| Part ? Research on TCM Syndrome Types of Patients with Coronary Heart Disease Post Percutaneous Coronary Intervention in Guangdong Province Based on Data MiningObjectve:After studying the relevant literatures of TCM syndromes in patients with coronary heart disease after PCI in the past 30 years in Guangdong Province,the main syndrome types of patients with coronary heart disease after PCI in Guangdong Province were obtained.After discussion by the research group,the four TCM syndrome-specific TCM database was established.Summarized the literature-based study of the distribution of TCM syndromes in patients with coronary heart disease after PCI in Guangdong Province and the basis of TCM syndrome differentiation.Method:Computer programs were used to automatically search relevant databases,and at the same time,manual search methods were used to retrieve relevant literature published in 1988 to 2017 on post-PCI patients with coronary heart disease in Guangdong,through data mining,frequency analysis,and correlation.Analysis and other statistical research methods to analyze the distribution of TCM syndromes in patients with coronary heart disease after PCI in Guangdong Province and the criteria for the differentiation of TCM syndromes in the major regions of China,and summarize the main TCM syndromes in patients with coronary heart disease after PCI in Guangdong Province.Based on the establishment of the database of dialectical items for each major Chinese medicine syndrome.Result:From the retrieved 685 relevant target documents,there were 78 literatures that met the post-PCI study requirements for coronary heart disease in Guangdong.Literature studies show that there are 6 major TCM syndromes in patients with coronary heart disease after PCI in Guangdong Province with a TCM syndrome frequency of more than 5%.The syndrome differentiation of traditional Chinese medicine syndrome in patients with coronary heart disease after PCI in Guangdong:1.Qi deficiency and blood stasis syndrome differentiation items include:God fatigue or less God,sublingual varicose veins,purple black or purple lips,chest tightness pain,astringent,pale tongue,fine veins,pale or pale,voice weak,Self-sweat,obesity,shortness of breath or shortness of breath or short breath,poor white appetite;2.The phlegm and blood stasis syndrome dialect items include: slippery or greasy moss,slippery veins,obesity,tooth prints or fat on the tongue,sputum thin or more,chest pain,poor appetite,white moss,thick moss,White peony,sublingual varicose veins,purple black or black purple lips,pale tongue,lethargy,veins,yellow moss,dizziness;3.Hot toxic blood syndrome syndrome entries include: sublingual varicose veins,purple black or purple lips,red face,red tongue,voice sorghum,loose stools,dryness,or hyperactivity,thick moss,veins,yellow moss,Numerous veins,slippery or greasy moss,heat-phobic,chest tightness pain,jaundice,yellow urine,thick sputum,shortness of breath or shortness of breath or short breath,low or low respiration,smooth veins,abnormal tone;4.Differentiation items for qi stagnation and blood stasis syndrome include: sublingual varicose veins,purple black or purple lips,chest tightness,astringent,poor appetite,chord veins,palpitations,insomnia,veinlets,yellow moss,dry mouth or mouth pain,Vegetation,hyperthyroidism or irritability,thin moss,loose stools,dark complexion,pale tongue,shortness of breath or shortness of breath,or short-term,on behalf of the pulse;5.Qi and Yin deficiency syndrome entry include: chest tightness pain,Shenpi or Shaoshen,red tongue,small veins,flushing,night sweats,cracks in the tongue,pale tongue,dizziness,shortness of breath or shortness of breath,or shortness of breath,promote Pulses,little moss or no moss,nodules,veins,pinch marks or fat on the sides of the tongue,speechlessness,weakness,hyperactivity or irritability,sinking of the veins,light mouth,and few pulses;6.Diagnostic items for yang deficiency and blood stasis syndrome include:tight veins,pale complexion or pale,sublingual varicose veins,purple black or purple lips,dark complexion,pale skin,clear urine,white or greasy moss,chest tightness,Shenmai,fine veins,Huaimai,astringent veins,Xuanmai,stool clear,thick moss,pale tongue,shortness of breath,or shortness of breath,short-term,late-vein,cold extremities.Diagnostic criteria for TCM syndromes in patients with coronary heart disease after PCI in Guangdong Province:1.Qi deficiency and blood stasis