Vulnerability In Patients With Coronary Heart Disease Early Warning And Toxin Clinical Presentation Of The Study

As updating of atherosclerosis and coronary heart disease concept,it provides a good opportunity to innovate pathogenesis theory of coronary heart diease(CHD).In view of TCM,blood-stasis is considered as the basic pathogenesis of CHD, it penetrates from beginning to the end. While inflammatory reaction results in rupturing of vulnerable atherosclerotic plaque, such as vascular endothelial dysfunction of injury, tissue necrosis and migration and activation of inflammatory mediator. TCM views that it is close with the pathogenic toxin theory. According to the dangers and characteristics of acute cardiovascular events, a hypothesis of "blood-stasis& toxin causing catastrophe" was put forward by the research group in close connection with clinical practice. It provides a new way to innovate the treatment method, clear opportunity to intervene high-risk patients with CHD and improve prevention level.Vulnerable plaque is the main reason of leading to acute cardiovascular events (ACE). However, with the further study, we find that the plaque which causes cardiovascular event is not always vulnerable plaque, it may be concerned with the whole systemic factors, so it could be better to name them as vulnerable patient better. We should further optimize the assessment of cardiovascular risk programs and intervene vulnerable patients earlier, in order to lower the occurrence of ACE. Combined of ACE follow-up, we use prospective study and clinical epidemiological methods to analyze the clinical data collected from stable patients of CHD, the data including past history, characteristic of onset, symptoms, TCM syndrome-differentiation, examination, drugs therapy and intervention therapeutic method is discussed,based on which to build the early warning model for vulnerable patients.Then the model is applied to verify the effectiveness by the method of ROC curves, and the result will be probed into the clinical manifestation of blood-stasis& toxin in the accepts of macro and micro characteristics.Syndrome of TCM is the external representation of the interaction between the individual patients, disease, social and psychological factors.It is very important to build early-warning system based on the overall and systemic concept. In the process of the disease, syndrome is changed along with Xie Zheng, and it leads the diagnosis and treatment changing. Therefore, the study of the evolution of syndrome is the most critical and core in the syndrome research. We decide to explore applications MDR (multi-factor dimensionality reduction) data mining methodology to analyze the syndrome evolution of the stable CHD patients with ACE, and try to find which syndrome easily triggering ACE in the near future, the result will be probed into the clinical manifestation of blood-stasis& toxin in the acceptance of the dynamic characterization.Clinical studyⅠ:Building early warning model for vulnerable patient of CHDObjective:To build early warning model for vulnerable patient of CHD, and it is applied to verify the effectiveness by the method of ROC curveMethod:From September 2007 to March 2010,397 stable CHD cases finished one year follow-up in China-Japan Friendship Hospital are enrolled, combined with ACE follow-up one year,the clinical data collected are analyzed.Results:Among 397 stable CHD patients, cases with the stroke-history is 59 patients, while 11 cases(18.6%) with ACE, there was significant difference between ACE and non-ACE (P=0.043);the patients who lacking physical exercises are 58 cases,while 12 cases with ACE(20.7%),there was significant difference between ACE and non-ACE groups (P=0.015);Concerning biochemical examinations, we stratify them into two levels, the results show that hs-CRP>lmg/L,ApoA1＜1.1g/L are more frequent in patients with ACE (P=0.005,P=0.015); From the characteristic of angina pectoris, we find that spontaneous angina,colic,the painful location in back are more frequent in patients with ACE(P=0.009,0.017,0.011);Symptoms, including suffocating and halitosis, are significant difference between two groups(P=0.011,0.039).By binary Logistic regression,the results show that the stroke-history,physical exercises,ApoAl,hs-CRP,suffocating are significant differenence between two groups (respectively, P＜0.05). Lack of physical exercises, ApoA1 show protective trends for ACE (OR=0.376,0.459),while combining stroke history, hs-CRP, suffocating appear predictive trends to ACE (OR=2.479,2.405,2.218).The other factors, including halitosis,spontaneous angina,colic,the location of angina pectoris in back, are not related to the risk of ACE (P>0.05)Early warning model:Logit(p)=-2.319-0.779ApoAl-0.978 physical exercises +0.908 stroke-history+0.877hs-CRP+0.797 suffocating.Then we apply the method of ROC curve to verify the effectiveness of the model, the results show that AUC=0.744, sensitivity=81.40%, specificity=62.20%, Youden index=0.436, positive likelihood=2.153, negative likelihood=0.29, positive predictive=0.218, negative predictive=0.964.Conclusion:Stroke-history,lack of physical exercises,suffocating which are probably the Clinical macro manifestation of "blood-stasis& toxin"; hs-CRP≥1mg/L and ApoA1＜1.1g/L are probably the Clinical micro manifestation of "blood-stasis& toxin". These conclusions need to be demonstrated by further study.Clinical studyⅡ:The syndrome distribution and dynamic evolution of stable CHD patients with ACEObjective:To analyze the syndrome distribution and dynamic evolution of stable CHD patients with ACE Method:303 cases finished 2-year follow-up are enrolled. According to the time of taking part in the research, the patients should finish the records of syndromes in half a year and one year, and the situations of events are recorded in 2-year follow-up. The patients with incomplete data and ACE happened within a year will be removed. First, we use frequency distribution method to analyze the characteristic of syndromes distribution; Then, we use MDR data mining methodology to analyze the syndrome change of the stable CHD patients with ACE.Results:Frequency distribution map shows that blood-stasis is the main syndrome of stable CHD patients. In the acceptance of excess, Qizhi syndrome and phlegm-cold (secondary phrase) show the same descending trends, but the blood-stasis and phlegm-heat show the different trends. Blood-stasis syndrome performs opposite direction of changing between two groups, and phlegm-heat shows gradually increasing trend in ACE group and first increasing then decreasing in the non-ACE group, the secondary phrase appears opposite changes. In the acceptance of deficiency, deficiency-yin and deficiency-qi show the same trends, while deficiency-yang performs opposite direction of changing. The results remind us that the blood-stasis, phlegm-heat and deficiency-yang may be the most important factors to lead ACE. Then we apply MDR data mining methodology to analyze the syndrome change of the stable CHD patients with ACE, The results show that the trends of deficiency-qi to phlegm-heat and deficiency-yang to phlegm-heat trigger ACE more easily. We find that the changes of blood-stasis with the course of disease, which is not the necessary condition for ACE, while the transformation from other syndromes to phlegm-heat is the pathogenesis hinge, these conclusions remind us that the accumulated heat is the key phenomenia to ACE, it needs further studies.Conclusion:The trends of syndrome from deficiency-qi to phlegm-heat and from deficiency-yang to phlegm-heat are probably the clinical dynamic manifestations of "blood-stasis& toxin".This conclusion is worth demonstrated by further studies.