水饮渐盛。CHD不同阶段的临床特征与证素分布存在显著差异,是以虚实消长、痰瘀共病为基本病机的病理过程。The clinical data of coronary heart disease(CHD)patients treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine and Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine from January 2022 to March 2023 were retrospectively collected.This study involved the descriptive analysis of demographic characteristics,clinical symptoms,and tongue and pulse features.Theχ2 test was conducted to analyze the distribution of syndrome elements and their combinations at different stages of CHD,so as to reveal the clinical characteristics and syndrome patterns at various pathological stages of CHD.This study extracted 28 symptom entries,10 tongue manifestation entries,and 7 pulse manifestation entries,summarized the 5 main disease loca-tions of the heart,lung,liver,spleen,and kidney,and the 8 main disease natures of blood stasis,phlegm turbidity,Qi stagnation,heat(fire),fluid retention,Qi deficiency,Yin deficiency,and Yang deficiency and 8 combinations of disease natures.Theχ2 test showed significant differences in the distribution of syndrome elements including the lung,liver,spleen,kidney,blood stasis,heat(fire),Qi stagnation,heat syndrome,water retention,Qi deficiency,Yin deficiency,and Yang deficiency between different disease stages.Specifically,the liver,blood stasis,heat(fire),and Qi stagnation accounted for the highest proportion during unstable stage,and the lung,spleen,kidney,water retention,Qi deficiency,Yin deficiency,and Yang deficiency accounted for the highest proportion at the end stage.The distribution of Qi deficiency varied in the different time periods after percutaneous coronary intervention(PCI).As shown by theχ2 test of the syndrome elements combination,the distribution of single disease location,multiple disease locations,single disease nature,double disease natures,multiple natures,excess syndrome,and mixture of deficiency and excess varied significantly at different stages of CHD.Specifically,single disease location,single disease nature,and excess syndro

关 键 词：冠心病 急性冠脉综合征 经皮冠状动脉介入术 慢性心力衰竭 证素 回顾性研究 

分 类 号：R259[医药卫生—中西医结合]