syndrome Obesity of the patient,fatigue or lack of God,chest tightness,low voice,weakness,shortness of breath or shortness of breath,shortness of breath,spontaneous perspiration,anorexia,pale or pale,purple lips,pale tongue,sublingual veins,Purple black,white moss,pulse astringent.2.Turbid blood stasis Obesity,cough,sputum,sputum,sputum,sputum,thin or heavy sputum,chest tightness,dizziness,part of the state of lethargy,anorexia,purple lips,pale tongue,side teeth or fat,sublingual varicose veins,Purple black,thick white or creamy or yellow,pulse slippery.3.Hot toxic blood syndrome Patients with chest tightness and pain,hyperthyroidism or irritability,vocal hyperactivity,shortness of breath or shortness of breath,short breath,abnormal tone,fear of heat,vomiting jaundice,red complexion,dry stool,short urine,dark purple lips,red tongue,Sublingual varicose veins,purple black,thick yellow coating or creamy,slippery pulse or real.4.Qi stagnation and blood stasis Patients with chest tightness and pain,hyperactive or irritability,dull complexion,palpitations,shortness of breath or shortness of breath,shortness of breath,insomnia,dry mouth,pain,anorexia,purple lips,loose stools,pale tongue,sublingual varicose veins,Purple black,thin yellow fur,astringent or astringent.5.Qi and Yin deficiency Patients with chest tightness,dizziness,or lack of spirit,dizziness,flushing,night sweats,shortness of breath or shortness of breath,hyperthyroidism,irritability,weak voice,pale mouth,pale tongue or red or cracked tongue,and tooth marks Or fat,little or no moss,pulse or sub-generation or promotion or number.6.Yang deficiency blood stasis Patients with chest tightness,pale or pale or pale or dark,shortness of breath or shortness of breath,chills,cold extremities,cough,spit flu,white lips,purple lips,loose stools,long urine,pale tongue,Sublingual varicose veins,purple black,thick white coating or creamy,thin pulse or tight string or slow slippery.Conclusion:By studying the relevant literatures of TCM syndromes in patients with coronary heart disease after PCI in the past 30 years in Guangzhou,statistical research methods such as data mining,frequency analysis,and association analysis were used to summarize the main TCM syndromes in patients with coronary heart disease after PCI in Guangdong Province.,And form a database of dialectical entries for each TCM syndrome.Part ? Establishment of TCM Syndrome Standards for Patients with Coronary Heart Disease after PCI in Delphi Method in Guangdong ProvinceObjective:Based on the literature review of the TCM syndromes in the first part of patients with coronary artery disease in Guangdong in the first 30 years,Delphi method was used to conduct a two-round questionnaire survey among experts in Guangdong Province and summarized the experts' experience in the treatment of coronary heart disease patients after PCI in Guangdong Province.The distribution pattern of syndromes and the key points of syndrome differentiation of each major TCM syndrome type,after discussion by the research group,the final diagnosis of coronary heart disease in Guangdong patients with clinical syndromes of the main syndrome type,initially formed in patients with coronary artery disease in Guangdong after PCI TCM syndrome differentiation criteria.Method:Based on the literature review of the first part of the recent 30 years of PCI in patients with coronary artery disease in Guangdong Province,combined with the clinical path of chest pain,Chinese medicine diagnostics textbooks and related guidelines issued by the Department of Medical Affairs of the State Administration of Traditional Chinese Medicine,The research group discussed and formulated the Questionnaire for the TCM Syndrome Type Expert Consultation Questionnaire for Patients with Coronary Heart Disease after PCI in Guangdong Province.Delphi method was used to investigate the cardiovascular specialists in tertiary level A hospital in Guangdong province.Experts used coronary heart disease PCI in Guangdong province after the use of statistical methods such as full-ratio ratio,average number,coordination coefficient,grade sum and coefficient of variation.The distribution pattern of TCM syndromes and the contents of major syndrome-based syndrome differentiation items,and reached an evaluation consensus,and finally based on the size of the weight of syndrome differentiation,initially formed the syndrome differentiation criteria of major TCM syndromes in