Study On The Clinical Diagnostic Criteria On Syndrome Of Heat Retention In Blood Vessels In Patients With Coronary Atherosclerotic Heart Disease

In recent years,on the basis of the traditional pathogenesis of phlegm heat,blood stasis heat,phlegm and blood stasis heat,according to the years of clinical research and exploration,professor Hu Jingqing innovated and put forward the concept of"heat retention in blood vessels",which was applied to the standardized diagnosis and treatment of heat related syndromes of cardio cerebrovascular diseases."Heat retention in blood vessels" refers to the adverse circulation process in which the pathogenic heat and blood stasis and other tangible things are concentrate and aggregate to resolve in the blood,cause and effect each other,and then accumulate heat,generate poison,develop symptoms and hurt the pulse.The main pathogenesis is that "pathogenic heat" and "blood stasis and phlegm dampness" and other tangible things in the blood beat each other,and the high incidence site is "blood vessel".More and more experts in the industry have come to know the syndrome of "heat retention in blood vessels".But at present,there is no clinical diagnostic standard of coronary heart disease with heat retention in blood vessels.Based on the theory and clinical basis,this study aims to establish the clinical diagnosis standard of coronary heart disease with heat retention in blood vessels,improve the diagnosis and treatment standardization of coronary heart disease with heat retention in blood vessels,and guide clinical application.1 ObjectiveObjective to deepen the theoretical research of coronary heart disease(CHD)with heat and blood stasis syndrome,and construct the clinical diagnostic criteria of CHD with heat retention in blood vessels.2 MethodsBy using the method of literature review,this paper analyzes the connotation,etiology and pathogenesis of coronary heart disease(CHD)with heat retention in blood vessels,and systematizes the diagnostic items of CHD with heat retention in blood vessels by using bibliometric method.The included items were determined by focus group discussion,and the weight of diagnostic items was determined by AHP questionnaire survey by means of expert meeting.Combined with expert discussion,the clinical diagnostic criteria of coronary heart disease with heat retention in blood vessels was determined.3 Results3.1 Study on the connotation of coronary heart disease with heat retention in blood vesselsAfter the accumulation of the previous theoretical and clinical basic research,professor Hu Jingqing proposed the pathogenesis hypothesis of "heat retention in blood vessels".The formation of heat retention is closely related to the heat evil and the tangible.The heat pathogenic factors in the hot knot blood vessels of coronary heart disease are mainly caused by phlegm damp and blood stasis.In addition,heat evil can also be derived from Yang Qi excess,five Chi extreme,yin deficiency heat,etc.Food accumulation,phlegm damp and blood stasis not only provide the place for attachment and aggregation of heat evil,but also accumulate heat,and then it can be difficult to solve with tangible things,and cause and effect each other.The main pathogenesis of the disease is that "heat evil" and "blood stasis,phlegm wet" and other tangible things in blood vessels are mutually linked,and the disease is located in"blood vein".Besides the characteristic symptoms of hot knot blood vessels,such as dry mouth and constipation,the symptoms of coronary heart disease itself,especially the symptoms of chest pain(depression)are obvious.Because the blood vessels of hot knot are the original concepts,we systematically collate the diagnostic standards of heat related syndromes of coronary heart disease to provide reference.The literature published in journals,international conferences,standards and achievements in China,such as CNKI and Wanfang Data knowledge service platform,were searched.17 diagnostic standards of coronary heart disease syndrome(including relevant documents of norms and guidelines)have been published.It is found that there are some problems in 17 criteria of TCM diagnosis of coronary heart disease,such as inconsistent symptom description,unknown primary and secondary diagnosis index,objective weight of diagnosis of various items,and the lack of standard terms.It can not guide the diagnosis of hot knot blood vessels syndrome of clinical coronary heart disease,thus affecting the application of the standard in clinical and scientific research.Therefore,it is urgent to establish the diagnostic standard of hot knot blood vessel syndrome in order to guide the clinical diagnosis and improve the clinical effect.3.2 Establishment of diagnostic item pool of coronary heart disease with heat retention in blood vesselsA total of 2485 clinical research papers on heat related syndromes of coronary heart disease published in CNKI,Wanfang Data knowledge service platform,CQVIP