Study On The Correlation Between Tongue Image And Clinical Examination In Patients With Chronic Stable Coronary Heart Disease

This article includes two parts:literature survey and clinical investigation.First, literature survey:Tongue diagnosis of traditional Chinese medicine (TCM) is one of the characteristics of it. Nowadays, the tongue diagnosis in traditional Chinese medicine clinical effect is still to be reckoned with. Jingluokao once said:"the meridians of the heart contact to the root of tongue, the meridians of the spleen contact to the edge of tongue, hepatic meridians... collaterals on the tongue, kidney fluid runs to the end of tongue. The five viscera all contact to the tongue, especially for the heart". Through the contact of the meridians, the tongue gets in touch with most of the viscera. The Yellow Emperor’s Internal Classic proposed that:"the tongue is the sprout and window of the heart", "heart governs the blood ". The physiological and pathological changes of the heart can objectively and dramatically be reflected on the tongue. The location of coronary heart disease is heart, and is closely related to viscera such as liver, spleen and kidney. Its pathological change on the tongue is obvious and worth studying. In recent years, there is a lot of researches on the tongue manifestation of coronary heart disease (CHD). The traditional research is given priority to with subjective of traditional Chinese medicine research. While, researches on the relationship between tongue manifestation and laboratory report of CHD is little. Because of the difference of individual clinical experience and habits, the accuracy and objectivity of traditional research result will be affected to some extent. It is not convenient to extensive exchange of learning as well. The literature survey systematically discusses the basic content of tongue diagnosis, the relationship between tongue manifestation and qi-blood, objectification of tongue diagnosis, mechanism of tongue manifestation and research progress of tongue manifestation of stable CHD.Second, clinical research:Objective:Study the tongue manifestation in patients with coronary heart disease and their clinical indexes like Gensini score, LVEF, FMD, blood lipid, etc, so as to do some help to condition assessment and combination of traditional Chinese and western medicine treatment for CHD, and provide data and basis for the application of tongue diagnosis in CHD.Methods:150 patients with coronary angiography diagnosis of patients with chronic stable coronary heart disease were selected. We recorded their age, sex, smoking history, body mass index (BMI) and complications, and collect their tongue manifestation, Gensini score, LVEF, FMD and lipid levels and other clinical data. Finally, we analyze the tongue manifestation and the indexes of western medicine. Enter all data in Epidata and analyze them with SPSS 21.0.Results:In terms of tongue color,150 cases of patients with stable coronary heart disease (CHD) are divide into pale tongue group(47 cases (31.33%)), red tongue group(47 cases (31.33%)), pink tongue group(22 cases(14.67%)) and purple tongue group(34 cases (22.67%)). In terms of tongue fur texture, they are divided into thin tongue fur group (60 cases (40.00%)), thick greasy tongue fur group (33 cases (22.00%)), and less tongue fur group (57 cases (38.00%)). In terms of the tongue fur color, they are divided into white tongue fur group (121 cases (80.67%)) and yellow tongue fur group (29 cases (19.33%)).In terms of the tongue body size, they are divided into fat big tongue group (35 cases (23.33%)), thin tongue group (12 cases (8.00%)) and normal tongue body group (103 cases (68.67%)). Under each of these four conditions, general clinical data (age, BMI, smoking index) and coronary heart disease complications’population distribution has no obvious difference between each group.1. Gensini score in the purple tongue group is higher than that in the pale tongue group, pink tongue group and red tongue group. There is significant difference between purple tongue group and pale tongue, red tongue group and pink tongue group (P= 0.000, P= 0.000, P=0.000). Gensini score in the thick greasy tongue fur group is higher than that in the less tongue fur group, which is higher than that in the thin tongue fur group. Compared with the thin and little tongue fur groups, in the thick greasy tongue fur group, Gensini score significantly higher (P= 0.000, P=0.000). Compared with the thin tongue fur group, Gensini score in the less tongue fur group is obviously higher (P= 0.000). This study found no obvious relationship