patients with coronary heart disease after PCI in Guangdong.Result:The research group selected 24 Chinese and Western medicine specialists for coronary heart disease in Guangdong and conducted two rounds of expert consultation questionnaires for Delphi.After statistical analysis,the two rounds of authority coefficients were all greater than 0.8,and the positive coefficients of both rounds were 100%.The authority and enthusiasm of the24 experts selected met the requirements of the task force.The coordination coefficient of the two rounds of Delphi's expert consultation questionnaire was: Qi Deficiency Blood Stasis Syndrome 0.240,0.289;Turbid turbid Blood Stasis Syndrome 0.417,0.409;Heat Toxic Blood Stasis Syndrome 0.418,0.230;Qi Stagnant Blood Stasis Syndrome 0.721,0.211;Qiyin Deficits 0.557,0.404;yang deficiency and blood stasis syndromes 0.623,0.270;reflecting the overall consistency of the expert group's assessment of the importance of the entire questionnaire project.Delphi method expert consultation questionnaire survey results suggest:1.The main TCM syndromes of patients with coronary heart disease after PCI in Guangdong Province are the same,which is the same as the first part of literature research findings.They are qi deficiency and blood stasis syndrome,turbid blood stasis syndrome,hot toxic blood stasis syndrome,and qi stagnation.Blood stasis syndrome,Qi and Yin deficiency syndrome,Yang deficiency and blood stasis syndrome;2.The distribution of preoperative syndromes in patients with coronary heart disease in Guangdong is: turbid blood stasis syndrome(25.40%),qi stagnation and blood stasis syndrome(20.44%),hot toxic blood stasis syndrome(17.66),and yang deficiency and blood stasis syndrome(15.48).%),Qi deficiency and blood stasis syndrome(14.48%),Qi and Yin deficiency syndrome(6.55%);3.Postoperative coronary heart disease in Guangdong patients after 2 years of syndrome distribution: turbid blood stasis syndrome(21.33%),qi stagnation and blood stasis syndrome(18.25%),Qi deficiency blood stasis syndrome(18.06%),hot toxic blood stasis syndrome(17.26%),Yang deficiency and blood stasis syndrome(14.48%),Qi and Yin deficiency syndrome(10.71%);4.The syndrome distribution of coronary heart disease in Guangdong after5 years of operation is: Qi deficiency and blood stasis syndrome(24.40%),qi stagnation and blood stasis syndrome(15.87%),turbid blood stasis syndrome(15.08%),and hot toxic blood stasis syndrome(15.08%),Qi and Yin Deficiency Syndrome(14.88%),Yang Deficiency Blood Stasis Syndrome(14.68%);5.Delphi method of expert consultation questionnaire differentiation criteria are as follows:1.Qi Deficiency Blood Stasis:Main symptoms: Shenpi or Shaoshen,sublingual varicose veins,purple black or black purple lips,pulse astringent,pale complexion or pale;secondary symptoms: chest tightness,pain,pale tongue,pulse fine,low voice,weakness,spontaneous perspiration,appetite Poor,white fur,obese,shortness of breath or shortness of breath or shortness of breath;2.Qi and Yin Deficiency:The main symptoms: chest tightness,night sweats,fatigue or lack of God,pale tongue;Secondary symptoms: pulse fineness,red tongue,shortness of breath or shortness of breath,shortness of breath,dizziness,cracks in the tongue,pulsation,little or no moss;3.Turbid blood stasis card:The main symptoms: slippery or greasy tongue sublingual varicose veins,purple black or purple lips,pulse slip,chest pain,white moss,obesity;Secondary symptoms: There are tooth marks or fat on the tongue,the sputum is thin or heavy,sleepiness,yellow moss,white sputum,thick moss,poor appetite,dizziness,pale tongue;4.Qi stagnation and blood stasis:The main symptoms: hyperthyroidism or irritability,sublingual varicose veins,purple or black purple lips,loose stools,chest tightness;Secondary symptoms: Xuanmai,astringent,pale tongue,knot veins,thin moss,dull complexion,shortness of breath or shortness of breath or short air,and pulse generation;5.Hot toxic blood card:The main symptoms: shortness of breath or shortness of breath or breath,sublingual varicose veins,purple black or purple lips,hyperthyroidism or irritability,red complexion,real pulse,red tongue;Secondary symptoms: voice sorghum,chest tightness,loose stools,yellow sputum,yellow urine,slippery or greasy moss,yellow moss,thick moss,heat,thick sputum,abnormal tone,low or low respiration;6.Yang deficiency blood stasis card:Main symptoms: pale tongue,sublingual varicose veins,purple black or purple