| Purpose:To reveal the regular pattern of coronary heart disease combimed diabetes at various stage from syndrome elements,syndrome characteristics.Furthermore,to explore the correlation between synedrome elements and objective indicators of coronary heart disease combined diabetes at various stage.By doing these,to standardize and improve the diagnosis criteria of coronary heart disease combined diabetes.Material and method: This study was conduted by using experts question survey.The clinical experts were selected according to a certain selection criteria and exclusion criteria.They all asked to fill the survey ‘experts' survey about syndromes elements,syndroms characteristics and pathogenesis evolution of coronary heart disease combined diabetes.The database has been established using the data information of 1,504 eligible questionaires from 51 hospitals of six rigions in China.There were 1,504 eligible questionnaires for the four diagnostic information and 867 elgible questionnaires for the physical and chemical indicators.The descriptive analysis,factor anlysis,logistic regression analysis of Chinese medicime four diagnostic and physical and chemical indicators of coronary heart disease combined diabetes were conducted by using the SPSS 17.0 statistical software(IBM SPSS Statistics 17)and Origin software(Origin Lab,Origin 8.6).Logistic regression analysis was used to study the correlation between TCM syndromes and clinical physicochemical indexes of coronary heart disease combined diabetes.Results: 1.During the early phase coronary heart disease and diabetes,the highest frequency of TCM four diagnostic was dry cough(56.91%),the lowest symptoms was hot flash night sweat(10.31%).The highest frequency was pale pink tongue(68.42%),and the lowest was moss-less moss or no moss(12.23%)among tongue diagnostic and pulse variable.During phase coronary heart disease combined diabetes,the highest frequency of TCM four diagnostic was dry eyes(63.03%),the lowest was facial pigmentation or stain(10.17%).The highest frequency was pulse slip(60.84%),and the lowest was purple tongue(10.70%)among tongue diagnostic and pulse variable.During chronic phase coronary heart diseasecombined diabetes,the highest frequency of TCM four diagnostic was visual fainting(55.19%),the lowest was dry mouth(10.04%).The highest frequency was pulse slip(60.84%),and the lowest was purple black vesicles(11.04%)among tongue diagnostic and pulse variable.2.During the early phase coronary heart disease and diabetes,patients had less than 7.0(79.70%)glycated hemoglobin,normal fasting blood insulin(76.70%),normal platelets(89.62%),microscopic examination of urine red blood cells negative(88.12%),normal alanine aminotransferase(90.31%),normal serum sodium(89.16%),normal plasma prothrombin time(88.24%),normal head CT(89.73%).During phase coronary heart disease combined diabetes,patients had 2 hours postprandial blood glucose greater than 11.1(82.35%),2 hours postprandial serum insulin decrease(78.43%),2 hours postprandial serum C-peptide(78.43%),normal neutrophils(669(77.16%),microscopic examination of urine red blood cells negative(68.40%),normal alanine aminotransferase(73.01%),normal serum chlorine(70.59%),normal thrombin rate(69.43%),ophthalmoscope abnormal,but no clinical significance(63.55%).During chronic phase coronary heart disease combined diabetes,patients had glycated hemoglobin greater than 7.0(89.16%),fasting serum C-peptide(80.05%),normal neutrophils(58.82%),microscopic urine white blood cells positive(60.44%),creatinine high(77.97%),normal serum sodium(43.25%),normal thrombin(46.14%),abnormal limb blood flow,but no clinical significance(66.44%).3.The main syndromes elements can be summarized as follows: yin deficiency,qi deficiency,qi stagnation,phlegm drinking,blood stasis,heat evil,etc.Among them,yin deficiency and qi deficiency were found throughout the disease;The disease location factors were related to the heart and spleen and related the kidney,liver and lung were different at different disease stage.4.Factor analysis and logistic regression analysis revealed the laws of the syndrome and syndrome inherent combination of coronary heart disease combined diabetes.