Chinese Medicine On Coronary Heart Disease At Different Stages Of Four Diagnostic Information And Objective Indicators Of Evolution

Purpose：Starting from syndrome characteristics of dynamic space-time, throughthe large sample and multi-center clinical expert questionnaires, we collectedfour diagnostic methods information and objective indicators of coronary heartdisease (CHD) in four phases that were early onset period, paroxysm period,remission period and recovery period.And then we can clear the coronary heartdisease (CHD) syndrome factors, syndrome features and the intrinsic combinationrules of syndromes in each phase,compare and verify the main syndrome factorsand characteristics in different statistical methods and To further explore thecorrelations of coronary heart disease (CHD) syndromes and objective indicatorsin the four stages.That may build and perfect the objective criteria of coronaryheart disease (CHD) disease-syndrome diagnosis.Material and method：On the earlier stage,we had done lots of basic work,suchlike using the TCM(Traditional Chinese Medicine) and western medicine clinicalguides and advices about coronary heart disease for diagnostic criteria.Afterthe foundation work we decide to make the the clinical expert questionnairebasing on large literature studies and experts’ advices, the theory of modernpsychological measurement, decision-making with structural ways and the scalestudy methods.The clinical expert questionnaire of coronary heart diseasesyndrome factors，syndrome features，syndrome pathology evolution rules wasdeveloped after three rounds Delphi method to modify, add, delete and adjustthe content of the questionnaire repeatedly, which in order to ensure the itemsand contents of questionnaire response clinical symptoms and signs of coronaryheart disease accurately. Before the large sample of clinical expertsinvestigation, we check and examine the questionnaire the reliability and validity, whose evaluated results were excellent, so we begin to do the surveyin many centers.At last,we collected1218qualified the clinical expertquestionnaires in total.The whole questionnaires consist of41hospitals on sixregions where were the Northeast (Shenyang), North of China (Beijing), Northwest(Lanzhou, Xining), Southeast (Guangzhou), Southwest (Chongqing), South of China(Shanghai). we use the computer equipment to establish the Access questionnairedatabase, input qualified questionnaire and second check,then establish theclinical expert questionnaire three-dimensional structured correlationdatabase.According to the clinical expert questionnaires of coronary heartdisease (CHD) syndrome factors，syndrome features，syndrome pathology evolutionrules,we got the four diagnostic methods information that included with cardinalsymptoms, secondary symptoms,other organs’ symptoms(spleen and stomach, liverand gallbladder, kidney and bladder,lung), tongue-appearances and colour offace), pulse condition,lab objective indicators(Electrocardiogram，X-ray ofheart，Color Vascular Ultrasonography of heart，Myocardial enzymology，Troponin，Coronary arteriography，Lipid，Blood viscosity raised) and other relevantfactors(inducing factors of coronary heart disease(CHD), change ofemotional,season of easy to fall ill). By means of SPSS16.0statistical software,we describe the coronary heart disease (CHD) four diagnostic methodsinformation,lab objective indicators and other relevant factors with frequencyand distribution in early onset period, paroxysm period, remission period andrecovery period.After factor analysis and Logistic regression analysis, we getthe the main syndrome factors, syndrome characteristics,the correlations andrisks between coronary heart disease (CHD) syndromes and objective laboratoryindexes, inducing factors, emotional factors, susceptible seasons in fourphases.Results：1. In early onset period, the highest frequency of occurrence is symptom variableof slight edema, that accounted for74.55%. The lowest is symptom variable of frequent asthma that accounted for20.11%. The thin white of tongue coating whoseaccounted for65.76%appears most among tongue and pulse variables, and deeppulse accounted for27.26%is the least. In paroxysm period, the highestfrequency of occurrence is symptom variable of chest tightness as smotheringor oppressed pain, that accounted for87.27%. The lowest is symptom variableof constipation that accounted for20.44%. The