lips,tight veins,pale skin,white or pale complexion,white fur;Second symptoms: chills,dull complexion,loose stools,string veins,slippery or greasy moss,chest pain,urine clear,thick moss,slippery veins,late pulse,cold extremities,astringent.Conclusion:1.According to the Delphi method,the main TCM syndromes in patients with coronary heart disease after coronary intervention in Guangdong were six.2.2.A preliminary diagnosis model of six major TCM syndrome types in patients with coronary heart disease after PCI in Guangdong region and the dialectical criteria for the weight of TCM syndrome differentiation items.3.Initially form the dialectical criteria for TCM syndromes in patients with coronary heart disease after PCI in Guangdong.Part ? Study on Distribution and Metastatic Patterns of Main TCM Syndromes in Patients with Coronary Heart Disease after PCI in Guangdong Province Objective:Based on the above diagnostic model,according to the previous database of the research group,a retrospective dialectical analysis was performed on the clinical cases from January 2010 to December 2013 at the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,and the preoperative coronary stenting for patients with coronary heart disease undergoing PCI in Guangdong Province was summarized.The composition ratio of TCM syndromes and TCM syndrome type transition matrix after 2 years and5 years after operation,and analysis of AMI group and non-TCM intervention group,respectively,to study the main TCM syndromes in patients with coronary heart disease after PCI in Guangdong Province.Distribution Law and TCM Syndrome Patterns.Method:1.By searching the archive database(previous topic data)of the Department of Cardiology,First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from January 2010 to December 2013,at three time points(preoperative and postoperative 2)Years and 5 years after surgery)follow-up and collect the case data;2.Using the previous literature and the Delphi method to study the results,re-unify the previous four diagnostic data for unified TCM syndrome differentiation;3.Distribution and outcome analysis of TCM syndromes in patients with coronary heart disease after PCI in all Guangdong provinces;4.According to the statistical analysis of clinical research,the distribution maps of different time nodes are depicted;5.Connect the lines of TCM syndromes that have undergone changes in TCM syndromes and statistics the transfer rate to form a transfer rate matrix,depicting the evolution pattern of syndromes.Result:1.The major TCM syndromes in patients with coronary artery disease after PCI in Guangdong preoperatively,postoperatively 2 years,and postoperative5 years are distributed as follows:1.Turbid blood stasis syndrome: all samples(28.97%,21.22%,17.41%);AMI subgroup(17.24%,16.82%,17.17%);no Chinese intervention subgroup(18.83%,12.62%,6.62%);2.Qi stagnation and blood stasis syndrome: All samples(27.93%,24.46%,20.73%);AMI subgroup(22.41%,27.10%,18.18%);no TCM intervention subgroup(13.64%,6.31%,2.09%);3.Heat-toxic blood stasis syndrome: All samples(20.34%,16.19%,12.11%);AMI subgroup(31.03%,28.04%,13.13%);no TCM intervention subgroup(30.52%,25.91%,19.16%);4.Qi deficiency and blood stasis syndrome: all samples(17.59%,24.2%,25.21%);AMI subgroup(9.48%,9.35%,26.26%);no intervention group of Chinese medicine(12.66%,13.62%,21.95%);5.Deficiency of both qi and yin: all samples(7.59%,7.91%,8.46%);AMI subgroup(5.17%,5.61%,9.09%);and no intervention group of Chinese medicine(10.06%,15.95%,22.65%);6.Yang deficiency and blood stasis syndrome: all samples(6.38%,10.25%,10.45%);AMI subgroup(6.90%,4.00%,12.12%);no Chinese intervention subgroup(8.77%,18.60%,24.04%);7.The sum of other types of syndromes: all samples(7.41%,6.65%,5.64%);AMI subgroup(7.76%,4.67%,4.04%);no intervention group of Chinese medicine(5.52%,6.98%,3.48%);2.The transfer rate of TCM syndromes before PCI,2 years after surgery,and 5 years after PCI in Guangdong patients with coronary heart disease are as follows:1.Whole sample: From preoperative to postoperative 2 years,TCM syndrome type shifts more than 10%: heat-toxic blood stasis syndrome to qi stagnation and blood stasis syndrome(10.17%),yang deficiency and blood stasis syndrome to qi deficiency and blood stasis.Certificate(18.92%).From 2 years after surgery to 5 years after surgery,more than 10% of the syndrome type metastases were: heat poison blood stasis blood stasis syndrome transferred to turbid blood