Coronary Heart Disease Syndrome Related Clinical Research Of The Characteristics And The Degree Of Coronary Lesions

BackgroundCoronary Heart Disease(CHD) is a common diseases with seriously harmful to health. Interventional diagnosis and treatment of CHD obtained growing attention in recent years, coronary angiography(CAG) is known as golden criterion of CHD diagnosis.Syndrome is the targetof syndrome differentiation in traditional Chinese medicine(TCM) and the basis of treatment determination.Study of syndrome help to improve the clinical level of prevention and treatment of CHD.In this study,we analysis characteristics of TCM syndromes on CHD patients,and study on the Correlation between TCM syndromes and degree of pathologic changes of the coronary artery(Gensini,number of stenosed coronary artery);use factor analysis for four clinics to summarize the factors to syndromes of CHD, and the relationship between syndrome elements and the extent of coronary artery disease.Method:(1) 502 cases underwent CAG in Chuiyangliu hospital and Dongfang hospital from Mar.2005-Mar.2009 with complete information.(2) Completed TCM symptoms collection within 48h after CAG which has been done by standard method,complete the relevant laboratories test before and after CAG within one week.Develop western medical diagnostic and TCM diagnosis with reference to the relevant standards.(3) Statistical methods:SPSS13.0 statistical software,Measurement data using t-test or analysis of variance,calculators information is chi-squaretest,grading information is rank sum test;To analysis the syndrome of CHD and Correlation with pathologic changes of the coronary artery,use Correlation Analysis of multivariate analysis including Binary Logistic Regression analysis,Liner Regression analysis,Multinominal Logstic Regression analysis; unsupervised data analysis using Factor analysis.Result:(1) Syndromes distribution of CHD:blood stasis syndrome(77.3%) and Qi deficiency syndrome(75.9%) are the most common Chinese medicine syndrome of CHD, followed by phlegm syndrome(42.7%),Yin deficiency syndrome(37.4%) and Yang deficiency syndrome(31.9%),Qi stagnation and cold are less(11.5%,10.1%);Kidney deficiency syndrome(74.3%) is most common in viscera deficiency syndrome,followed by deficiency of liver(50.9%),spleen deficiency(22.5%),stomach deficiency(20.1%),lung deficiency(13.5%).By chi-square test,Qi deficiency,the ratio of blood stasis,phlegm and cold in CHD group was significantly higher than non-CHD group.(2) The characteristics of syndromes combination:three syndromes combination are the most common both in TCM syndrome and viscera deficiency syndrome(42.2%,35.8%),followed by the two syndromes combination(28.7%,20.9%) and four syndromes combination(20.0%, 13.5%).The regulation of syndromes changing are as follows:Qi-deficiency and blood stasis syndrome are the basic combination,heart and kidney Qi deficiency are the basic combination of viscera deficiency syndrome,Qi-deficiency→Yang deficiency→cold is the changing axis of snydrome.(3) Syndrome factors of CHD:The result of Logistic Regression analysis indicates that blood stasis and Qi deficiency,phlegm(relative risk are 2.952 and 2.295,and 2.266 respectively) are important syndrome factors of CHD;patients with blood stasis,Qi deficiency,and phlegm has the tendency of suffering from CHD; kidney and heart deficiency syndromes patients has the tendency of suffering from CHD, (relative risk are 1.844 and 2.184).(4) Correlation between TCM syndromes and degree of pathologic changes of the coronary artery:The result of Linear Regression analysis show that cold,phlegm,blood stasis is correlated with the Gensini score(partial correlation coefficient are 0.219,0.164,0.159 respectively),the order of relevance is cold＞phlegm＞blood stasis.Through Multinominal Logstic Regression analysis,result indicates that phlegm,blood stasis,cold,Qi Deficiency syndromes are all positively related to the number of pathologic changes of the coronary artery associated:Comparing with non-lesion, correlation between single artery stenosis and syndrome have no significant;Blood stasis and Qi deficiency,phlegm related to dual-artery lesions,Probability of double artery stenosis of CAG result is the 3.057 times in patients with blood stasis than patient without blood stasis;2.912 times in patients with Qi deficiency than without Qi deficiency,2.119 times in patients with phlegm than without phlegm;Cold,phlegm and Qi deficiency associated with three artery stenosis.Comparing with non-lesion,Probability of three artery stenosis of CAG result is the 4.565 times in patients with cold snydrome than patient without cold snydrome;2.268 times in patients with phlegm than without phlegm;2.044 times in patients with Qi deficiency than without Qi deficiency.Furthermore,blood stasis syndrome associated with left main artery stenosis,risk of left main tenosis in patients with blood stasis syndrome is 2.3 times than patients without blood stasis syndrome.(5) Syptoms factor analysis:four-diagnositic information reducted to the 15 components,in which 7 components representated deficiency,4 components representated mixed syndrome of deficiency excessiveness,4 components representated syndrome of excessiveness;Factor analysis of syndrome Elements reducted to the 5 components,components 1,2 syndrome representated visceral deficiency,components 3,4,5 representated characteristic of syndrome,in accordance with the set and classification of syndromes.Gensini score is associated with the component 2 and component 5,representing the heart,kidney,liver deficiency and Yang deficiency and cold snydrome.Conclusion:(1) Qi deficiency and blood stasis is the basic TCM pathogenesis of CHD, syndrome characterized by deficiency as the virtual snydrome,visceral is the main syndrome,and Qi deficiency had the most common.(2) Qi deficiency,blood stasis,phlegm, heart and kidney Deficiency Syndromes are important influence factors of CHD,appearing these syndromes have the tendency of suffering frome CHD.(3) The syndromes of cold,phlegm,blood stasis and Qi deficiency associated with the degree of coronary artery disease,with appearance of syndromes,suggesting that the extent of coronary artery disease tends to serious,and reflects a trait of mixed syndrome of deficiency and excess.TCM syndrome barely contribute to single artery stenosis.However,phlegm,blood stasis,cold and Qi deficiency contribute to double-artery and triple artery stenosis comparing with non-stenosis.Blood stasis in patients with coronary heart disease had high-risk of left main artery coronary disease.(4) The trait and number of deficiency or excess components from four diagnostic information factor analysis indicate the trait of deficiency based in CHD,Qi deficiency is most frequently,visceral deficiency existed universally,the combination of four diagnostic information reflects the regulation of pathogenesis.Factor analysis of 13 syndrome elements reducted to five components,which matched the pre-designed structure.Syndrome components reflects the degree of coronary artery and Gensini score.The more seriously visceral efficiency,Yang deficiency and cold, degree of coronary artery disease tend to be serious.This result is consistent with the descriptive statistical analysis,and with coronary heart disease syndromes Logstic Regression analysis results,and further reflects the regularity of combination of syndromes. Factor analysis conclude the elements with internal association into certain components,the pathogenesis is one of the dominant factor in potential.