and CBM from 1980 to 2019 were searched.The clinical features of heat related syndromes of coronary heart disease were comprehensively analyzed.The main symptoms were chest pain(85.00%),chest tightness(80.00%),irritability(60.00%),dry mouth(55.00%),palpitation(55.00%),bitter mouth(45.00%),constipation(45.00%),shortness of breath(40.00%);the main tongue signs were red tongue(45.00%),purple tongue(35.00%),tongue ecchymosis(32.50%);the tongue coating was yellow(67.00%)50%),greasy moss(42.50%),and pulse conditions were mainly numeral pulse(47.50%),smooth pulse(45.00%)and string pulse(30.Through focus group discussion,12 items were finally determined:1.Chest pain(stuffy);2.Recent fluctuation(aggravation);3.Irritability;4.Palpitation;5.Constipation;6.Dry mouth;7.Bitter mouth;8.There are ecchymosis and ecchymosis on the tongue;9.The tongue is red and crimson;10.The tongue is yellow;11.Several pulse;12.Smooth pulse.3.3 Determination of diagnostic item weight and threshold value of coronary heart disease with heat retention in blood vesselsIn this study,the analytic hierarchy process(AHP)was used to design the questionnaire of clinical diagnosis items(clinical symptoms,tongue and pulse)of coronary heart disease with heat retention in blood vessels.The TCM clinical and heat syndrome related research experts were invited to fill in the AHP expert questionnaire designed by our research group to determine the weight of clinical diagnosis items of coronary heart disease with heat retention in blood vessels.The weight of symptoms was as follows:(1)red tongue syndrome>Hot tongue syndrome>blood stasis.In general,red and crimson tongue(0.1812),yellow fur(0.1762),ecchymosis and ecchymosis on tongue(0.1335),pulse counting(0.0897),chest pain(0.0637)and recent illness fluctuation(0.0597)accounted for 70.4%of the total weight of clinical diagnosis items of coronary heart disease with heat retention In blood vessels.They have important reference basis in the diagnosis of coronary heart disease with heat retention in blood vessels.After discussion,the items are adjusted locally,and the weighted items are divided into three levels:high,medium and low.High level weight:tongue ecchymosis,yellow fur,red tongue,chest pain(stuffy),recent fluctuations(aggravation).Middle weight:irritability,constipation,slippery pulse,several pulse.Low level weight:bitter mouth,dry mouth,palpitation.The established diagnostic criteria are shown in the table below.3.4 Cross sectional retrospective analysis based on clinical epidemiology of 7187 cases of coronary heart diseaseAfter the establishment of the standard,we used the cross-sectional survey data of patients with coronary heart disease collected in the national key basic research and development plan(973 Plan)to retrospectively analyze five groups of data(healthy people,metabolic syndrome,acute coronary syndrome,stable coronary heart disease and coronary heart disease heart failure)using the new standard.Among the included patients,6.8%of the healthy people were diagnosed as heat retention in blood vessels syndrome,the proportion of metabolic syndrome patients with total score diagnosed as heat retention in blood vessels syndrome was 18.75%.In the stable stage of coronary heart disease(CHD),756 patients were diagnosed as the syndrome of heat retention in blood vessels according to the clinical diagnostic criteria of CHD,with a total proportion of 28.99%.Among 663 patients with ACS,332 patients with total score≥ 10 were diagnosed by the diagnostic criteria of coronary heart disease with heat retention in blood vessels syndrome,and the proportion of patients diagnosed as coronary heart disease with blood stasis syndrome was as high as 50.08%.The total score of patients with coronary heart disease of heat retention in blood vessels and heart failure was 39.74%.Comparison of the data of the 5 groups revealed that the score of heat retention in blood vessels was significantly higher in patients with acute coronary syndrome(ACS),which also fully indicated the significant law of thermalization during the active phase of coronary heart disease machine.A nonparametric test was applied to the metered data among the 5 groups for pairwise comparisons,and all values were statistically different(P<0.01).4 ConclusionThis study takes the development of the diagnostic standard of coronary heart disease with heat retention in blood vessels as an example,and systematically shows the operation process of "Development and application specification of clinical diagnostic criteria for traditional Chinese medicine syndrome based on combination of disease and syndrome" established by our research group.At the same time,it provides standardized clinical diagnostic standard of coronary heart disease with heat retention in blood vessels for clinical and scientific researchers of traditional Chinese medicine,and provides reference for the research of syndrome standardization Strong reliability and practicability.