The Study On Traditional Chinese Medicine Syndromes Rule And Objectivity Around Percutaneous Coronary Intervention

Objective:To explore traditional Chinese medicine(TCM) syndromes distribution and changing rule around percutaneous coronary intervention(PCI),and influence of syndrome on account of PCI.To analyses correlation between TCM syndromes and risk factors for coronary heart disease(CHD),and coronary angiography results.Based on analysis of relationship between TCM syndromes and blood lipid,endothelin,C—reactive pretein,To explore correlation between TCM syndromes of CHD and Laboratory Indexes,such as blood lipid,endothelin, C—reactive pretein,etc,research relative standard TCM syndromes criterion around PCI.To raise therapeutic effect of TCM differentiation of symptoms and signs and treat CHD,promote research on TCM syndromes objectivity,develop TCM theoretical connotation of CHD.Methods:1 Literature researchSystematic Review ancient and contemporary literatures,to understand distribution characteristic about TCM syndromes of CHD,and research progression,Meta-analysis is used to assess the randomized controlled trials of TCM in preventing and treating restenosis after PCI.Clinical therapeutic effect on TCM in preventing and treating restenosis after PCI is analyzed, to provide evidence—based medicine proof for research TCM in preventing and treating restenosis after PCI,and provide evidence for clinical decision.2 Clinical Research445 patients of CHD were selected in the study by coronary angiography. In accordance with TCM differentiation of symptoms and signs criterion in 1990, CHD patients were differentiated for syndrome classification around PCI.TCM syndromes distribution and change rule around PCI were analyzed;Risk factor and coronary artery abnomal information of CHD patients were recorded.The correlation between risk factor and coronary angiography results and TCM symptoms were analyzed.Patients were to draw blood 5ml from vein on an empty stomach within admission 24h,In order to detect blood lipid,CRP,Big ET—1,NT—proBNP etc,and analyze relationship between macroscopic TCM syndromes and microcosmic indexes.Results:1 Literature researchReview ancient and contemporary literatures about CHD,we found it was short of unification specification and cognition although there was much TCM differentiation of Syndromes of CHD,thought existing various kinds of method and thinking of differentiation of syndromes of CHD is significant to clinical and research of CHD.28 literatures that coincide internalize specification TCM in preventing and treating restenosis after PCI was evaluated by the statistical software of RevMan 4.2 and meta—analysis method.The incidence rate of the treatment group is lower than the control group,and differences have statistics significance(P＜0.01).2 Clinical researchTCM syndromes of CHD were divided into 7 classfication by hierarchical Cluster,They are Qi deficiency syndrome,Yang asthenia syndrome,Yin deficiency syndrome,Qi stagnation syndrome,cold coagulation syndrome, blood stasis syndrome and phlegm—turbid syndrome.The most syndrome type are Qi deficiency syndrome,blood stasis syndrome and phlegm—turbid syndrome around PCI.Chest pain,chest distress,hesitant pulse had a significant decrease.Spiritlessness and weadness,anorexia,thready pulse had a significant increase after PCI.Qi deficiency syndrome increased.Blood stasis syndrome and phlegm—turbid syndrome decreased after PCI.In risk factor analysis,age is correlated with Qi deficiency syndrome and cold coagulation syndrome.Smoking was correlated with blood stasis syndrome and Qi stagnation syndrome.Diabetes was correlated with Qi deficiency syndrome and Yin deficiency syndrome.Hyperlipoidemia,BMI and greasiness diet were correlated with phlegm—turbid syndrome.In coronary artery abnormal changes analysis, coronary artery lesion number was correlated with Yin deficiency syndrome. Qi stagnation syndrome,blood stasis syndrome and phlegm—turbid syndrome. One—artery lesion was most existed in Qi stagnation syndrome.Multi—artery lesion constituted the majority in Yin deficiency syndrome,blood stasis syndrome and phlegm—turbid syndrome.Coronary artery stenosis degree was correlated with Qi deficiency syndrome,cold coagulation syndrome,Qi stagnation syndrome,blood stasis syndrome and phlegm—turbid syndrome. Slight—degree stenosis could be seen frequently in Qi stagnation syndrome. Serious—degree stenosis was commonly existed in Qi deficiency syndrome,cold coagulation syndrome,blood stasis syndrome and phlegm—turbid syndrome. Coronary artery stenosis type is correlated with blood stasis syndrome.Blood stasis syndrome have more B,C stenosis type,and less A stenosis type.Gensini score is correlated with Qi deficiency syndrome,Yang asthenia syndrome,cold coagulation syndrome,Qi stagnation syndrome and blood stasis syndrome. Gensini score of Qi stagnation syndrome was lower,Gensini score of Qi deficiency syndrome,Yang asthenia syndrome,cold coagulation syndrome,and blood stasis syndrome are higher.In relationship analysis between TCM syndromes and laboratory indexes,phlegm—turbid syndrome and blood stasis syndrome were markedly correlated with blood lipid,especially TC,TG and LDL. TC,TG and LDL level of phlegm—turbid syndrome and its complex symptoms were higher than those of non—phlegm—turbid syndrome.Except for Qi stagnation syndrome in sthenia syndrome,CRP,ESR level of blood stasis syndrome and phlegm—turbid syndrome had significant raise.CRP,ESR level of blood stasis, CRP,ESN level of their complex symptoms also had notable raised.Big ET—1 level of blood stasis syndrome and their complex symptoms had markedly increased.Blood stasis syndrome possibly had a relationship with Big ET—1.NT—proBNP level of Yang asthenia syndrome and cold coagulation syndrome had a significant raised.Yang asthenia syndrome and cold coagulation syndrome were possibly correlation with NT—proBNP.Conclusions:1 The Meta—Analysis to the total effect of the 28 study results was evaluated, TCM in preventing and treating restenosis and patients' angina pectoris recurrence rate after PCI could have certain therapeutic effect.2 Qi deficiency syndrome,blood stasis syndrome and phlegm—turbid syndrome were TCM syndromes of CHD could be seen frequently in clinic.In accordance with hierarchical cluster result,TCM syndromes of CHD are divided into 7 classfication:Qi deficiency syndrome,Yang asthenia syndrome,Yin deficiency syndrome,Qi stagnation syndrome,cold coagulation syndrome,blood stasis syndrome and phlegm—turbid syndrome.PCI could have a influence for TCM syndromes of CHD,Qi deficiency syndrome increase,blood stasis syndrome and phlegm—turbid syndrome decreased after PCI.Intervention of Qi deficiency syndrome,blood stasis syndrome and phlegm—turbid syndrome should be reinforced about TCM preventing and treating thinking around PCI.3 There was a correlation between TCM syndromes of CHD and risk factors. Preventing and treating risk factors of CHD should be done according to different risk factor of TCM syndromes.There was a correlation between TCM syndromes of CHD and CAG results,CAG indexes have a certain clinical value as assessment of TCM syndromes of CHD.4 Phlegm—turbid syndrome and blood stasis syndrome of CHD significantly correlated with blood lipid,blood stasis syndrome and phlegm—turbid syndrome correlated with CRP,ESR,blood stasis syndrome possibly had a relationship with Big ET—1,Yang asthenia syndrome and cold coagulation syndrome were possibly correlation with NT—proBNP,these laboratory indexes possibly are biochemistry material base of different TCM syndromes of CHD.