Research On The Distribution Of TCM Syndrome Types In Patients With Chronic Complete Coronary Occlusion And Its Correlation With Cognitive Impairment

This paper includes two literature reviews and one clinical observation.1.Literature ReviewsThe title of the first review is"Cognition of the etiology and pathogenesis of Chronic Total Occlusion in Chinese Medicine,and the theoretical basis of Chinese Medicine for CTO influencing Cognitive Function".There is no corresponding name for chronic coronary occlusive disease in ancient medical literature.At present,most scholars believe that coronary heart disease belongs to the category of "chest pain".Other Chinese medicine names corresponding to coronary heart disease include true heartache and stroke heartache.In the Jin Dynasty,Ge Hong proposed the term "long heart pain".Its clinical manifestation is similar to chronic coronary occlusion,so the current CTO is generally attributed to "long heart pain" in traditional Chinese medicine.Later generations of medical experts have distinguished the names of other Chinese medicine coronary heart disease such as "long heart pain" and true heartache,and supplemented the etiology and pathogenesis of chronic coronary occlusive disease,but we have not yet formed a complete treatment system for the treatment of chronic total occlusive.As early as the theory of Chinese medicine in ancient China,the theory of"heart dominates the gods" was narrated,which is the theoretical basis of the effect of coronary heart disease on cognitive function.Later generations have continuously enriched the theory and applications,and the "heart dominates the gods" theory has been recognized by later generations of scholars.The impact of chronic total occlusive on cognitive function has a rich theoretical basis of traditional Chinese medicine,but modern western medicine clinical research is still scarce.Clinical investigation of the impact of scarce,disease on cognitive function is not only a verification of traditional Chinese medicine theory,but also reminds clinical patients and physicians to prevent and treat early cognitive dysfunction in patients with chronic total occlusive,which has certain clinical significance.The title of the second review is "New progress of Modern Medicine on the effect of Chronic Total Occlusion on Cognitive Function".The second review mainly expound the definition,occurrence and development mechanism and influencing factors of CTO,and the definition,assessment methods,influencing factors of Cognitive Function,the influence of cardiovascular system and other system diseases on Cognitive Function,as well as serum cystatin in CTO and cognitive impairment.More and more studies explore the relationship between coronary heart disease and cognitive function,and use more indicators to assess the relationship between them,but the clinical study of the specific effect mechanism of CTO on cognitive function is not perfect.Clinically,patients with Chronic Total Occlusion disease should be screened for cognitive function as soon as possible,and patients with cognitive dysfunction should be identified and intervened in time,which is of great significance for slowing the progression of cognitive dysfunction and choosing their own optimal treatment plan.2.Clinical ObservationObjective:To discuss the distribution characteristics of TCM syndromes in patients with Chronic Total Occlusion disease and their relationship with cognitive function by studying the cognitive function and the distribution of TCM syndromes in patients with Chronic Total Occlusion.Methods:176 patients who were hospitalized in Cardiology Department of Integrated Traditional Chinese and Western Medicine or cardiology department of China-Japan Friendship Hospital from June 2019 to January 2020,and planned to undergo coronary angiography,were divided into chronic coronary occlusion group(CTO group)and mild coronary artery disease group(control group)based on medical history and coronary angiography results.Collected general information,TCM syndrome types,Montreal Cognitive Assessment Scale(MoCA)scores and serum biochemical indexes of the two groups of patients.Analyzed the distribution of TCM syndromes in CTO patients and the relationship between CTO and cognitive function,and applied correlation analysis and regression analysis to explore the correlation between CTO and cognitive function.Results:?Description of enrolled patients:176 patients were between 47-90 years old,with an average age of 61.47±11.93 years old,119 males(67.6%),57 females(32.4%).The BMI of male patients is higher than that of female patients(P<0.001),the age of male patients is lower than that of female patients(P<0.05).?Comparing