| Objectives:To explore the tongue characteristics of the patients with Coronary Heart Disease(CHD)in stable period by observing the tongue picture and the objective description of instrument data.Methods:90 patients were included for a cross-sectional study by strict inclusion and exclusion screening criteria,who participated in the National key basic Research Program(973)(project number:2014cb542903)between October 2016 and February 2018.The study designed the information collection table of patients with CHD which includes patients’ basic information,disease diagnosis,symptom and signs,tongue image,pulse image,syndrome differentiation and so on.Meanwhile,DS01-G hand-held tongue diagnostic instrument produced by Shanghai daosheng medical technology co.,LTD was used to collect and analyze patients’ tongue images.The portable instrument for inspection of tongue analysis the patients’ tongue imagine with teeth marks,sharp edges red,moss color,crack,prick,weight,thickness of tongue coating,rot fur,greasy fur,peeling fur,tongue,petechiae,etc.On this basis,the tongue image discriminant questionnaire for patients with stable coronary heart disease was designed.Five TCM experts with rich clinical experience were invited to identify the twelve indexes of tongue imager and the dry and wet condition of tongue.Requirements:the same lingual photo is independently identified by two experts.For one item if the two experts have same opinion,it will be regarded as the final result of expert judgment.If two experts have different opinions on a certain item,a third expert is invited to make another judgment and enter the final result in accordance with the principle of "three choose two".If there are three different answers to the same question,consensus will be reached after careful discussion by experts as the final result.Data analysis methods:use the SPSS17.0 statistical software analyze the basic condition of the patients with CHD in stable period,basic tongue characteristics and tongue diagnosis instrument judgment results,expert judgment results,comparing the tongue diagnosis instrument and the result of expert judgment consistency.Results:1 General information1.1 Basic information of patientsThe basic condition of 90 patients with coronary heart disease in stable period:age 64.15 ± 13.46 years old;male 56 cases,female 34 cases;male age 61.82 ± 14.4,female 68.03 ±10.90,female significantly higher than male 89 cases,Hui nationality 1 case;Source:63 cases of Beijing first Integrated Chinese and Western Medicine Hospital,12 cases of Beijing Fengtai Integrated Chinese and Western Medicine Hospital,9 cases of Suixian Chinese Medicine Hospital,4 cases of Guanganmen Hospital of Chinese Academy of traditional Chinese Medicine,2 cases in Beijing Sanjianfang Community Health Service Center.1.2 Basic information of Experts:There are five experts,four with senior professional title and one with intermediate professional title,aged between 36 and 52 years old,with an average age of 46.4±7.44 years.2 Clinical syndrome differentiations of patients with CHDThe clinical TCM practitioners classified 90 patients with stable coronary artery disease,and the top five were 42 patients(46.67%)with dampness syndrome,40 patients(44.44%)with blood stasis syndrome,and 28 patients with sputum syndrome(31.11%),7 cases of kidney deficiency(7.78%),5 cases(5.56%)with yu febrile syndrome,5 cases with qi deficiency syndrome(5.56%)and 5 cases with heart and kidney Yang deficiency syndrome(5.56%).Regarding the signs/symptoms of dampness,there were 53 cases(58.89%)of puddles or slips and 46 cases(51.11%)of them.In terms of blood stasis symptoms/signs,there were 45 cases(50.00%)of dark lips or gingival palates,44 cases(48.89%)of thick bulging or varicose veins in the sublingual veins,or tongues in color cyanosis,magenta,cyanosis,and purpura,37 cases(41.11%)of purple or dark tongue,respectively.3.General characteristics of tongue image of patients with CHD3.1 Tongue image discrimination of the experts’ resultsExperts on the tongue of the 90 patients with coronary heart disease as the analysis of the general characteristics,the top five order from high to low is greasy moss,65 cases(72.22%),moderate tongue body wet 60 cases(66.67%),thin moss 59 patients(55.56%),50 cases(55.56%),reddish tongue crack tongue in 49 cases(54.44%).In terms of tongue color,there were 49 cases(54.44%)of pink tongues and 20 cases(22.22%)of red tongues;in terms of tongue shape,there were 50 cases(55.56%)of cracked tongue,47 cases(52.22%)of moderate tongue,42 cases(46.67%)of fat tongue,39 cases(43.33%)of teeth-marked tongues,and 33 cases of spotting tongue,respectively.