Research On TCM Syndromes And Risk Factors Of Coronary Heart Disease Complicated With Anxiety And Depression Based On Data Mining

Coronary heart disease(CHD)combined with anxiety and/or depression is a psychosomatic disease that has a high incidence rate,high disability rate,and a heavy burden of disease,which seriously endangers people's health.Although the medical treatment with selective serotonin reuptake inhibitors has relieved patients'psychiatric symtoms to a certain extent,but drug's slow onset,low remission rate,and various side effects has confined its clinical application.Traditional Chinese medicine(TCM)has dominant advantages in the treatment of psychosomatic diseases.Based on its multi-target and network regulation,TCM can improve patients'mental and physical status as a whole,and it's of great significance to achieve psycho-cardio rehabilitation.Syndrome differentiation and treatment is the core of TCM theory.Clarifying the TCM syndromes distribution characteristics is the key to precise treatment and enhancement of clinical effect.However,there is no uniform standard for TCM syndromes distribution characteristics of coronary heart disease combined with anxiety and/or depression,which seriously hinders TCM'development in the field of Psycho-Cardiology.This study uses data mining technology,combining with TCM theory and expert experiences,to explore the distribution characteristics of TCM syndromes of coronary heart disease combined with anxiety and/or depression,in order to provide references for clinical diagnosis and treatment of psycho-cardio comorbidity.Clarifying the risk factors of CHD combined with anxiety and/or depression can provide a scientific basis for clinically efficient identification of the corresponding risk group.Through retrospective collection of general data,CHD history and related biological indicators of CHD patients with or without anxiety and depression,this study aims to analyze risk factors of CHD combined with anxiety and/or depression and provide intervention targets for clinical prevention work.Study 1:Study on the TCM syndromes of coronary heart disease combined with anxiety and/or depression based on data miningObjective:To explore the TCM syndromes distribution characteristics of CHD combined with anxiety and/or depression,and provide references for the diagnosis and treatment of psycho-cardio comorbidities in the manner of combination of disease and syndrome.Method:This is a retrospective study.By searching the Hetai electronic medical record database,194 patients are consecutively included,who were hospitalized in the cardiovascular center of Xiyuan hospital in the past 5 years,with CHD being their first discharge diagnosis and anxiety/depression as their comorbidities.We Collect patients' clinical symptoms,tongue and pulse signs and then process them in a normative manner to establish TCM information database.Occurrence frequencies of clinical symptoms,tongue and pulse signs are counted by Excel 2010 software.By selecting data with a higher occurrence frequency as the research variable and then using factor analysis to extract common factors,we distinguish the syndrome elements preliminarily according to the constitution of common factors.Next,TCM syndromes are deduced by clustering analysis of common factors.Furthermore,the syndrome types are integrated by relevant experts based on clinical practice,the naming rules of syndromes and whether the syndromes are repeated.Finally the distribution characteristics of TCM syndromes in CHD combined with anxiety and/or depression are obtained.Result:(1)The top 15 symptoms of CHD patients combined with anxiety and/or depression are chest tightness,poor sleep,chest pain,palpitation,fatigue,dizziness,anorexia,constipation,shortness of breath,dry mouth,shoulder and back pain,sweating,condition aggravating with activity,cough,abdominal distension;The top 9 tongue signs in the order of frequency are dark tongue,greasy coating,red tongue,yellow coating,white coating,thin white coating,pale red tongue,thick coating,and cracked tongue;the top 6 pulse signs in the order of frequency are stringy pulse,slippery pulse,thready pulse,deep pulse,weak pulse,rapid pulse.(2)A factor analysis with 38 variables having a higher frequence of occurrence is performed to obtain a total of 15 common factors with characteristic values>1.The differentiation of syndrome elements for common factors shows that the syndrome elements of CHD patients combined with anxiety/depression mainly involve phlegm(41.24%),blood stasis(19.07%),fire(heat)(6.7%),qi deficiency(25.26%),yin deficiency(16.49%)and yang deficiency(10.31%);the disease location is more common in the heart,liver,spleen and kidney.