Study On The Distribution Of TCM Syndromes And Correlation With Physical And Chemical Indexes Of Stable Coronary Heart Disease In The Elderly

Objective: To observe the distribution of TCM syndrome types in elderly patients with stable coronary heart disease;to study the differences between physical and chemical indicators in the distribution of syndrome types;to find the risk factors affecting the distribution of syndrome types;to establish a discriminative model combining physical and chemical indicators with TCM syndrome types.Methods: A total of 152 inpatients were collected from February 2019 to December 2019 in the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine.The researchers used a unified questionnaire to collect clinical data of the study subjects.The data processing uses Excel to establish a database,and SPSS 21.0 is used for statistical analysis.General information is descriptive statistics.Differences in physical and chemical indicators between syndrome types are analyzed by analysis of variance and non-parametric tests.The analysis of risk factors affecting the distribution of TCM syndromes uses disordered multi-class logistic regression analysis.The discriminant model was established using Fisher discriminant analysis.Results:(1)The distribution of TCM syndromes in elderly patients with stable coronary heart disease is as follows: qi deficiency and blood stasis syndrome> syndrome of mutual obstruction of phlegm and blood stasis> heart and kidney yang deficiency syndrome>qi and yin deficiency syndrome> qi stagnation and blood stasis syndrome.(2)In the general data,there were significant differences in the distribution of syndrome types between age,sex,and body mass index(BMI)(P <0.05).Females are mainly syndrome of mutual obstruction of phlegm and blood stasis,followed by qi deficiency and blood stasis syndrome and qi and yin deficiency syndrome.Men are mainly heart and kidney yang deficiency syndrome,followed by qi deficiency and blood stasis syndrome and qi stagnation and blood stasis syndrome.Age showed the distribution trend of qi deficiency and blood stasis syndrome>syndrome of mutual obstruction of phlegm and blood stasis>qi and yin deficiency syndrome>qi stagnation and blood stasis syndrome>heart and kidney yang deficiency syndrome.The distribution of BMI is as follows:heart and kidney yang deficiency syndrome> syndrome of mutual obstruction of phlegm and blood stasis>qi stagnation and blood stasis syndrome> qi deficiency and blood stasis syndrome> qi and yin deficiency syndrome.(3)Physical and chemical indicators:There are differences in qi deficiency and blood stasis syndrome and qi and yin deficiency syndrome in high-density lipoprotein cholesterol(HDL-C)and D-dimer(P <0.05).Cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),HDL-C,fibrinogen(Fib),D-dimer,and thyroid stimulating hormone(TSH)are risk factors affecting their distribution.There are differences in qi deficiency and blood stasis syndrome and qi and yin deficiency syndrome in red blood cells(RBC),hematocrit(PCV),hemoglobin concentration(HB),TC,LDL-C,HDL-C,triglycerides(TG),and D-dimer(P <0.05).HB,TC,BNP,LDL-C,D-dimer,and thyroid stimulating hormone(TSH)are risk factors affecting the distribution of their syndrome types.There are differences in qi deficiency and blood stasis syndrome and qi stagnation and blood stasis syndrome in RBC,HB,PCV,D-dimer,and TSH(P <0.05).HB,TC,LDL-C,D-dimer,and TSH are risk factors affecting their syndrome distribution.There are differences in qi deficiency and blood stasis syndrome and heart and kidney yang deficiency syndrome in RBC,PCV,HB,TG,TC,LDL-C,D-dimer,and BNP(P <0.05).HB and BNP are the risk factors affecting the distribution of their syndrome types.There are differences in qi and yin deficiency syndrome and syndrome of mutual obstruction of phlegm and blood stasis in PCV,HB,TC,LDL-C,and HDL-C(P <0.05).BNP is a