Study On The Characteristics And Regularity Of TCM Syndromes In Patients With Different Degrees Of Coronary Artery Stenosis By Coronary Angiography

BackgroundCoronary angiography(CAG)is the gold standard for the diagnosis of Coronary heart disease(CHD),and coronary atherosclerosis is the pathological basis of coronary stenosis.Based on the degree of stenosis and treatment options of coronary stenosis,the patient can be divided into 4 types,including coronary artery atherosclerosis with less than 30%stenosis,borderline coronary lesion with 30%to 70%stenosis,scheduled to undergo percutaneous coronary intervention(PCI),and scheduled to undergo coronary artery bypass grafing(CABG).Previous studies on Traditional Chinese Medicine(TCM)Zheng of CHD mainly focused on patients diagnosed by CAG(stenosis?50%),but there were relatively few studies on the characteristics of patients with coronary artery atherosclerosis,borderline coronary lesion and patients scheduled to undergo CABG who with three-vessel or left main coronary artery disease.The prognosis and the treatment strategies of different degrees of coronary stenosis are not the same,and the classification of patients with coronary stenosis according to clinical treatment strategies is more instructive.Through the study of the whole process of TCM Zheng from mild coronary stenosis to severe coronary stenosis,it is helpful to discover the pathogenesis of TCM and the evolution of Zheng in patients with coronary artery stenosis,and guide the usage of the medication.ObjectiveTo explore the characteristics and regularity of TCM Zheng in patients with different degrees of coronary stenosis;to establish a classification model of TCM Zheng in patients with borderline coronary lesion,and explore the symptoms and signs which having a great contribution to the diagnosis of TCM Zheng,and provide alternative entries for the TCM Zheng quantitative diagnostic criteria.MethodsThis study was a multi-center cross-sectional survey including 2138 patients with coronary stenosis confirmed by CAG from September 1,2017 to December 31,2018 at Guang'anmen Hospital,Beijing Anzhen Hospital Capital Medical University,Yunnan Provincial Hospital of Traditional Chinese Medicine and the First Affiliated Hospital of Xinxiang Medical University.The multi-center investigators were trained before the study,and the training contents included the standard of filling the case report form and the standard of collecting the information.Baseline characteristics(gender,age,affiliated disease,etc.),TCM symptoms(symptoms,signs,tongues,pulses,etc.),and CAG results were recorded.Clinical data were analyzed by frequency analysis,analysis of variance,and X2 test.For the patients with borderline coronary lesion,the neural network in SPSS Modeler 18.0 software was used to construct the TCM Zheng classification model,and the gain graph and the income graph were drawn to test the accuracy of the model.This study was approved by the Ethics Committee of Guang'anmen Hospital of the China Academy of Chinese Medical Sciences(no.2017-058-KY-01)and was registered in the chictr.org(registration number:ChiCTR-ROC-17013221).Results1 Characteristics and regularity of TCM Zheng in patients with different degrees of coronary stenosis diagnosed by CAGIn this study,2138 patients with coronary stenosis were from 4 centers,and according to the CAG results,they were divided into 181 patients with coronary artery atherosclerosis,826 patients with borderline coronary lesion,986 patients scheduled to undergo PCI and 145 patients scheduled to undergo CABG.(1)The degree of coronary stenosis was closely related to the gender,the age and the affiliated disease.?In terms of gender distribution,the proportion of female patients with coronary artery atherosclerosis(52.49%)>the proportion of female patients with borderline coronary lesion(43.46%)>the proportion of female patients scheduled to undergo CABG(33.10%)>the proportion of female patients scheduled to undergo PCI(32.66%).The proportion of male patients scheduled to undergo PCI(67.34%)>the proportion of male patients scheduled to undergo CABG(66.90%)>the proportion of male patients with borderline coronary lesion(56.54%)>the proportion of male patients with coronary artery atherosclerosis(47.51%).?In the age distribution,there were significant differences in in the 4 groups(P=0.000<0.01),and the ages of patients with coronary artery atherosclerosis were the youngest in the 4 groups.?In the case of affiliated disease,there were significant differences in hypertension(P=0.000<0.01),type 2 diabetes(P=0.000<0.01),and cerebral infarction(P=0.045<0.05)in the 4 groups.The proportion of type 2 diabetes mellitus increased with the progress of coronary stenosis.