(1)During the early phase coronary heart disease and diabetes,deficiency qi and blood are positively related to abdominal discomfort with fatigue(0.524,P=0.006,OR=1.448),sleep change with forgetfulness(0.855,P=0.036,OR=1.779),palliative(0.452,P=0.024,OR=1.677),ventricularemptiness(0.599,P=0.001,OR=1.634),sleep change follwed palpitations(0.416,P=0.008,OR=1.501)and negative correlated with tetanic fever foll insomnia(0.609,P=0.000,OR=0.546<1).There were positive correlation between yin deficiency syndrome and chest pain(0.662,P = 0.001,OR = 1.482),less sleepiness(0.585,P = 0.000,OR = 1.405),hand,foot and heart with fever(0.580,P = 0.000,OR = 3.164)and negative correlated with eyelid edema(0.556,P = 0.000,OR = 0.411 <1),and food intake increase(0.550,P = 0.000,OR = 0.606 <1).Temper stagnation syndrome were positive related with abdominal distension(0.619,P = 0.008,OR = 1.766),chest tightness such as paralysis or dyspnea(0.602,P = 0.000,OR = 3.273),abdominal discomfort with napping(0.818,P = 0.000,OR = 2.581),overweight(0.615,P = 0.017,OR = 1.586)and negative related with surface redness(0.434,P = 0.040,OR = 0.546 <1).There was a positive correlation between stagnation of blood stasis syndrome and chest pain(0.544,P=0.002,OR=1.748),anxiety(0.609,P=0.000,OR=2.009).(2)During coronary heart disease combined diabetes,Deficiency qi and yin were positive related with no appetite(0.626,P = 0.003,OR = 1.526),chest pain(0.524,P = 0.000,OR = 2.140),dryness of both eyes(0.410,P = 0.007,OR = 1.463),Body weight loss(0.666,P = 0.000,OR = 1.686),hand-foot-and-heart heat with fatigue(0.804,P = 0.000,OR = 1.995).There was a positive correlation with drinking water with thirst(0.715,P = 0.000,OR = 0.370 < 1),weight gain(0.651,P = 0.000,OR = 0.408 <1).Hot and humid knot card syndromes were positive related with chest tightness squatting or suffocation pain(0.581,P = 0.000,OR = 2.443),abdominal discomfort with hiccups or belching(0.437,P = 0.002,OR = 1.511),abdominal distension(0.526,P = 0.040,OR = 1.352),the mouth sticky(0.401,P = 0.000,OR = 2.425).There was a positive correlation between stagnation syndrome and chest tingling(0.633,P=0.002,OR=1.592),physical obesity(0.677,P=0.000,OR=1.372),subdiscipline(0.644,P=0.040,OR=1.984)bloating and nausea(0.412,P=0.037,OR=1.555).Deficiency of the spleen and kidney were positive related with the weakness of the waist and knee with low back pain(0.583,P=0.000,OR=2.545),chest pain(0.611,P=0.000,OR=2.056),abdominal discomfort and fatigue(0.461,P=0.000,OR =2.243)and drinking more urine more(0.560,P=0.007,OR=1.520).(3)During chronic phase coronary heart disease combined diabetes,there was a positive correlation between heart and spleen deficiency syndrome and chest pain(0.458,P=0.000,OR=1.757),palpitations with hand chest protection(0.416,P=0.037,OR=1.404),limb weakness(0.451,P=0.008,OR=1.347),abdominal discomfort with panevil(0.615,P=0.001,OR=1.432).Yang deficiency and blood stasis syndrome were positive related with chest tightness phlegm pain(0.838,P=0.000,OR=2.726),waist knee weak with low libido(0.540,P=0.003,OR=1.672),skin visible tinea versicolor spots(0.621,P=0.004,OR=1.666),drinking more urine more(0.425,P=0.008,OR=1.388),Pneumonia with lower extremity edema(0.524,P=0.000,OR=5.844),Skin ulceration for a long period of time(0.634,P=0.000,OR=1.717).Yin deficiency blood stasis syndrome were positive relative with