stasis syndrome(10.00%),hot blood stasis blood stasis syndrome to gas The stagnation of blood stasis syndrome(11.11%),most of the remaining to maintain the original diagnosis(the lowest of the gas and yin deficiency syndrome to retain the original diagnosis of 66.67%);2.AMI subgroup: From preoperative to postoperative 2 years,the highest metastasis rate was blood stasis of blood stasis and blood stasis syndrome;from 2 years postoperatively to 5 years postoperatively,the highest metastatic rate was yang deficiency and blood stasis.The certificate turned muddy blood stasis card.3.No TCM Intervention Subgroup: From preoperative to postoperative 2 years,the highest rate of metastasis was qi stagnation,blood stasis syndrome,yang deficiency and blood stasis syndrome;from 2 years after operation to 5 years after surgery,the highest metastasis rate occurred.For qi stagnation and blood stasis syndrome,yang deficiency and blood stasis syndrome.Conclusion:1.Distribution of TCM syndromes in patients with coronary heart disease after PCI in Guangdong Province.The results of clinical studies are consistent with the results of literature studies and expert questionnaire surveys.It is proved that previous TCM syndromes based on coronary heart disease are inferred for traditional Chinese medicine after coronary artery disease PCI.The pattern of syndromes is of guiding significance,and the distribution of TCM syndromes in patients with coronary heart disease after PCI in Guangdong Province has its own regular characteristics;2.In the comparison of clinical TCM syndrome surveys with literature studies and expert questionnaire surveys,more preoperative distributions of TCM syndromes in patients with coronary heart disease after PCI in Guangdong province are biased towards the heat-toxic blood stasis syndrome;Less;the incidence of yang deficiency and blood stasis syndrome in patients with coronary heart disease after PCI in the postoperative period of 2 years is even lower;postoperative PCI in patients with coronary artery disease in Guangdong after 5 years is more likely to have qi deficiency and blood stasis syndrome.Qi stagnation and blood stasis syndrome,and Yang deficiency blood stasis syndrome,hot toxic blood stasis syndrome appear less;3.About half of the patients in coronary artery disease in Guangdong after clinical trials retained the original syndrome,and the rest mostly shifted from the empirical to the actual or inclusion of virtual syndromes;4.The distribution pattern of syndromes in patients with coronary artery disease after PCI in Guangdong area is significantly higher than that of the whole group.5.The distribution pattern of patients without coronary artery disease after PCI in Guangdong area showed a trend of shifting from an empirical to a virtual syndrome.Part ? Long-term follow-up results of PCI in patients with coronary heart disease after PCI in GuangdongObjective:Based on the above research data,we have a preliminary understanding of the characteristics of clinical syndrome differentiation and pattern of syndrome differentiation in patients with coronary heart disease after PCI in Guangdong Province.This section will investigate patients with coronary artery disease after PCI in Guangdong through retrospective investigation and analysis.The long-term follow-up situation evaluated the long-term clinical efficacy of TCM intervention in patients with coronary heart disease after PCI,and further discussed the clinical efficacy and safety of Qingreo Huoxue Decoction for such patients,providing a theoretical basis for the long-term treatment of coronary heart disease patients after PCI.in accordance with.Method:Based on the research data database of the research group,the data of patients with coronary artery disease after PCI from January 2010 to December2013 in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine were searched,and the information was searched through the outpatient computer and the outpatient visit.Follow-up telephone home visits were divided into traditional Chinese medicine + western medicine treatment group and simple western medicine treatment group according to the long-term treatment plan,and statistics were made on the occurrence of cardiovascular events within 5 years(such as recurrent myocardial infarction,re-admission,and re-PCI Hard end events such as conditions and deaths).Based on the use of traditional Chinese medicine in the long-term treatment process,they