Clinical Study On Severity Of Coronary Artery Disease And TCM Syndrome In Patients With Acute Coronary Syndrome Complicated With Stress Hyperglycemia

Objective:To explore the difference between patients with acute coronary syndrome combined with stress-induced hyperglycemia and patients without stress-induced hyperglycemia in sex,age,BMI,tobacco and alcohol habits,basic metabolic indicators and cardiac function,severity of coronary artery pathological changes,etc.To probe into the distribution characteristics of TCM syndrome types in patients with acute coronary syndrome combined with stress-induced hyperglycemia To attach importance to the primary doctors and patients and provide a theoretical basis which combines TCM and clinical medicine for the prevention and treatment of coronary heart disease.Method:According to diagnostic and research criteria,a total of 171 patients diagnosed with acute coronary syndrome who were admitted to the Cardiovascular Department of Eastern Theater General Hospital and Jiangsu Provincial Hospital of Traditional Chinese Medicine from September 2017 to December 2019 were included.According to the random blood glucose or fasting blood glucose,combined with glycated hemoglobin and the blood glucose fluctuation before and after,patients were divided into two groups:79 patients in acute coronary syndrome with stress-induced hyperglycemia group(ACS+SHG),and 92 patients in acute coronary syndrome group(ACS).The pre customized clinical research table was used to collect the results of blood biochemical examinations at the time of admission to the emergency department and after the onset of the disease,including blood glucose,glycated hemoglobin,liver and kidney function,myocardial enzymes,blood lipids,also results of electrocardiogram,cardiac ultrasound and coronary angiography.After the patients' condition is stable,we collect patients'age,height,weight,tobacco and alcohol addiction,past medical history,and the four diagnosis of traditional Chinese medicine,etc.,then conduct TCM dialectics based on relevant diagnostic criteria.The research data is analyzed and processed by statistical software,and the research results and conclusions are drawn.Results:1.There were 171 patients in total,79 in the ACS+SHG group and 92 in the ACS group.The total complications of SHG in ACS cases were 46.2%(79/171).Among the cases,61 were diagnosed with a history of diabetes,43 were compliant with SHG diagnostic criteria after the onset of ACS,and 70.5%of complications occurred in SHG.There were 110 patients with no history of diabetes and 36 patients with SHG after the onset of ACS.The complications of SHG were 32.7%.The incidence of SHG in ACS patients with diabetes was higher than that in ACS patients with no history of diabetes,and there was a significant statistical difference between the occurrences(P<0.05).2.The random blood glucose level of patients in the ACS+SHG group was higher than that in the ACS group,and there was a significant statistical difference between the two groups(P<0.05).3.The coronary angiography Gensini score of the ACS+SHG group was significantly higher than that of the ACS group,and the severity of coronary artery disease was more serious than that of the ACS group(P<0.05),suggesting that the severity of coronary artery disease was related to the occurrence of stress hyperglycemia in ACS patients.4.In ACS+SHG group and ACS group,the most common type of TCM syndrome are Heart Weakness Syndrome,followed by Heart Blood Stasis Syndrome>Phlegm Stasis Syndrome>Heart Kidney Yang-deficiency Syndrome>Heart Kidney Yin-deficiency Syndrome>Cold Coagulation Heart Pulse Syndrome.There is no statistical difference between the groups.(P>0.05).5.Sex,age,BMI,tobacco and alcohol habits have no statistically difference between ACS+SHG group and ACS group.(P>0.05).6.Metabolic related index analysis and processing results show that the level of HDL-C in the blood lipid index of patients in the ACS+SHG group was lower than that of the ACS group,with statistical differences between groups(P<0.05)7.Observation of renal function indexes found that the blood SCr level of the ACS+SHG group was higher than that of the ACS group,and there was a statistical difference between the groups(P<0.05).It is suggested that the patient's renal function is related to the occurrence of stress hyperglycemia.8.The LVDd and LVDs of ACS+SHG group were higher than those of ACS group,but the values of LVEF and FS were lower than that of ACS group.There was a statistical difference between each index group(P<0.05).Prompt the patient's heart function and stress hyperglycemia have a certain correlation.Conclusion:1.The incidence of stress hyperglycemia in ACS patients is 46.2%,and the incidence of patients with a confirmed history of diabetes is higher,reaching 70.5%,and the blood glucose level after onset is significantly higher than that of patients without stress hyperglycemia.Stress hyperglycemia is a common metabolic disorder in the early stages of ACS,especially in patients with diabetes and ACS.2.Coronary angiography results Gensini score confirmed that the severity of coronary artery disease in patients with ACS combined with stress hyperglycemia was more serious than that in patients without stress hyperglycemia,suggesting that the severity of coronary artery disease and the occurrence of stress hyperglycemia have certain The correlation between ACS patients with severe underlying coronary artery disease and ACS patients with stress hyperglycemia should be closely monitored after the onset of blood glucose changes,and timely treatment should be taken to improve the patient's prognosis.3.Regardless of whether ACS is combined with stress hyperglycemia,the medical syndrome type is the weakest heart-qi syndrome.Analysis of the cause may be related to revascularization treatment.For ACS patients,on the basis of promoting blood circulation and removing blood stasis,qi and blood circulation treatment should be strengthened.And supplemented with heat and detoxification,qi and blood yin and yang.4.The cardiac function of patients with ACS combined with stress hyperglycemia has a certain correlation with stress hyperglycemia,suggesting that ACS combined with stress hyperglycemia can aggravate cardiac function damage,which may be one of the factors that lead to poor prognosis of patients.5.The blood SCr level of patients with ACS combined with stress hyperglycemia was significantly higher than that of patients without stress hyperglycemia,suggesting that renal function may be related to the occurrence of stress hyperglycemia in ACS patients.The HDL-C level of patients with ACS combined with stress hyperglycemia was significantly lower than that of patients without stress hyperglycemia.Whether the renal function status and blood HDL-C level before the onset of the patient affect each other and the incidence of stress hyperglycemia are mutually causal,and it is worth further discussion and clarification.