(36.67%);in the color of tongue coating,50 cases(55.56%)were in white fur and 34 cases(37.78%)were yellow and white;in terms of thickness of tongue coating,59 cases(65.56%)were thin and 31 cases(34.44%)were thick;in terms of tongue-tied greasy rot,65 cases(72.22%)were greasy tongue fur and 19 cases(21.11%)were curdy fur;in terms of dryness and wetness on the tongue surface,more than 60 cases(66.67%)were dry and wet tongue,and 20 cases(22.22%)of dry tongue were dry.3.2 Tongue image discrimination of the instrument diagnosis resultsAmong the 90 patients with stable coronary artery disease,examination results showed that 71(78.89%)of the white moss,60(66.67%)of the greasy moss,and 58(64.44%)of the thin moss,Cracks in 50 cases(55.56%),tongue fat in 46 cases(51.11%)were ranked in the top five.In terms of tongue color,38 cases(42.22%)of pink tongue were distributed,followed by 35 cases(38.89%)of tongue,and 12 cases(13.33%)of pale tongue;in terms of tongue coating:71 cases(78.89%)were white moss,60 cases(66.67%)were greasy moss,and 58 cases(64.44%)were thin moss;in terms of tongue shape,there were 50 cases(55.56%)of cracks,46 cases(51.11%)of fat,43 cases(47.78%)of fat and moderate,41 cases of spotting(45.56%),respectively.3.3 features of different syndrome differentiation3.3.1 Phlegm dampness syndromesThere were 41 cases of stable coronary heart disease diagnosed as phlegm and dampness syndrome,28 cases(68.29%),28 cases(68.29%)and 25 cases(60.97%)of lichen were found in tongue elephant and tongue.In terms of tongue color,there were 18 cases of pale red tongue(43.90%)and 11 cases of red tongue(26.83%).In the aspect of tongue shape,there were more than 21 cases(51.22%)of cracked tongue.In the aspect of lichen quality,28 cases(68.29%)and 28 cases(68.29%)of lichen were more common.In terms of lichen quality,25 cases(60.97%)of white lichen and 13 cases(31.71%)of yellow and white lichen were more common.3.3.2 Blood stasis syndromesThere were 14 patients with stable coronary heart disease diagnosed with blood stasis syndrome,11 cases(78.57%)with lichen,10 cases(71.42%)with lichen,and 9 cases with lichen(64.28%)with tongue image.In terms of tongue color,8 cases(57.14%)and 3 cases(21.43%)were mostly seen with pale red tongue.In the aspect of tongue shape,10 cases(71.42%)and 9 cases(50.00%)of cracked tongue were more common.In the aspect of lichen quality,11 cases(78.57%)and 10 cases(71.42%)of lichen were more common.In terms of lichen color,7 cases(50.00%)of white lichen and 7 cases(50.00%)of yellow and white lichen were more common.3.3.3 Obstruction of phlegm and blood stasis syndromesThere were 20 cases of coronary heart disease diagnosed with phlegm and stasis syndrome,16 cases(80.00%)with lichen,15 cases(75.00%)with moderate dry and wet tongue,and 14 cases with pale red tongue(70.00%).In terms of tongue color,there were 14 cases of pale red tongue(70.00%)and 4 cases of red tongue(20.00%).In the aspect of tongue shape,there were 12 cases(60.00%)of cracked tongue and 11 cases(55.00%)of fat tongue.In terms of tongue coating,16 cases(80.00%),15 cases(75.00%),11 cases(55.00%),11 cases(55.00%)and 11 cases(55.00%)of white moss were more common.4 Man-machine comparison results4.1 Comparison of tongue recognition results of tongue recognition and tongue diagnosis between three groups of expertsThe consistency analysis between the judgment of the tongue diagnosis instrument and the experts showed that:the top five rankings of the discriminant