tongue purple or dark whoseaccounted for58.62%appears most among tongue and pulse variables, and stifftongue accounted for20.69%is the least. In remission period, the highestfrequency of occurrence is symptom variable of little chest pain, that accountedfor84.32%. The lowest is symptom variable of slight activities can feel shortof breath that accounted for20.28%. The thin white of tongue coating whoseaccounted for51.15%appears most among tongue and pulse variables, and weekpulse accounted for20.20%is the least. In recovery period, the highestfrequency of occurrence is symptom variable of dull pain on chest, that accountedfor81.03%. The lowest is symptom variable of epigastric pain that accountedfor20.44%. The thin white of tongue coating whose accounted for68.56%appearsmost among tongue and pulse variables, and Teeth marks tongue accounted for23.48%is the least.2.The highest frequency of occurrence about objective laboratory indicators:①Early onset period: ECG（Electrocardiogram）ST-T changed（48.77%），NormalX-ray performance（75.45%），No abnormal cardiac structure and blood flow(ColorVascular Ultrasonography)（58.70%），No change of myocardial enzymology（79.89%），No change of troponin（74.55%），CAG（Coronary arteriography) stenosis0-25%（47.87%）， TC (Total cholesterol) raised（83.83%），Triglycerides raised（90.72%），LDL-C（Low density lipoprotein cholesterol）raised（77.50%），HDL-C（High density lipoprotein cholesterol）raised（63.05%），Blood viscosity raised（67.98%）；②Paroxysm period: ECG（Electrocardiogram）ST-T changed（77.59%），Protruded aortic arch（47.13%），Decrease of left ventricular compliance(ColorVascular Ultrasonography)（70.69%），Multiples raised of myocardial enzymology（60.51%），Multiples raised of troponin（55.58%），CAG（Coronary arteriography) stenosis76-90%（48.85%），High TC (Total cholesterol)（79.39%），High triglycerides（86.12%），High LDL-C（Low density lipoprotein cholesterol）（73.32%），HighHDL-C（High density lipoprotein cholesterol）（59.93%），Blood viscosity raised（90.80%）；③Remission period: ECG（Electrocardiogram） ST-T changed（55.25%），Normal X-ray performance（51.81%），Decrease of left ventricular compliance(ColorVascular Ultrasonography)（65.85%），Myocardial enzymology mildly elevated（43.92%），No change of troponin（45.24%），CAG（Coronary arteriography) stenosis51-75%（44.33%），High TC (Total cholesterol)（79.72%），High triglycerides（88.10%），High LDL-C（Low density lipoprotein cholesterol）（74.14%），HighHDL-C（High density lipoprotein cholesterol）（61.74%），Blood viscosity raised（60.92%）；④Recovery period：ECG（Electrocardiogram） ST-T changed（42.45%），Normal X-ray performance（51.81%），Decrease of left ventricular compliance(ColorVascular Ultrasonography)（58.46%），No change of myocardial enzymology（77.09%），No change of troponin（76.03%），CAG（Coronary arteriography) stenosis26-50%（39.08%），TC (Total cholesterol)reduced （65.76%），Triglycerides reduced（72.25%），LDL-C（Low density lipoprotein cholesterol）reduced（62.48%），HDL-C（High density lipoprotein cholesterol） reduced（55.50%），No change ofblood viscosity（44.91%）.3.The highest frequency of occurrence about other relevant factors(inducingfactors of coronary heart disease(CHD), change of emotional,season of easy tofall ill):①Early onset period: Overwork（83.99%）,Anxiety（dysphoria）（60.76%）,Winter（81.86%）；②Paroxysm period: Overwork（83.58%）,Fear（66.58%），Winter（89.33%）；③Remission period: Overwork（77.50%），Anxiety（dysphoria）（51.31%）,Winter（59.03%）；④Recovery period：Overwork（79.89%），Melancholy（42.12%），Winter（57.64%）.4.Main syndrome factors of coronary heart disease in the four stages (early onsetperiod,paroxysm period,remission period and recovery period) are qi stagnation,cold pathogen, phlegm and fluid retention, static blood, phlegm and retainedfluid, blood stasis, deficiency of heart yang, deficiency of heart qi，deficiencyof heart yin，deficiency of lung qi，deficiency of spleen qi，deficiency of spleen yang，deficiency of kidney yang，deficiency of kidney yin.The locating syndromefactors are heart，liver，spleen，lung，kidney.5.In the early onset phase, the syndrome features of coronary heart disease (CHD)are heart pain with syndrome of qi stagnating in chest and syndrome of deficiencyof both qi and yin，the frequency of syndromes are50.19%and49.81%. In theparoxysm phase, the syndrome features of coronary heart disease (CHD) aresyndrome of qi stagnation and phlegm blockade，syndrome of debilitated heartyang，heart pain with syndrome of yang deficiency