dullness or disappearance(0.537,P = 0.028,OR = 1.420),] soreness and weakness of waist and knees with backache(0.434,P = 0.000,OR = 1.852),local skin color purple or dark red(0.592,P = 0.018,OR = 1.708),chest tingling(0.601,OR = 2.173,P = 0.000),hunger and unbearable susceptibility to hypoglycemia(0.696,OR = 2.185,P = 0.000)and visual fainting(0.484,P=0.005,OR=11.478)but negative related with cold extremities(0.427,P=0.001,OR=0.544<1).5.The correlation has been obtained between eleven clinical syndromes in three phase of coronary heart disease combined diabetes and physical and chemical indicators by using logistic regression analysis.(1)During coronary heart disease with diabetes in the early phase,deficiency of blood and qi were positive related with thrombocytopenia(P = 0.011,OR = 5.063),urinary ketone body(+)(P = 0.000,OR = 3.329),microscopic examination of urine red blood cells(P = 0.049,OR = 2.234)and serum albumin(P=0.043,OR=1.320)but negative correlation with serum potassium(P=0.037,OR=0.189<1).Syndrome of hyperactivity of fire due to deficiency of yin were positive related with urinary glucose(++)(P=0.007,OR=3.638),urine glucose(+++)(P=0.027,OR=6.087),microscopic examination with urine red blood cells(P=0.004,OR=1.254),elevated plasma total protein(P=0.032,OR=8.894),increased plasma prothrombin time(P=0.026,OR=1.147),urinary ketone body(++)(P=0.009,OR=1.130),urine ketone body(+++)(P=0.015,OR=1.096),urinary ketone(++++)(P=0.037,OR=1.010)while negatively correlated with decreased total protein(P=0.039,OR=0.225).Stagnation of qi and stagnation of phlegm were positively related with fasting serum C peptide(P=0.023,OR=1.914),fasting insulin(P=0.033,OR=2.998),elevated fibrinogen(P=0.033,OR=5.217)but negatively related with urinary glucose(++)(P=0.043,P=0.018).Blood stasis and blood stasis syndrome were positively correlated with postprandial after 2 hours serum insulin reduction(P=0.012,OR=6.328),while negatively related with urine protein(++)(P=0.027,0R=0.010)and urine ketone body(+)(P=0.012,P=0.176)and elevated uric acid(P=0.017,P=0.023).(2)Syndrome of deficiency of Qi and Yin were positively related with increased glycated hemoglobin(P=0.023,OR=1.220),microscopic examination urine with red blood cells(P=O.048,OR=1.759),decreased total blood protein(P=0.029,OR=2.429),decreased thrombin time(P=0.023,OR=3.507)while negatively related with decrease in glycated hemoglobin(P=0.002,OR=0.131)and abnormal ophthalmoscopy but not clinically significant(P=0.031,OR=0.559).Syndrome of damp heat internal syndrome were positively related with fasting serum C-peptide decreased(P=0.025,OR=3.536),urinary glucose(++++)(P=0.044,OR=1.152),and the activated partial thromboplastin time decreased(P=0.011,OR=3.050)and the decrease of thrombin time(P=0.006,OR=2.418).Stagnation of phlegm and stasis syndrome were positively correlated with 2 hours postprandial blood glucose(>11.1)(P=0.029,OR=1.049),urinary glucose(++++)(P=0.034,OR=6.897),plasma prothrombin time decreased(P=0.039,OR= 3.677)but negatively related with postprandial blood glucose(<7.8)(P=0.028,OR=0.063)and hemoglobin(60?hb<90)(P=0.027,OR=0.219).Two deficiency syndrome of spleen and kidney were positively related with 2 hours postprandial blood glucose(>11.1)(P=0.022,OR=2.006),fasting insulin decreased(P=0.024,OR=1.242),thrombin rate decreased(P=0.049,OR=1.253),fundoscopy abnormalities But no clinical significance(P=0.031,OR=1.559)while negatively correlated with 2 hours postprandial blood glucose(<7.8)(P=0.040,OR=0.018),urinary protein(+)(P=0.006,OR=0.398)and urine protein(++)(P=0.020,OR=0.316).