(2)Regional differences in TCM Zheng distribution in patients with coronary artery stenosis.Blood stasis Zheng>qi deficiency Zheng>qi stagnation Zheng>heat Zheng>turbid p hlegm Zheng>yin deficiency Zheng>yang deficiency Zheng>cold Zheng in Beijing area,qi deficiency Zheng>turbid phlegm Zheng>qi stagnation Zheng>yin deficiency Zheng>blood stasis Zheng>yang deficiency Zheng>heat Zheng>cold Zheng in Henan area,qi deficiency Zheng>blood stasis Zheng>turbid phlegm Zheng>heat Zheng>yin deficiency Zheng>qi stagnation Zheng>yang deficiency Zheng>cold Zheng in Yunnan aera.The qi stagnation Zheng(45.24%)and the heat Zheng(39.64%)in Beijing were significantly higher than the other two regions.The turbid phlegm in Henan was significantly higher(44.58%)than the other two regions,and the qi deficiency Zheng(75.48%)in Yunnan was more prominent.(3)TCM Zheng of patients with different degrees of coronary artery stenosis showed certain regularity.?The characteristics of Zheng factors:qi deficiency Zheng>qi stagnation Zheng>blood stasis Zheng>turbid phlegm Zheng>yang deficiency Zheng>yin deficiency Zheng>heat Zheng>cold Zheng in patients with coronary artery atherosclerosis;qi deficiency Zheng>blood stasis Zheng>turbid phlegm Zheng>qi stagnation Zheng>heat Zheng>yin deficiency Zheng>yang deficiency Zheng>cold Zheng in patients with borderline coronary lesion;qi deficiency Zheng>blood stasis Zheng>qi stagnation Zheng>heat Zheng>turbid phlegm Zheng>yin deficiency Zheng>yang deficiency Zheng>cold Zheng in patients scheduled to undergo PCI;qi deficiency Zheng = blood stasis Zheng>turbid phlegm Zheng>heat Zheng>qi stagnation Zheng>yin deficiency Zheng>yang deficiency Zheng>cold Zheng in patients scheduled to undergo CABG.There were significant differences in qi stagnation Zheng(P=0.000<0.01)and yang deficiency Zheng(P=0.02<0.05)in the 4 groups.The proportion of qi stagnation Zheng(55.25%)and yang deficiency Zheng(32.60%)in patien ts with coronary artery atherosclerosis was significantly higher than other three groups.?The combination of Zheng factors:The Zheng factors of the 4 groups were the most common in the combination of the two Zheng factors,especially the qi deficiency Zheng plus blood stasis Zheng.Qi deficiency Zheng,blood stasis Zheng,qi stagnation Zheng and yang deficiency Zheng had the highest correlation in the patients with coronary artery atherosclerosis,and the common Zheng types were qi deficiency and blood stasis Zheng,qi stagnation and yin deficiency Zheng,and qi deficiency Zheng,etc.Qi deficiency Zheng,blood stasis Zheng,turbid phlegm Zheng and heat Zheng had the highest correlation in the patients with borderline coronary lesion,and the common Zheng types were qi deficiency and blood stasis Zheng,qi deficiency,blood stasis,turbid phlegm and heat Zheng,and qi deficiency,blood stasis and turbid phlegm Zheng,etc.Qi deficiency Zheng,blood stasis Zheng,qi stagnation Zheng and turbid phlegm Zheng had the highest correlation in the patients scheduled to undergo PCI.,and the common Zheng types were qi deficiency and blood stasis Zheng,qi deficiency Zheng,and blood stasis Zheng,etc.Qi deficiency Zheng,blood stasis Zheng,turbid phlegm Zheng and heat Zheng had the highest correlation in the patients scheduled to undergo CABG,and the common Zheng types were qi deficiency and blood stasis Zheng,qi deficiency and turbid phlegm Zheng,and qi deficiency,blood stasis and turbid phlegm Zheng,etc.(4)Predicting pathogenesis through TCM Zheng.The pathogenesis of coronary stenosis made the "deficiency" as the root,and made the "turbid phlegm,blood stasis,qi stagnation and heat"as the conditions.They were mainly qi deficiency Zheng(59.68%)and blood stasis Zheng(56.74%),and could also see qi stagnation Zheng(40.46%),turbid phlegm Zheng(37.79%)and heat Zheng(35.41%).2 Based on neural network to study TCM Zheng classification model of patients with borderline coronary lesionA total of 826 patients from 4 hospitals with borderline coronary lesion were included in the study.The TCM Zheng classification model of seven kinds of single Zheng factor,five kinds of two Zheng factors combination,two