between the tongue fur color or tongue body size and Gensini score in patients with stable coronary heart disease.2. LVEF in the pink tongue group and red tongue group is higher than that in the pale tongue group, which is higher than that in the purple tongue group. The purple tongue group is significantly lower than that in the pink tongue group and the red tongue group (P=0.008, P= 0.013). LVEF in the thin tongue fur group is higher than that in the thick greasy tongue fur group, which is higher than that in the less tongue fur group. Compared with that in the thin tongue fur group, LVEF in the thick greasy tongue fur group and the little tongue fur group is significantly reduced (P= 0.006, P= 0.001). This study found no obvious relationship between the tongue fur color or tongue body size and LVEF in patients with stable coronary heart disease.3. FMD in the pink tongue group and red tongue group is higher than that in the pale tongue group, which is higher than that in the purple tongue group. In the purple tongue group, FMD is significantly lower than that in the pink tongue group and red tongue group (P= 0.000, P= 0.001). Compared with that in the red tongue group, FMD in the pale tongue group is also significantly reduced (P= 0.002). FMD in the thin tongue fur group is higher than that in the less tongue fur group, which is higher than that in the thick greasy tongue fur group. Compared with the thin tongue fur group, FMD in the thick greasy tongue fur group and the less tongue fur group is significantly decreased (P= 0.000, P= 0.001). This study found no obvious relationship between the tongue fur color or tongue body size and FMD in patients with stable coronary heart disease.4. Patients’ CHO, LDL-C and Apo-B levels in the pale tongue group are higher than that in the purple tongue group, which are higher than that in the pink tongue group and red tongue group. Compared with the red tongue group and the pink tongue group, CHO in the pale tongue group are significantly higher (P=0.000, P=0.000), so as that in the purple tongue group (P= 0.038, P= 0.001). Compared with the red tongue group and pink tongue group, LDL-C in the pale tongue group is significantly higher (P=0.001, P=0.000) and LDL-C in the purple tongue group is significantly higher as well (P= 0.005, P= 0.002). Compared with the red tongue group and pink tongue group, Apo-B in the pale tongue group is on the higher side (P= 0.002, P=0.001). CHO, LDL-C, APO-B level in the thick greasy tongue fur group is higher than that in the thin tongue fur group, which is higher than that in the less tongue fur group. Compared with the less tongue fur group, CHO in the thick greasy tongue fur group is obviously higher (P= 0.015). Compared with the thin tongue fur group and the less tongue fur group, LDL-C level in the thick greasy tongue fur group is obviously higher (P= 0.015, P= 0.009). This study found no obvious relationship between the tongue fur color or tongue body size and lipid levels in patients with stable coronary heart disease.5. Tongue color, tongue fur texture and quality check index correlation:Gensini score is significantly positively related to purple tongue and thick greasy tongue fur (P= 0.000, P= 0.000), significant negatively related to thin tongue fur (P= 0.000), negatively correlated with the pink tongue (P= 0.000). LVEF is positively related to thin tongue fur (P= 0.002), and weakly negatively correlated with purple tongue and thick greasy tongue fur (P= 0.026, P= 0.033). FMD is negatively related to purple tongue and thick greasy tongue fur (P= 0.000, P=0.001), and positively related to pink tongue (P= 0.000). CHO, LDL, Apo B are negative correlated with red tongue (P= 0.000, P= 0.000, P= 0.000), negatively related with the pink tongue (P= 0.000, P= 0.000, P= 0.004), positively related to pale tongue (P= 0.000, P= 0.001, P= 0.002), and weakly positively correlated with thick greasy tongue fur (P= 0.021, P = 0.014, P= 0.037).Conclusion:1. Normal size of red or pale tongue with thin white tongue fur or less tongue fur is more often seen in the tongue manifestations in patients with stable coronary heart disease.2. The patients with stable coronary heart disease with no obvious clinical symptoms or deficiency syndrome (mainly for qi and Yin deficiency syndrome) are in the majority.3. In the patients with stable coronary heart disease with purple tongue and thick greasy tongue fur, the condition of coronary lesions and endothelial function injury are heavier and the cardiac function is worse. Dyslipidemia is more apparent in pale tongue, purple tongue and thick greasy tongue fur group.