| This paper consists of two parts:literatures reviews and clinical study.Literatures reviews:In the first review, I comprehensively collected previous clinical studies about the relationship between Metabolic Syndrome(MS) and Cardiovascular Disease(CVD) on pathogenesis, prognosis and et al. I found that patients with MS were vulnerable to CVD, and the pathogeneses were mainly focused on central obesity, insulin resistance and inflammation. In addition, the components in MS such as Diabetes mellitus, hypertension, hyperlipoidemia also played positive effect on the onset and development of CVD in patients with MS. And genetic factors might be playing the similar positive effect too.In the second review, I summarized the studies on the TCM-syndrome characteristics of MS which demonstrated in the following three parts:the syndrome characteristics of MS, the syndrome characteristics of MS complicated by other diseases, the relationship between TCM-syndrome and some biochemical indicators in MS. I also discussed the advantages and insufficiency about recent researches briefly.Clinical study:Objectives:To demonstrate the TCM-syndrome characteristics of stable Coronary Heart Disease(CHD) complicated by MS. Try to find out the key syndromes vulnerable to Cardiovascular events in patients with CHD complicated by MS. Analyse the relationship among TCM-syndrome, high sensitivity C-reactive protein(hs-CRP), the components in MS and Cardiovascular events.Methods:Multicenter nested case-control method was used in this study, we enrolled1503patients in stable CHD from5hospitals. We followed up the patients in three time points (at intake, six months and one year) and collected necessary information according to handbook desiged in advance. Endpoints mainly focused on Cardiovascular events including cardiac death, non-fatality myocardial infarction, apoplexy, need Percutaneous coronary intervention(PCI) or Coronary artery bypass graft (CABG) ascribe to unstable angina pectoris, need hospitalization due to unstable angina pectoris. All patients were divided into two subgroups:one group was stable CHD complicated by MS and another group was stable CHD not complicated by MS. Descriptive analysis, single factor analysis and logistic regression analysis were applied in this study. TCM-syndrome characteristics of patients with stable CHD, TCM-syndrome characteristics of patients with stable CHD complicated by MS, relationship between TCM-syndrome and Cardiovascular events and relationship among biochemical indicators, TCM-syndrome and Cardiovascular events were analysed.Results:1. General information:1503patients with stable CHD were included, there were896patients (59.6%) complicated by MS and607patients (40.4%) without MS. In the group of stable CHD complicated by MS, the average age was (62.3±9.1) years old, including559males (62.4%) and337females (37.6%), and374patients (41.7%) with type2diabetes mellitus,633patients (70.6%) with hypertension,621patients (69.3%) with hyperlipidemia.2. TCM-syndrome characteristics:In patients with stable CHD,1233patients(82.0%) had Ben deficiency and Biao excess. The single syndromes were showed in descending order as following:blood stasis> phlegm turbidity>Qi deficiency> Yang deficiency> Yin deficiency>Qi stagnation> cold coagulation, and the proporation of patients with blood stasis, phlegm turbidity and Qi deficiency up to50%. Phlegm turbidity and blood stasis syndrome, Qi deficiency and blood stasis syndrome were two of the most common complex syndromes in our study. In summary, syndrome characteristics of patients with stable CHD complicated by MS were similar to patients with stable CHD with the same ratio tendency of single syndromes and key complex syndromes. However, Chi-square test showed that Qi deficiency syndrome(P=0.007), Qi deficiency and blood stasis syndrome(P=0.025) were more common in stable CHD complicated by MS.3. Cardiovascular events:①72patients(4.8%) had Cardiovascular events,48patients (5.4%) in the group of stable CHD complicated by MS and24patients(4.0%) in another group, the difference between the two groups had no statistical significance (Chi-square: P=0.211).②Single factor analysis indicated there were some relationships between the components in MS and Cardiovascular events on the patients with stable CHD:firstly, patients with FPG>5.6mmol/l might be vulnerable to Cardiovascular events (P=0.007); secondly, patients in TG>2.26mmol/l might have more chance for Cardiovascular events (P=0.040).③In patients with stable CHD complicated by MS, single factor analysis showed patient with Ben deficiency might have higher morbidity to Cardiovascular events(Chi-square:P=0.021); Logistic regression analysis indicated that patients with Yang deficiency and phlegm turbidity syndrome [P=0.002, OR=7.866,95%CI(2.168,28.542)] or Qi deficiency and blood stasis syndrome [P=0.008, OR=4.234,95%CI(1.456,12.314)] would have a higher risk on Cardiovascular events in one year; Chi-square test and Logistic regression showed that patients with hs-CRP≧3mmol/l might be a independent risk for Cardiovascular events[P=0.018, OR=2.077,95%CI(1.136,3.797)]; when hs-CRP≧3mmol/l, most patients without Yang deficiency syndrome(P=0.012), Qi stagnation and Yang deficiency syndrome (P=0.006), Qi stagnation and Yin deficiency syndrome (P=0.039)4. Conclusion:①The TCM-syndrome characteristics of patients with stable CHD complicated by MS were Ben deficiency and Biao excess; blood stasis, phlegm turbidity, Qi deficiency were the key single syndromes; phlegm turbidity and blood stasis syndrome, Qi deficiency and blood stasis syndrome were mainly complex syndromes in these patients. Compared with stable CHD did not complicated by MS, Qi deficiency syndrome, Qi deficiency and blood stasis syndrome were more common syndromes in stable CHD complicated by MS.②In the morbidity of Cardiovascular events in one year’s follow up, there was no significant difference between the two groups. However, patients with FPG≥5.6mmol/l or TG≥2.26mmol/l might have higher risk to Cardiovascular events.③In stable CHD complicated by MS, patients with Ben deficiency might be vulnerable to Cardiovascular events; further analysis indicated patients with Yang deficiency and phlegm turbidity syndrome or patients with Qi deficiency and blood stasis syndrome might have a higher risk on Cardiovascular events; the level of hs-CRP could predict the risk of Cardiovascular events; patients with Yang deficiency syndrome, Qi stagnation and Yang deficiency syndromes or Qi stagnation and Yin deficiency syndromes were less when hs-CRP≧3mmol/l. |
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