中医学关于冠心病不同阶段四诊信息与指标客观化的规律研究

【作者】 曲淼；

【导师】 张明雪；

【作者基本信息】 辽宁中医药大学 ， 中医内科学， 2013， 博士

【摘要】 目的：从证候动态时空特征出发，通过大样本、多中心的临床专家问卷调查，采集冠心病在发病早期、发作期、缓解期和恢复期四个阶段的中医四诊信息和客观化指标，明晰冠心病在不同阶段的证候要素、证候特征及证候内在组合规律，比较并验证不同统计分析方法得到的冠心病主要证候要素及证候特征，进一步探讨冠心病各阶段中医证候与客观指标的相关性，构建并完善冠心病病证诊断的客观化标准。材料与方法：本研究通过《冠心病证候要素、证候特征及证候病机演变规律临床专家调查问卷》采集冠心病不同阶段中医四诊信息、实验室客观指标及其他相关信息，将收集到的全国六大地区、41家医院的1218份合格问卷建立三维结构化关联数据库，运用SPSS16.0统计软件分别对冠心病发病早期、发作期、缓解期和恢复期中医四诊信息和客观化指标进行描述性分析，运用因子分析和Logistic回归分析研究冠心病各阶段主要证候要素和证候特征，以及冠心病中医证候与实验室客观指标、诱发因素、情志变化及易患病季节的相关性和危险度。结果：1.冠心病发病早期症状出现频率最高为稍有浮肿，占74.55%，最低为经常有喘促，占20.11%，舌脉变量中薄白苔出现频率最高，占65.76%，沉脉最低，占27.26%；冠心病发作期症状出现频率最高为胸闷如窒而痛或憋闷疼痛，占87.27%，最低为便秘，占20.44%，舌脉变量中舌紫（或暗）出现频率最高，占58.62%，舌强硬最低，占20.69%；冠心病缓解期症状出现频率最高为偶有胸痛，占84.32%，最低为稍有活动即感气短，占20.28%，舌脉变量中薄白苔出现频率最高，占51.15%，弱脉最低，占20.20%；冠心病恢复期症状出现频率最高为胸隐痛，占81.03%，最低为胃脘痛其他情形，占20.44%，舌脉变量中薄白苔出现频率最高，占68.56%，齿痕舌最低，占23.48%。2.出现率最高的实验室客观指标：①发病早期：心电图ST-T改变（48.77%）、正常X线表现（75.45%）、心脏内部结构及血流未见异常（58.70%）、心肌酶学无变化（79.89%）、肌钙蛋白无变化（74.55%）、冠脉造影狭窄0-25%（47.87%）、总胆固醇升高（83.83%）、甘油三酯升高（90.72%）、LDL-C升高（77.50%）、HDL-C升高（63.05%）、血液黏度升高（67.98%）；②发作期：心电图ST-T改变（77.59%）、X线主动脉弓突出（47.13%）、左室舒张期顺应性下降（70.69%）、心肌酶学呈倍数升高（60.51%）、肌钙蛋白呈倍数升高（55.58%）、冠脉造影狭窄76-90%（48.85%）、总胆固醇升高（79.39%）、甘油三酯升高（86.12%）、LDL-C升高（73.32%）、HDL-C升高（59.93%）、血液黏度升高（90.80%）；③缓解期：心电图ST-T改变（55.25%）、正常X线表现（51.81%）、左室舒张期顺应性下降（65.85%）、心肌酶学轻度升高（43.92%）、肌钙蛋白无变化（45.24%）、冠脉造影狭窄51-75%（44.33%）、总胆固醇升高（79.72%）、甘油三酯升高（88.10%）、LDL-C升高（74.14%）、HDL-C升高（61.74%）、血液黏度升高（60.92%）；④恢复期：心电图ST-T改变（42.45%）、正常X线表现（51.81%）、左室舒张期顺应性下降（58.46%）、心肌酶学无变化（77.09%）、肌钙蛋白无变化（76.03%）、冠脉造影狭窄26-50%（39.08%）、总胆固醇降低（65.76%）、甘油三酯降低（72.25%）、LDL-C降低（62.48%）、HDL-C降低（55.50%）、血液黏度无变化（44.91%）。3.出现率最高的其他相关因素：①发病早期：劳累过度（83.99%）、焦虑（烦躁）（60.76%）、冬季（81.86%）；②发作期：劳累过度（83.58%）、恐惧（66.58%）、冬季（89.33%）；③缓解期：劳累过度（77.50%）、焦虑（烦躁）（51.31%）、冬季（59.03%）；④恢复期：劳累过度（79.89%）、忧郁（42.12%）、冬季（57.64%）。