(3)When 15 common factors are clustered into 7 categories,the results are the most reasonable.Seven clusters are differentiated into 7 syndrome types:syndrome of internal accumulation of turbid phlegm,syndrome of dual deficiency of the heart and kidney yin and yang,syndrome of intense exuberant heart fire,syndrome of yin deficiency with effulgent fire,syndrome of intermingled phlegm and blood stasis,syndrome of spleen qi deficiency.syndrome of qi deficiency in spleen and kidney.Because of the overlap between category 6 and category 7,the category 6,spleen-qi deficiency,is classified into category 7,spleen-kidney qi deficiency.Conclusion:Phlegm,blood stasis,fire(heat),qi deficiency,yin deficiency,and yang deficiency are common syndrome elements of CHD combined with anxiety and/or depression.Inferring from the generation of phlegm,blood stasis,and fire(heat),qi stagnation should also be its basic and core syndrome elements;the heart,liver,spleen and kidney are its common disease location syndrome elements.The TCM syndrome classifications of CHD combined with anxiety and/or depression mainly include syndrome of internal accumulation of turbid phlegm,syndrome of intermingled phlegm and blood stasis,syndrome of intense exuberant heart fire,syndrome of yin deficiency with effulgent fire,syndrome of qi deficiency in spleen and kidney,syndrome of dual deficiency of the heart and kidney yin and yang.Study 2:Study on the risk factors of coronary heart disease combined with anxiety and/or depressionObjective:To explore the risk factors of coronary heart disease combined with anxiety and/or depression,and provide scientific evidence for identifying corresponding risk group and carrying out specific prevention work.Method:This study adopts a retrospective design.113 CHD patients combined with anxiety and/or depression with complete coronary artery medical data are identified as the case group,and 284 patients without anxiety and depression are selected as the control group.General information(gender,age,length of hospitalization),history of CHD(number of diseased coronary artery,Gensini score,history of revascularization,number of stents),comorbidities(hypertension,diabetes,dyslipidemia,peripheral arterial disease,renal insufficiency)and laboratory indexes(inflammatory markers,blood lipids,thyroid function,cardiac ejection fraction)are collected.For outliers that are obviously not logical,they are treated as missing values after being eliminated.Missing data are filled with multiple imputation.Some potentially meaningless independent variables are excluded primarily by univariate analysis.Finally independent variables with P<0.05 or variables with P? 0.05,but which are believed to be closely related to the dependent variable are included in the Logistic regression model to analyze risk factors of coronary heart disease combined with anxiety and/or depression.Result:(1)Univariate analysis shows that there are no statistical differences in age and proportion of female between the case group and control group(P>0.05),and the difference in length of stay is statistically significant(P<0.01).There are no statistical differences in the comorbidities,such as hypertension,type 2 diabetes,dyslipidemia,peripheral artery disease and renal insufficiency(P>0.05);there are also no significant differences in the number of diseased coronary artery,Gensini score,number of stents,and the number of people receiving revascularization between the two groups(P>0.05).There are no statistical differences in neutrophil-lymphocyte ratio and fibrinogen levels between the two groups(P>0.05),and the difference in hsCRP level between two groups is statistically significant(P<0.01).The differences in levels of TC,HDL-C,ApoA1,Lp(a)between the two groups are of no statistical significance(P>0.05),and the differences in LDL-C,TG,ApoB levels are statistically significant(P<0.05).The differences in FT3,TSH,T3,T4 levels between the two groups are statistically significant(P<0.05),and the difference in FT4 level is of no statistical significance(P>0.05).The difference in left ventricular ejection fraction between the two groups is not statistically significant(P>0.05).(2)Woman,HDL-C and independent variables with statistically significant differences in the univariate analysis are included in the binary logistic regression model.The results show that compared with male patients,female CHD patients have an increased risk of combiding with anxiety and/or depression[OR=1.69,95%CI(1.04,2.76),P<0.05];prolonged length of stay causes increased risk of combining with anxiety and/or depression in CHD patients[OR=1.13,95%CI(1.07,1.20),P<0.001];increased ApoB levels reduce the risk of combining with anxiety and/or depression in CHD patients[OR=0.32,95%CI(0.12,0.85),P<0.05];increased levels of TSH and T4 reduce the risk of combining with anxiety and/or depression in CHD patients[OR=0.84,95%CI(0.73,0.97),P<0.05;OR=0.98,95%CI(0.97,0.99),P<0.001].Conclusion:Long length of stay,female,and low resum levels of ApoB,TSH,T4 are the risk factors of coronary heart disease combined with anxiety and/or depression.Therefore,focusing on these risk factors and conducting proper identification and intervention is expected to improve the onset and prognosis of coronary heart disease combined with anxiety and/or depression.