(3)During chronic phase coronary heart disease combined diabetes,syndrome of yin deficiency and blood stasis were positively correlated with serum C-peptide decreased(P = 0.005,OR = 1.089),platelet elevation(P = 0.015,OR = 1.403),serum potassium elevation(P = 0.042,OR = 2.042),plasma thrombin time decreased(P = 0.016,OR = 3.351),the activated partial thromboplastin time decreased(P = 0.009,OR = 4.248),the head EMG abnormal and clinically significant(P = 0.020,OR = 1.357)and irror abnormalities and clinically significant(P = 0.012,OR = 2.650).Syndrome of yang deficiency and blood stasis were positively correlated with glycated hemoglobin(>7.0)(P=0.003,OR=7.320),ionized sodium decreased(P=0.033,OR=1.978),platelet elevation(P=0.037,OR=1.730),and reduced activation thromboplastin time(P=0.002,OR=2.680),limb blood flow abnormalities and clinically significant(P=0.027,OR=1.465)and renal ultrasound abnormalities and clinically significant(P=0.028,OR=1.640)while negatively correlated with increased fibrinogen time((P=0.048,OR=0.448).Syndrome of deficiency of both heart and spleen were positively related with hemoglobin(60 ? hb < 90)(P = 0.024,OR = 1.388),red blood cells decreased(P = 0.021,OR = 1.340),serum albumin decreased(P = 0.004,OR = 1.301),serum potassium decreased(P = 0.037,OR = 1.565)and head CT abnormaland clinically significant(P = 0.045,OR = 1.457).Conclusion: 1.The survey clinical experts based on geography is an important method for the study of coronary heart disease and diabetes.The descriptive analysis shows that the clinical expert questionnaire used in this study can fully reflect the closely related four diagnostic information and physical and chemical indicators to the disease.2.The main syndromes of coronary heart disease combined diabetes were summarized as following: Yin deficiency,qi deficiency,qi stagnation,phlegm drinking,blood stasis,and heat evil.The disease location were all related to the heart and spleen,involving the kidney,liver and lung etc.Syndrome features of coronary heart disease combined diabetes were revealed and validated.(1)During phase of coronary heart disease and diabetes early time,it manily showed hyperactivity of fire due to yin deficiency,deficiency of Qi and blood stasis,spleen stasis and obstruction of collaterals by blood stasis syndrome.(2)During phase coronary heart disease combined diabetes,it mainly demonstrated syndrome of deficiency of both qi and yin,syndrome of internal damp heat,syndrome of stagnation of phlegm and stasis and deficiency syndrome spleen and kidney.(3)During chronic phase coronary heart disease combined diabetes,it mainly showed yang deficiency and blood stasis,yin deficiency and blood stasis,heart and spleen deficiency syndrome.3.The main syndrome elements and main syndrome,additive syndrome,tongue performance and pulse performance has been revealed by factor analysis and logistic regression analysis.The statistical models related to symptoms signs,and syndromes were established and revealed the correlation and specificity of the main symptoms and TCM syndromes.4.Statistical model of the correlation between TCM syndromes and physical chemical indicators of all phase of coronary heart disease combined diabetes were established by using Logistic regression.A physical and chemical index with specific diagnostic value for a TCM syndrome were screened.It wil benefit for the development of microscopic syndrome differentiation and syndrome disease combination.It will useful to provide an important theoretical basis for the modernization and objectification of TCM syndromes.5.It has confirmed that factor analysis and logistic regression analysis are effective methods for the study of TCM syndromes.The quantitative criteria for the diagnosis of coronary heart disease combined diabetes were constructed and improved.It will provided a certain theoretical basis for standardization of coronary heart disease and diabetes diagnosis. |
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