Study On The Correlation Between Traditional Chinese Medicine Syndrome Types And Coronary Artery Lesions In Coronary Heart Disease Combined With Hyperhomocysteinemia

Aim:The aim of this study was to analyze the relationship between TCM syndrome types,homocysteine level and the degree of coronary artery disease in order to provide evidence for TCM syndrome differentiation and clinical treatment of coronary heart disease combined with hyperhomocysteinemia.Methods:Patients who met the diagnostic criteria of coronary atherosclerotic heart disease and hyperhomocysteinemia were included in this study.Personal data(age,sex,height,weight,blood pressure,heart rate,history of hypertension,diabetes and cerebrovascular disease),biochemical indicators(homocysteine,glucose,total cholesterol,triglycerides,low density lipoprotein,high density lipoprotein,prothrombin time,thrombin time,activated partial thromboplastin time,D-dimer,blood urea nitrogen,serum creatinine and uric acid),the severity index of coronary artery lesions(the number of diseased coronary arteries),Gensini scores were collected according to the uniformly formulated medical data collection forms.TCM syndrome types were determined by the four diagnostic methods,including symptoms,tongue and pulse.SPSS 25.0 statistical software was run to process the data of this study.Measurement data were expressed as mean±standard deviation((?)±s).For the comparison of measurement data between multiple groups,analysis of variance was used for the normal distribution,while the rank-sum test was used for the non-normal distribution and rank variables.Correlation analysis was carried out by Spearman analysis.Enumeration data were expressed as percentages(%)and analyzed by chi-square test or Fisher’s exact test.P values less than 0.05 were considered to indicate a statistically significant difference,and P values less than 0.01 were considered to indicate highly statistically significant differences.Results:1.A total of 302 patients were enrolled in this study,and they were divided into seven syndrome types.There were 77 cases of heart blood stasis syndrome,accounting for the highest proportion(25.50%),followed by Qi stagnation and blood stasis syndrome(22.85%),phlegm blocking heart vessel syndrome(17.88%),Qi deficiency and blood stasis syndrome(17.22%),Qi-Yin deficiency syndrome(7.95%),Yin deficiency of heart and kidney syndrome(7.28%),Yin-cold stagnation(1.32%).2.No significant differences were found in systolic blood pressure,diastolic blood pressure,BMI,heart rate,history of hypertension,diabetes and cerebrovascular disease among different syndrome types(P>0.05),but there was highly significant difference in age distribution among Yin deficiency of heart and kidney syndrome and Qi stagnation and blood stasis syndrome(P<0.01).There were differences in smoking history and drinking history among different syndrome types(P<0.01).The proportion of patients with history of smoking and drinking in phlegm blocking heart vessel syndrome was higher than that of other syndromes.3.Significant differences were identified in HDL-C,BUN and Scr among different syndrome types(P<0.05),but further pairwise analyses did not reveal a significant difference in HDL-C and BUN(P>0.05).There was significant difference among phlegm blocking heart vessel syndrome and Yin deficiency of heart and kidney syndrome,Qi deficiency and blood stasis syndrome in Scr,respectively(P<0.05).4.The Hcy level of heart blood stasis syndrome was highly significantly different from that of Yin deficiency of heart and kidney syndrome,Qi-Yin deficiency syndrome,Qi deficiency and blood stasis syndrome,Qi stagnation and blood stasis syndrome(P<0.01).Hcy level of phlegm blocking heart vessel syndrome was significantly different from that of Yin deficiency of heart and kidney syndrome and Qi deficiency and blood stasis syndrome(P<0.05).Regarding the Hcy,heart blood stasis syndrome showed the highest levels,followed by phlegm blocking heart vessel syndrome.5.There was significant difference in the number of coronary arteries with stenosis among different syndrome types(P<0.05).Bonferroni method showed that there was highly significant difference in the number of coronary arteries with stenosis between heart blood stasis syndrome and Qi stagnation and blood stasis syndrome(P<0.01).Heart blood stasis syndrome and Qi-Yin deficiency syndrome accounted for a relatively high proportion of three-vessel lesions.6.The Gensini scores of heart blood stasis syndrome,phlegm blocking heart vessel syndrome were significantly different from those of Qi deficiency and blood stasis syndrome and Qi stagnation and blood stasis syndrome,respectively.The Gensini score of phlegm blocking heart vessel syndrome was the highest,followed by heart blood stasis syndrome.7.Highly Significant difference in Hcy level was found between female and male patients(P<0.01),and the Hcy level in male was significantly higher than that in female.8.There was a significant difference in Hcy level among different number of coronary arteries with stenosis.The serum level of Hcy between the single-vessel and three-vessel coronary artery disease groups had highly significant difference(P<0.01).Hcy level was highest in patients with three-vessel disease.The elevated level of Hcy was positively correlated with the number of coronary arteries with stenosis(P<0.01,r_s=0.175).9.There was a significant positive correlation between the elevated level of Hcy and Gensini score(P<0.01,r_s=0.204).10.Spearman analysis showed that sex,smoking history,drinking history,BUN,Scr and UA were found to have obvious correlation with Hcy level(P<0.01),except for age,BMI,FBG and other factors.Conclusions:1.Heart blood stasis syndrome is the most common TCM syndrome in CHD patients with HHcy.2.The heart blood stasis syndrome and phlegm blocking heart vessel syndrome have higher Hcy level and more severe degree of coronary artery lesions.3.The higher Hcy level in CHD combined with HHcy patients have more numbers of diseased coronary arteries,higher Gensini scores,and more serious degree of coronary artery lesions.4.The level of Hcy is associated with gender,smoking history,drinking history,BUN,Scr,UA.5.The degree of coronary artery lesions is more severe in patients with heart blood stasis syndrome and phlegm blocking heart vessel syndrome,which suggests that the prevention and treatment of CHD combined with HHcy in TCM should pay more attention to heart blood stasis syndrome and phlegm blocking heart pulse syndrome.