risk factor affecting its syndrome distribution.There are differences in qi and yin deficiency syndrome and qi stagnation and blood stasis syndrome in RBC,PCV,HB,and TC(P <0.05).Fibrinogen(FIB)and TSH are risk factors affecting their syndrome distribution.There are differences in qi and yin deficiency syndrome and heart and kidney yang deficiency syndrome in RBC,PCV,HB,and BNP(P <0.05).HB and BNP are the risk factors affecting the distribution of their syndrome types.There are differences in syndrome of mutual obstruction of phlegm and blood stasis and qi stagnation and blood stasis syndrome in HB,TC,HDL-C(P <0.05).No risk factors affecting the distribution of syndrome types were found.There are differences in syndrome of mutual obstruction of phlegm and blood stasis and heart and kidney yang deficiency syndrome in RBC,PCV,HB,TC,LDL-C,HDL-C,and BNP(P<0.05).No risk factors affecting the distribution of syndrome types were found.There are differences in qi stagnation and blood stasis syndrome and heart and kidney yang deficiency syndrome in TC,LDL-C,BNP,and TSH(P <0.05).TSH is a risk factor affecting its syndrome distribution.(4)A discriminant function formula combining physical and chemical indicators with TCM syndrome types was established through Fisher discriminant analysis.The training sample re-assessment method shows that the diagnostic accuracy rate of the syndromes in the sample is 79.7%.The diagnostic efficiency of the five groups of syndromes is> 0.5.Sensitivity:qi and yin deficiency syndrome(91.67%)>heart and kidney yang deficiency syndrome(90.47%)>qi stagnation and blood stasis syndrome(76.47%)>qi deficiency and blood stasis syndrome(74.19%)>syndrome of mutual obstruction of phlegm and blood stasis(60.71%).Specificity: qi deficiency and blood stasis syndrome(98.85%)>heart and kidney yang deficiency syndrom(96.91%)>qi stagnation and blood stasis syndrome(95.05%)>qi and yin deficiency syndrome(94.49%)>syndrome of mutual obstruction of phlegm and blood stasis(92.47%).Positive predictive value: qi deficiency and blood stasis syndrome(95.83%)>heart and kidney yang deficiency syndrome(86.36%)>qi and yin deficiency syndrome(73.33%)>qi stagnation and blood stasis syndrome(72.22%)>syndrome of mutual obstruction of phlegm and blood stasis(70.83%).Nnegative predictive value: heart and kidney yang deficiency syndrome(97.91%)>qi and yin deficiency syndrome(97.72%)>qi stagnation and blood stasis syndrome(96.00%)>syndrome of mutual obstruction of phlegm and blood stasis(91.49%),qi deficiency and blood stasis syndrome(91.49%).Youden index: heart and kidney yang deficiency syndrome(87.38%)>qi and yin deficiency syndrome(86.16%)>qi deficiency and blood stasis syndrome(73.04%)>qi stagnation and blood stasis syndrome(71.52%)>syndrome of mutual obstruction of phlegm and blood stasis(53.18%).Conclusions:(1)The distribution pattern of TCM syndromes of elderly patients with stable coronary heart disease presents a trend of qi deficiency and blood stasis syndrome>syndrome of mutual obstruction of phlegm and blood stasis>heart and kidney yang deficiency syndrome>qi and yin deficiency syndrome>qi stagnation and blood stasis syndrome.(2)In this study,there were significant differences in the distribution of syndrome types in the general data among age,sex and BMI.(3)Physical and chemical indexes of modern medicine: red blood cell count,hematocrit,hemoglobin concentration,triglyceride,cholesterol,ldl-c,hdl-c,fibrinogen,d-dimer,TSH and BNP showed significant differences in the distribution of TCM syndromes;Hemoglobin concentration,cholesterol,LDL-C,HDL-C,fibrinogen,D-dimer,TSH,and BNP are risk factors affecting the distribution of TCM syndrome types.(4)In this study,a Fisher discriminant model combining physical and chemical indicators of modern medicine with TCM syndrome types was established,which can provide a certain reference for clinical syndrome differentiation.