kinds of three Zheng factors combination and two kinds of four Zheng factors combination were constructed by neural network algorithm.The model had high accuracy,and could extract the symptoms and signs that had a great contribution to the diagnosis of TCM Zheng.The results were as follows.Single Zheng factors:?Blood stasis Zheng:The accuracy rate of model was 90.3%,and the order of contribution was purple lips(0.0677)>dark red tongue(0.0659)>purple dark tongue(0.0515).?Qi deficiency Zheng:The accuracy rate of model was 84.4%,and the order of contribution was fatigue(0.1261)>shortness of breath(0.0581)>poor appetite(0.0266).?Qi stagnation Zheng:The accuracy rate of model was 92.6%,and the order of contribution was restlessness and irritability(0.1371)>sighing(0.061)>chest fullness(0.0299).?Turbid phlegm Zheng:The accuracy rate of model was 85.1%,and the order of contribution was greasy tongue coating(0.0743)>thick tongue coating(0.0483)>heavy sensation in limbs(0.0413).?Heat Zheng:The accuracy rate of model was 89.7%,and the order of contribution was yellow tongue coating(0.155)>white tongue coating(0.0544)>urine yellow(0.0443).?Yin deficiency Zheng:The accuracy rate of model was 81.8%,and the order of contribution was night sweat(0.0513)>less tongue coating(0.0411)>aversion to hot(0.0272).?Yang deficiency Zheng:The accuracy rate of model was 96.7%,and the order of contribution was chills(0.2716)>cold limbs(0.2127)>waist cold(0.0198).Combination of two Zheng factors:?Blood stasis Zheng+qi deficiency Zheng:The model accuracy rate was 93.4%,and the order of contribution was fatigue(0.061)>dark red tongue(0.0388)>purple lips(0.0274)>purple collaterals under tongue(0.0223).?Blood stasis Zheng+turbid phlegm Zheng:The model accuracy rate was 94.7%,and the order of contribution was dark red tongue(0.0418)>thick tongue coating(0.0375)>greasy tongue coating(0.037)>ecchymosis on tongue(0.0364).?Qi stagnation Zheng+blood stasis Zheng:The model accuracy rate was 98.0%,and the order of contribution was restlessness and irritability(0.1623)>purple lips(0.0888)>sighing(0.0523)>purple tongue(0.0269)·?Turbid phlegm Zheng+ heat Zheng:The model accuracy rate was 94.6%,and the order of contribution was yellow tongue coating(0.0903)>greasy tongue coating(0.0567)>white tongue coating(0.0261)>constipation(0.0258).?Qi deficiency Zheng+yin deficiency Zheng:The model accuracy rate was 91.0%,and the order of contribution was fatigue(0.0643)>shortness of breath(0.0336)>complexion red(0.0248)>night sweat(0.0226).Combination of multi-Zheng factors:?Blood stasis Zheng+turbid phlegm Zheng+qi deficiency Zheng:The model accuracy rate was 98.4%,and the order of contribution was dark red tongue(0.038)>fatigue(0.0357)>greasy tongue coating(0.0258)>thick tongue coating(0.0249).?Blood stasis Zheng+turbid phlegm Zheng+heat Zheng:The model accuracy rate was 97%,and the order of contribution was yellow tongue coating(0.0462)>greasy tongue coating(0.0324)>chest pain(0.0236)>constipation(0.0219).?Blood stasis Zheng+turbid phlegm Zheng+heat Zheng+qi deficiency Zheng:The model accuracy rate was 98.2%,and the order of contribution was greasy tongue coating(0.0254)>dark red tongue(0.0251)>yellow tongue coating(0.0204)>poor appetite(0.0204)>fatigue(0.0194).?Blood stasis Zheng+turbid phlegm Zheng+qi stagnation Zheng+qi deficiency Zheng:The model accuracy rate was 98.1%,and the order of contribution was restlessness and irritability(0.0532)>fatigue(0.0351)>greasy tongue coating(0.029)>knotted and intermittent pulse(0.0258)>rapid pulse(0.0239)>purple lips(0.0217).ConclusionThe core pathogenesis of the patients with different coronary stenosis made the"deficiency"as the root,and made the"turbid phlegm,blood stasis,qi stagnation and heat" as the conditions.The deficiency Zheng was mainly based on qi deficiency,and the excess Zheng was based on blood stasis.And the different regions and different degrees of coronary stenosis were slightly different.Patients with mild stenosis were more prominent with qi stagnation Zheng and yang deficiency Zheng.Besides,the neural network had a good classification performance for TCM Zheng,and could extract the symptoms and signs that had a great contribution to the diagnosis of TCM Zheng,and could provide alternative entries for the TCM Zheng quantitative diagnostic criteria for patients with borderline coronary lesion,and could provide the reference for clinical Zheng differentiation.