the relevant indicators of the CTO group and the control group:There were 94 patients in CTO group(53.4%)and 82 patients in control group(46.6%).There was no statistical difference in age,age stratification and BMI between the two groups.The proportion of males in the CTO group was more than that in the control group,the correlation coefficient between group and gender was 17.8%.The proportion of patients with smoking history in the CTO group was higher than that in the control group,the difference was statistically significant(P<0.001),the correlation coefficient between group and smoking history was 28.1%;The MoCA score of the CTO group was significantly lower than that of the control group,the difference was statistically significant(P<0.01);According to the MoCA score,whether the patient has cognitive impairment(less than 26 points is considered to be cognitive impairment),the number of cognitive dysfunction in the CTO group was higher than that in the control group(P<0.05),and the correlation coefficient between group and number of people with cognitive impairment cognitive dysfunction was 15.8%.Serum CysC level in CTO group was significantly higher than that in control group,the difference was statistically significant(P<0.05);Serum TC(P<0.001),HDL-C(P<0.05)and LDL-C(P<0.01)in CTO group were significantly lower than those in control group,the difference was statistically significant.?Distribution of Traditional Chinese Medicine Syndrome in CTO Group and the Comparison of Related Factors:The patients in the CTO group were divided into four groups based on four different TCM syndromes,including 41 patients in the phlegm-turbidity blocking syndrome group,22 patients in the qi deficiency and blood stasis syndrome group,20 patients in the qi and yin deficiency syndrome group,11 patients in the heart-kidney-yang deficiency syndrome group.The age of patients with phlegm-turbidity blocking syndrome was significantly higher than that of qi and yin deficiency syndrome and heart-kidney-yang deficiency syndrome(P<0.05).There was no statistical difference in the remaining baseline indicators;Comparing the serum Cys C levels of the four type syndromes,Cys C level from high to low is:e phlegm-turbidity blocking syndrome,qi deficiency and blood stasis syndrome,qi and yin deficiency syndrome or heart-kidney-yang deficiency syndrome(P<0.05).?Comparison of Cognitive Functions of Different TCM Syndromes in CTO Group:Comparing the MoCA scores of the four syndromes groups,it was found that the MoCA scores of the qi-deficiency and blood stasis syndrome and the phlegm-turbidity blocking syndrome groups were significantly lower than those of the qi-yin deficiency syndrome group and the heart-kidney-yang defi ciency syndrome groups(P<0.05).Number of syndrome types in patients with cognitive dysfunction:qi deficiency and blood stasis syndrome>qi and yin deficiency syndrome and heart and kidney yang deficiency syndrome,phlegm-turbidity blocking syndrome>heart and kidney yang deficiency syndrome(P<0.05).?Analysis of factors influencing cognitive function:Used bivariate correlation analysis to screen out indicators that were correlated with MoCA scores,and further analyzed of the influencing factors of MoCA score through multi-factor linear regression model,got the linear regression equation:MoCA=33.36-(0.129 × age)-(1.01 × statin history)+(0.009×platelet)-(3.249 × phlegm+blood stasis syndrome)-(1.553 × CTO).The impact of the above indicators on the MoCA score was statistically significant,F=32.738,P<0.001,which could explain 49.1%of the variation of the MoCA score,and the degree of influence was moderate(R2=0.491).Through single factor Logistic regression analysis,screened out CTO,age,thrombocytopenia,decreased platelet lymphocyte ratio,and decreased statin drug history were screened as risk factors for cognitive dysfunction.Further using multi-factor Logistic regression analysis,obtained CTO(OR=2.517,P=0.017,95%CI?1.178-5.377),age(OR?1.110,P<0.0001,95%CI?1.065-1.156),statin history(OR=1.900,P=0.123,95%CI=0.841-4.293),platelets(OR=0.992,P?0.033,95%CI?0.985-1.000),PLR(OR?0.991,P=0.010,95%CI=0.985-0.998).Conclusion:Patients with coronary artery disease have cognitive impairment.Patients with chronic coronary occlusion have more severe cognitive impairment.Patients with qi deficiency and blood stasis syndrome,phlegm-turbidity blocking syndrome have more significant impairment of cognitive function.Increased serum Cys C levels may be associated to CTO,cognitive dysfunction and phlegm-turbidity blocking syndrome.Statins are risk factors for cognitive dysfunction.Chronic total occlusion and increased age are independent risk factors for cognitive dysfunction.