and cold congelation andsyndrome of static blood and yang debility，the frequency of syndromes are21.80%，47.33%，13.71%and16.42%.In the remission phase, the syndrome features ofcoronary heart disease (CHD) are syndrome of disharmony between liver and spleen，syndrome of yang deficiency of heart and kidney and syndrome of qi deficiencyof heart and lung，the frequency of syndromes are20.20%，19.25%and60.55%.In the recovery phase, the syndrome features of coronary heart disease (CHD)are syndrome of deficiency of heart qi，syndrome of yang deficiency and qistagnation and syndrome of deficiency of both qi and yin，the frequency ofsyndromes are23.93%，40.52%and35.55%.6.There are so many affecting factors in coronary heart disease (CHD) earlyperiod.They are Aortic valvular regurgitation(Color Vascular Ultrasonography)（OR=2.702）, Aortic valvular sclerosis(Color Vascular Ultrasonography)（OR=1.632），No change of blood viscosity（OR=1.304），Aortic calcification(ColorVascular Ultrasonography)（OR=0.751），CAG（Coronary arteriography) stenosis0-25%（OR=0.748），No change of HDL-C（High density lipoprotein cholesterol）（OR=0.657），Pulmonary valve regurgitation(Color Vascular Ultrasonography)（OR=0.268），Overwork（OR=1.675），Overeating greasy food（OR=1.567），Depression（OR=1.347），Engorgement（OR=0.699），Sad（OR=1.872），Others（OR=1.827），Worry too much（OR=1.524），Anxiety（dysphoria）（OR=1.446），Panic（OR=0.711），Long summer（OR=1.624）and Spring（OR=1.299）in syndrome of qi stagnating inchest.And Pulmonary valve regurgitation(Color Vascular Ultrasonography)（OR=3.728），No change of HDL-C（High density lipoprotein cholesterol） （OR=1.522），CAG（Coronary arteriography) stenosis0-25%（OR=1.336），Aorticcalcification(Color Vascular Ultrasonography)（OR=1.332），No change of bloodviscosity（OR=0.767），Aortic valvular sclerosis(Color Vascular Ultrasonography)（OR=0.613），Aortic valvular regurgitation(Color Vascular Ultrasonography)（OR=0.370），Engorgement（OR=1.43），Depression（OR=0.743），Overeating greasyfood（OR=0.638），Overwork（OR=0.597），Panic（OR=1.406），Anxiety（dysphoria）（OR=0.692），Worry too much（OR=0.656），Others（OR=0.547），Sad（OR=0.534），Spring（OR=0.77），Long summer（OR=0.616）are the affecting factors with syndromeof deficiency of both qi and yin.7. The affecting factors are different from four syndromes in paroxysm phase.X-ray Right atrium hypertrophy (RAH)（OR=4.436），Myocardial enzymology reduced（OR=3.788），Blood viscosity reduced（OR=2.396），High TC (Total cholesterol)（OR=1.898），No change of troponin（OR=1.763），No change of myocardial enzymology（OR=1.752），CAG（Coronary arteriography) stenosis51-75%（OR=1.523），Aorticvalvular regurgitation(Color Vascular Ultrasonography)（OR=0.649），ECG（Electrocardiogram）Q wave or QS wave（OR=0.473），X-ray right ventricularhypertrophy（OR=0.420），Intemperance（OR=0.687），Melancholy（OR=1.48），Panic（OR=0.519），Summer（OR=1.505）effect the syndrome of qi stagnation and phlegmblockade. CAG（Coronary arteriography) stenosis51-75%（OR=0.780），Normal X-rayperformance（OR=0.759），No change of troponin（OR=0.507），Myocardial enzymologyreduced（OR=0.472），Overwork（OR=1.405），Other emotional change（OR=0.148）effect syndrome of debilitated heart yang. Other CAG（Coronary arteriography)situations（OR=2.232），No abnormal cardiac structure and blood flow(ColorVascular Ultrasonography)（OR=2.129），CAG （Coronary arteriography) stenosis100%（OR=1.519），No change of blood viscosity（OR=0.461），Fat（OR=1.778），Overwork（OR=0.52），Other emotional change（OR=4.449），Spring（OR=0.716），Summer（OR=0.572）effect syndrome of yang deficiency and cold congelation. Rightventricular hypertrophy of color Doppler Ultrasound（OR=2.287），No change oftriglycerides(Color Vascular Ultrasonography)（OR=1.979）， ECG （Electrocardiogram）Q wave or QS wave（OR=1.397），Valvula tricuspidalis regurgitation(Color Vascular Ultrasonography)（OR=0.480），No abnormal cardiacstructure and blood flow(Color Vascular Ultrasonography)（OR=0.469），Triglycerides reduced（OR=0.392），Other CAG（Coronary arteriography) situations（OR=0.293），Other inducing factors（OR=0.311），Panic（OR=1.963），Worry toomuch（OR=0.64）effect syndrome of static blood and yang debility.8. The affecting factors are different from three syndromes in remission phase.High triglycerides （OR=1.829）， Mitral regurgitation(Color VascularUltrasonography)（OR=0.678），CAG（Coronary arteriography) stenosis0-25%（OR=0.646），X-ray left atrial enlargement（OR=0.600）effect syndrome ofdisharmony between liver and spleen. X-ray right ventricular