Clinical Study On Hand Characteristics Of Qi Deficiency And Blood Stasis Syndrome In Coronary Heart Disease

Manual diagnosis has certain value in early warning and syndrome identification of Coronary Heart Disease(CHD),and has the characteristics of simplicity,convenience,simplicity and verification.On the basis of literature review and previous studies,it is clear that hand characteristics(hereinafter referred to as "hand signs")can reflect the severity and severity of cardiac lesions,and it is also believed that the importance of hand diagnosis in TCM syndrome differentiation and key elements of syndrome differentiation need to be further explored.Therefore,we carried out a series of studies focusing on hand diagnosis and CHD syndrome of qi deficiency and blood stasis.Firstly,a retrospective study was carried out based on previous data to analyze the feasibility of hand diagnosis in identifying qi deficiency and blood stasis syndrome of CHD.Secondly,the diagnostic model of Qi-deficiency and blood-stasis syndrome of CHD was constructed by combining the factors of hand sign and traditional syndrome differentiation,so as to clarify the importance of hand diagnosis in the identification of Qi-deficiency and blood-stasis syndrome of CHD,and to explore the hand characteristics of this syndrome to provide clinical reference.PurposeBased on the "three-dimensional hand inspection method" proposed by the tutor,this study explored the correlation between hand signs and the syndrome of qi deficiency and blood stasis in CHD,and constructed the syndrome diagnosis model of QI deficiency and blood stasis in CHD by integrating hand signs,so as to clarify the hand characteristics of qi deficiency and blood stasis in CHD,providing a scientific basis for the TCM syndrome diagnosis of CHD.Contents1.Based on the theoretical basis of hand diagnosis to identify CHD,the feasibility of hand diagnosis to identify CHD was preliminatively confirmed through clinical studies,and the causes of occurrence of qi deficiency and blood stasis syndrome of CHD were analyzed to provide theoretical basis for the establishment of syndrome diagnosis model.2.Based on the results of content 1 of the study,a diagnostic model of Qi-deficiency and blood-stasis syndrome of CHD was constructed to integrate the factors of chiral signs,so as to clarify the importance of hand diagnosis in the identification of Qi-deficiency and blood-stasis syndrome of CHD,providing key elements for the inclusion of chiral signs in the clinical syndrome differentiation index system.Methods1.Study on correlation between hand sign and Qi deficiency and blood stasis syndrome of CHDBasic information,physical data,past history,family history,personal life history and hand diagnosis data of outpatients and inpatients treated in Guang’anmen Hospital,Dongcheng Hospital and Beijing Anzhen Hospital from November 2020 to May 2021 were retrospectively selected.According to the diagnostic criteria of Qi deficiency and blood stasis syndrome of CHD,they were divided into CHD Qi deficiency and blood stasis syndrome group(observation group)and non-CHD group without obvious symptoms of Qi deficiency and blood stasis(control group),including 66 cases in the observation group and 65 cases in the control group.Statistical software SPSS 26.0 and R language(version 3.6.2)were used for descriptive statistical analysis of counting data based on frequency and frequency.Chi-square test and non-parametric test were used to screen the different handiwork between the observation group and the control group,and Logistic multi-factor regression was used to analyze the screened handiwork.Area under the ROC curve(AUC)was used to evaluate three different hand diagnosis methods.2.Construct the diagnostic model of qi deficiency and blood stasis syndrome of CHD combined with chiral signsPatients with CHD in out-patients and inpatients treated in Guang ’anmen Hospital,Dongcheng Hospital and Beijing Anzhen Hospital from June 2021 to October 2021 were selected.Firstly,the hand signs were collected and recorded according to the diagnostic criteria of hand diagnosis.Then,syndrome was determined by TCM syndrome score,and according to the results,they were divided into Qi deficiency and blood stasis syndrome group(observation group)and non-Qi deficiency and blood stasis syndrome group(control group),including 80 cases in the observation group and 87 cases in the control group.Chi-square test and nonparametric test were used to analyze the comparability of baseline data and the specificity of TCM symptom data,hand diagnosis data,face diagnosis data and tongue diagnosis data.Then,based on random forest algorithm,TCM symptom data,hand diagnosis data,face diagnosis data and tongue diagnosis data were used to construct the syndrome diagnosis model of Qi deficiency and blood stasis syndrome of CHD.Mean Decrease Gini method was used to analyze the influence degree of four kinds of data on the syndrome differentiation of Qi deficiency and blood stasis in CHD,and to clarify the importance of hand diagnosis in the identification of Qi deficiency and blood stasis in CHD.The syndrome diagnosis model constructed by random forest algorithm was evaluated by area under the ROC curve(AUC).Results1.Study on correlation between hand sign and Qi deficiency and blood stasis syndrome of CHD(1)Comparative analysis of the baseline data of the two groups:the baseline data of the two groups were balanced and comparable.In comparison of personal life history,the observation group was higher in smoking and addiction to salt than the control group,and less in physical activity standards than the control group,with statistical significance(P<0.05).(2)Comparative analysis of the chirality of the two groups:the chirality of the two groups had obvious specificity.Compared with the control group,the observation group had significantly more blue vein in thumb root,thenar blue vein,thenar morphology,thenar fold,thenar red,thenar red and palm red,and the difference was statistically significant(P<0.05).