were divided into two groups,the Qingre Huoxue Decoction group and the non-Qingre Huoxue Decoction group.The occurrence of cardiovascular events within 5 years was further observed and compared,and the Qingre Huoxue Decoction was further evaluated in the treatment of coronary artery disease in Guangdong.The long-term clinical efficacy and safety of postoperative patients were followed up on December 31,2017.Result:1.The average follow-up time for patients with coronary heart disease after PCI in Guangdong was 4.01 years.The cumulative incidence of major cardiovascular events in the two groups was compared: There were 20 major cardiovascular events in the TCM+Western medicine group and 34 major cardiovascular events in the Western medicine group alone.There was no statistical difference between the two groups(p>0.05).The incidence of cumulative minor cardiovascular events in the two groups was compared: TCM and Western medicine groups had a total of 31 incidents of minor cardiovascular events,while the western medicine group had a total of52 minor incidents of cardiovascular events.The accumulation of traditional Chinese medicine + Western medicine group was compared with that of Western medicine group alone.The incidence of minor cardiovascular events was significantly reduced(p<0.05).The cumulative incidence of total cardiovascular events in the two groups was compared: Traditional Chinese medicine and Western medicine were superior to western medicine group(p<0.05).2.A total of 14 patients died during the observation period.Specifically,6 patients in the Chinese medicine + western medicine group died,and 8 patients in the western medicine group died.Compared with the death causes of Chinese medicine and Western medicine patients,patients in the Western medicine group died more from cardiac causes.This is also a better indication that Chinese medicine has an improved effect on the prognosis of patients with coronary heart disease after PCI,and it is even more certain.The clinical effect of traditional Chinese medicine.3.The clinical research part is a retrospective follow-up study,because the number of cases included is limited to the Guangdong region,and it is also single-centered into the observation,so the number of study patients is relatively small,in the clinical observation can be found if only a single cardiovascular Incidence of events,due to the small sample size and statistical constraints on data,after discussion by the research group,it was decided to compare the incidence of cumulative events between groups,so that the clinical results obtained are more in line with the actual situation in the clinic,hoping that in the future The study can be more complete.4.Follow-up results of clinical studies suggest that the cumulative incidence of major cardiovascular events,Chinese medicine + Western medicine group compared with Western medicine group were statistically different,suggesting that the treatment of coronary heart disease after PCI patients with major adverse cardiovascular events rate Lower.Specifically in the analysis of the occurrence of cardiovascular events,the Chinese medicine +Western medicine group was significantly better than the western medicine group in improving the recurrence of angina pectoris and reducing the rate of rehospitalization due to cardiovascular disease.In the subgroup analysis,the cumulative incidence of total cardiovascular events in the Qingre Huoxue Decoction group was significantly lower than that in the non-Qing group,which fully demonstrated that long-term use of detoxification and detoxification of traditional Chinese medicine can indeed improve the prognosis of patients with coronary artery disease after PCI in Guangdong Province.To a certain extent,the pathogenesis of coronary artery disease in patients with coronary heart disease is not changed in Guangdong Province.Therefore,attention should be paid to the heat-clearing,blood-activating and detoxifying methods when clinically treating such patients.We hope that the results of this study can provide reference for follow-up studies.If we can conduct multi-center,forward-looking,larger sample size studies,and further extend the clinical follow-up time,we can better and more objectively evaluate the integration of Chinese and Western medicine in Guangdong.Diagnosis and treatment of patients with coronary heart disease after PCI. |
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