hypertrophy（OR=0.395），Cold（OR=1.565），intemperance（OR=0.691） effect syndrome of yangdeficiency of heart and kidney. X-ray left atrial enlargement（OR=1.609），Troponin reduced（OR=1.467），ECG（Electrocardiogram） ST-T changed（OR=1.374），High triglycerides（OR=0.681）effect syndrome of qi deficiency of heart and lung.9. The affecting factors are different from three syndromes in remission phase.Left ventricular hypertrophy of color Doppler Ultrasound（OR=1.529），TC (Totalcholesterol) reduced（OR=0.705），No change of HDL-C（High density lipoproteincholesterol）（OR=0.668）effect syndrome of deficiency of heart qi. X-ray Rightatrium hypertrophy (RAH)（OR=3.933），Pulmonary valve regurgitation(ColorVascular Ultrasonography)（OR=0.350），Engorgement（OR=1.604），Frenzy（angry）（OR=0.719） effect syndrome of yang deficiency and qi stagnation. Multiplesraised of troponin（OR=2.710），ECG（Electrocardiogram）ST-T changed（OR=1.297），X-ray Left ventricular hypertrophy（OR=0.724），X-ray Right atrium hypertrophy(RAH)（OR=0.368）effect syndrome of deficiency of both qi and yin.Conclusion：1.According to factor analysis,we summarized the main syndrome factors ofcoronary heart disease (CHD).They are qi stagnation, cold pathogen, phlegm andfluid retention, static blood, deficiency of heart yang, deficiency of heartqi，deficiency of heart yin，deficiency of lung qi，deficiency of spleen qi， deficiency of spleen yang，deficiency of kidney yang，deficiency of kidneyyin.The locating syndrome factors are heart，liver，spleen，lung，kidney.2. Combining with factor analysis and Logistic regression analysis,we concludethe coronary heart disease (CHD) syndrome features that check the clusteringanalysis results and prove the consistency from the angle of methodology.Thatcan enrich and perfect the syndromes diagnosis research on coronary heart disease(CHD),make them normalization and standardization.The syndrome features aredifferent from each phase. In the early phase, the syndrome features are syndromeof qi stagnating in chest and syndrome of deficiency of both qi and yin. In theparoxysm phase, the syndrome features are syndrome of qi stagnation and phlegmblockade，syndrome of debilitated heart yang，syndrome of yang deficiency andcold congelation and syndrome of static blood and yang debility.In the remissionphase, the syndrome features are syndrome of disharmony between liver and spleen，syndrome of yang deficiency of heart and kidney and syndrome of qi deficiencyof heart and lung. In the recovery phase, the syndrome features are syndromeof deficiency of heart qi，syndrome of yang deficiency and qi stagnation andsyndrome of deficiency of both qi and yin.3. Coronary heart disease By means of factor analysis and Logistic regressionanalysis, we got major syndrome factors of coronary heart disease（CHD）andthe primary symptoms, secondary symptoms and accompanied symptoms about12syndromes in the four stages. And then, we established statistics models ofsymptoms related to syndromes. Also revealed the relevance and specificitybetween syndromes and syndromes of their primary symptoms, secondary symptomsand accompanied symptoms. From the perspective of methodology, we tested andverifyed that application of combining factor analysis and Logistic regressionanalysis were the effective method on the research of syndromes in TCM. Thatstructured and optimized the quantitative criteria of coronary heart disease（CHD）syndromes. It provided the basis for the standardization andobjectification research on binding of disease and syndrome diagnosis ofcoronary heart disease（CHD）. 4. According to establishing statistics models with coronary heart disease（CHD）syndromes, objective laboratory indexes and other relevant factors, we singledout the objective indexes and influencing factors that distinct specificallyfrom a unique syndrome. The systematic research and evaluation were objectivelaboratory indexes, the natural environment, modern change and psychologicalfactors up from qualitative and location research of coronary heart disease（CHD）syndromes. That reflected overall and synthetical thought and cognitiveviews with attaching great importance to the spiritual level and externalenvironment impact syndromes. From the above, it is beneficial tocomprehensively reveal the rules and essence of syndrome which is relativelystable and repeatable, and then promote the objectification development processof syndrome research on coronary heart disease（CHD）.