(3)Correlation analysis between the hand sign of both hands and the syndrome of qi deficiency and blood stasis of CHD:a multi-factor Logistic regression equation was established by including thenar morphology,blue vein of thumb root,thenar color,thenar fold,thenar blue vein,thenar color and palm color.The results showed that compared with the normal OR hypertrophic thenar group,the flattening OR depression of thenar could increase the risk of the occurrence of Qi deficiency and blood stasis syndrome of CHD,and the difference was statistically significant(OR=4.932,95%CI 0.002-6.010,P<0.05).Compared with the skin without green tendons and the skin with green tendons raised in thumb root,the skin without green tendons raised in thumb root increased the risk of the occurrence of Qi deficiency and blood stasis syndrome of CHD,and the difference was statistically significant(OR=1.356,95%CI 0.121-21.290,P<0.05).Compared with no OR longer than 3cm in thenar,if the length of thenar blue vein was less than 3cm,the risk of occurrence of Qi deficiency and blood stasis syndrome of CHD was increased,and the difference was statistically significant(OR=3.145,95%CI 0.066-18.320,P<0.05).(4)Comparison of accuracy of different hand diagnosis methods:ROC curve showed that the areas of single reference left hand,single reference right hand and double reference were 0.767,0.804 and 0.831,respectively,suggesting that the three methods have high identification value for THE syndrome of qi deficiency and blood stasis in CHD.Among them,the AUC value of the model in bimanual combination mode was the largest,indicating that bimanual combination has the best efficacy in predicting the syndrome of qi deficiency and blood stasis of CHD.2.Construct the diagnostic model of qi deficiency and blood stasis syndrome of CHD combined with chiral signs(1)Comparative analysis of the baseline data of the two groups:the baseline data of the two groups were balanced and comparable.In the comparison of TCM symptom data,there were statistically significant differences between the two groups in shortness of breath,fatigue,spontaneous sweating and sleeplessness.In comparison of hand diagnosis data,the observation group had more blue veins in thumb root,thenar blue veins,and thenar morphology non-filling(mostly flat grade Ⅰ,Ⅱ and depression grade Ⅱ)than the control group,which was basically consistent with the results in the first content of the study.In the comparison of face diagnosis data,the complexion of the group with qi deficiency and blood stasis was higher than that of the group without qi deficiency and blood stasis.In the comparison of tongue diagnosis data,the fat tongue body,purple tongue,blue and wide hypoglossal veins in the Qi deficiency and blood stasis syndrome group were significantly higher than those in the non-Qi deficiency and blood stasis syndrome group.(2)Random forest model results:The model of Qi deficiency and blood stasis syndrome of CHD had 86%Accuracy in training data,88%Specificity and 87%Sensitivity for whether CHD was Qi deficiency and blood stasis syndrome.The top 15 important factors of random forest screening are listed as follows:shortness of breath,sublingual vein blue,spontaneous sweating,fatigue,complexion blue,green tendons in thumb root,purple and dark tongue,purple and red lips,degree of depression in thenar,tiger mouth blue tendons,fat tongue,degree of flattening in thenar,chest tightness,and thenar blue tendons.Among them,the importance degree of blue vein in thumb root was the highest,and the degree of thenar depression and blue vein in tiger mouth were more important than fat tongue and chest tightness.(3)Evaluation of the random forest model:The test set was applied to test the random forest model,and its AUC value was 0.926,indicating that the prediction accuracy of the model was high,indicating that the chiral sign has high identification value for the syndrome of qi deficiency and blood stasis of CHD.ConclusionThis study confirmed that the results of this study are in line with clinical practice and have clinical application value and can be extended.1.Hand features can assist the identification of qi deficiency and blood stasis syndrome in coronary CHD.The factors of syndrome differentiation of qi deficiency and blood stasis in CHD include shortness of breath,sublingual vein blue,spontaneous sweating,fatigue,complexion blue,green tendons in thumb root,purple and dark tongue,purple and red lips,degree of depression in thenar,tiger mouth blue tendons,fat tongue,degree of flattening in thenar,chest tightness,and thenar blue tendons,these include five hand features.2.Hand diagnosis has similar value to traditional syndrome differentiation.The accuracy of the random forest model based on the combination of chiral and traditional syndrome differentiation data to the training data was as high as 86%,and the ROC curve test result of the random forest model was as high as 0.926,indicating that the prediction accuracy of the model was high.3.The method of hand diagnosis emphasizes the combination of both hands to reduce misjudgment and missed judgment.According to the ROC curve test results,it was found that compared with the left or right hand alone,the results of syndrome differentiation by the combination of two hands had more clinical reference significance.4.The results of the study on the hand characteristics of qi deficiency and blood stasis syndrome of CHD showed that:in terms of morphology,the depression and flattening of thenar had significance in guiding syndrome differentiation.In the aspect of collaterals,the presence of blue veins in thumb root,tiger mouth and thenar has the significance of guiding syndrome differentiation.