results of the tongue diagnosis instrument and the expert-distinguishment rate were highest(PBT)(100%);spot(95.56%),weight(92.22%),borderline(90.00%),Sacrificial moss(71.11%),the lowest rate of the twelve items was the tongue color(44.44%).The top five rankings for the rate of coincidence between the tongue diagnosis results and the experts’ second-level discrimination results are stripped fur(95.56%),defective spots(93.33%),rotted moss(86.67%),tipped red(83.33%),Puncture(83.33%),tooth marks(83.33%),cracks(81.11%),and the minimum rate of match for the twelve items was tongue color(62.22%).The top five rankings in terms of the discriminant results of tongue diagnosis and experts’ comprehensive discriminating opinions were stripped fur(98.89%),defective spots(96.67%),sharp edges(87.78%),and decayed moss(85.56%),Thickness(83.33%),the lowest rate of the twelve items is the tongue color(52.22%).4.2 Consistency Comparison of Tongue Image Distinguishing Results of Experts and Tongue Diagnosis InstrumentsThe comparison of the Tongue diagnosis instrument and the expert Tongue image discriminant result showed that the tongue diagnosis,expert opinion,and the Kappa and P values were better in terms of tongue fatness,leanness and deafness,respectively(Kappa= 0.869,P<0.05),(Kappa=0.805,P<0.05).There was no significant difference in the diagnostic positive rate between the two methods(P>0.05).The Kappa and P values of tongue diagnosis,tongue color,tongue coating thickness,cracked tongue,point thorn tongue,decayed moss,and greasy moss in the tongue diagnosis and expert discriminative results are generally the same(Kappa=0.504,P<0.05),(Kappa=0.455,P<0.05),(Kappa=0.648,P<0.05),(Kappa=0.640,P<0.05),(Kappa=0.569,P<0.05),(Kappa=0.611,P<0.05),(Kappa=0.525,P<0.05).Among them,the positive rates of the two methods were statistically significant(P<0.05)in terms of moss color,thickness of tongue coating,spotting,and rot.The positive rate of tongue diagnosis on white fur(76.7%)was higher than that of expert(55.6%).The positive rate of yellow tongue(7.8%)was higher than that of expert(6.7%);the two methods have the same positive diagnostic rate for yellow-white and moss(15.6%).The diagnostic positive rate of thin tongue coating on tongue examination(62.2%)was lower than that of experts(65.6%);the positive rate of diagnosis on thin moss(3.3%)was higher than that of expert discrimination(0.0%);The diagnostic positive rate was equal(34.4%).The positive rate(46.7%)of the tongue diagnosis point of the tongue examination was higher than the expert judgment(34.4%).The tongue diagnosis rate of rot(30%)was higher than that of experts(17.8%).However,in terms of cracked tongue and greasy fur,there was no statistical difference in the positive rate of diagnosis between the two methods(P>0.05).In terms of red tongue and tongue color,tongue diagnosis and expert discriminant results were inconsistent.The Kappa and P values were(Kappa=0.000,P<0.05),(Kappa=0.332,P<0.05).The diagnostic positive rate of the method was statistically different(P<0.05).The rate of red tip positive diagnosis of tongue diagnosis(12.2%)was higher than that of expert judgment(0.00%).The positive rate of tongue diagnosis for pale red tongue(41.1%)was lower than expert discrimination(54.4%);the diagnostic positive rate of pale purple tongue(13.3%)was lower than expert discrimination(16.7%);The diagnostic positive rate of tongue(5.6%)was lower than that of expert judgement(22.2%);the positive rate of deep red tongue diagnosis(40.0%)was higher than that of expert judgement(6.7%).Conclusions:Tongue pictures of patients with coronary heart disease at stable stage have rules to follow.Understanding of the general features of tongue pictures of stable patients with coronary heart disease and its objective study can guide relevant scientific research and judge the characteristics of pathological changes、the severity of the disease and the prognosis and guide the clinical diagnosis and treatment of patients with coronary heart disease. |
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