4.冠心病在发病早期、发作期、缓解期、恢复期的主要证候要素有气滞、寒邪、痰饮、瘀血、心阳虚、心气虚、心阴虚、肺气虚、脾气虚、脾阳虚、肾阳虚、肾阴虚，病位证素涉及心、肝、脾、肺、肾。5.冠心病的证候特征为：①发病早期：气滞心胸证（50.19%）和气阴两虚证（49.81%）；②发作期：气滞痰阻证（21.80%）、心阳不振证（47.33%）、寒凝心脉证（13.71%）、瘀血阳微证（16.42%）；③缓解期：肝脾不调证（20.20%）、心肾阳虚证（19.25%）、心肺气虚证（60.55%）；④恢复期：心气虚证（23.93%）、阳虚气滞证（40.52%）、气阴两虚证（35.55%）。6.冠心病发病早期证候的影响因素：①气滞心胸证：主动脉瓣返流（OR=2.702）、主动脉瓣硬化（OR=1.632）、血液黏度无变化（OR=1.304）、主动脉钙化（OR=0.751）、冠脉造影狭窄0-25%（OR=0.748）、HDL-C无变化（OR=0.657）、肺动脉瓣返流（OR=0.268）、劳累过度（OR=1.675）、过食肥甘厚腻（OR=1.567）、抑郁（OR=1.347）、暴食（OR=0.699）、悲伤（OR=1.872）、其他因素（OR=1.827）、多虑（OR=1.524）、焦虑（烦躁）（OR=1.446）、惊慌（OR=0.711）、长夏（OR=1.624）、春季（OR=1.299）；②气阴两虚证：肺动脉瓣返流（OR=3.728）、HDL-C无变化（OR=1.522）、冠脉造影狭窄0-25%（OR=1.336）、主动脉钙化（OR=1.332）、血液黏度无变化（OR=0.767）、主动脉瓣硬化（OR=0.613）、主动脉瓣返流（OR=0.370）、暴食（OR=1.43）、抑郁（OR=0.743）、过食肥甘厚腻（OR=0.638）、劳累过度（OR=0.597）、惊慌（OR=1.406）、焦虑（烦躁）（OR=0.692）、多虑（OR=0.656）、其他（OR=0.547）、悲伤（OR=0.534）、春季（OR=0.77）、长夏（OR=0.616）。7.冠心病发作期证候的影响因素：①气滞痰阻证：X线右房大（OR=4.436）、心肌酶学降低（OR=3.788）、血液黏度降低（OR=2.396）、总胆固醇升高（OR=1.898）、肌钙蛋白无变化（OR=1.763）、心肌酶学无变化（OR=1.752）、冠脉造影狭窄51-75%（OR=1.523）、主动脉瓣返流（OR=0.649）、相应导联可见Q波或QS波（OR=0.473）、X线右室大（OR=0.420）、酗酒（OR=0.687）、忧郁（OR=1.48）、惊慌（OR=0.519）、夏季（OR=1.505）；②心阳不振证：冠脉造影狭窄51-75%（OR=0.780）、正常X线表现（OR=0.759）、肌钙蛋白无变化（OR=0.507）、心肌酶学降低（OR=0.472）、劳累过度（OR=1.405）、其他情志变化（OR=0.148）；③寒凝心脉证：冠脉造影其他（OR=2.232）、心脏内部结构及血流未见异常（OR=2.129）、冠脉造影狭窄100（%OR=1.519）、血液黏度无变化（OR=0.461）、肥胖（OR=1.778）、劳累过度（OR=0.52）、其他情志变化（OR=4.449）、春季（OR=0.716）、夏季（OR=0.572）；④瘀血阳微证：彩超右室大（OR=2.287）、甘油三酯无变化（OR=1.979）、相应导联可见Q波或QS波（OR=1.397）、三尖瓣返流（OR=0.480）、心脏内部结构及血流未见异常（OR=0.469）、甘油三酯降低（OR=0.392）、冠脉造影其他（OR=0.293）、其他诱发因素（OR=0.311）、惊慌（OR=1.963）、多虑（OR=0.64）。8.冠心病缓解期证候的影响因素：①肝脾不调证：甘油三酯升高（OR=1.829）、二尖瓣返流（OR=0.678）、冠脉造影狭窄0-25%（OR=0.646）、X线左房大（OR=0.600）；②心肾阳虚证：X线右室大（OR=0.395）、寒冷（OR=1.565）、酗酒（OR=0.691）；③心肺气虚证：X线左房大（OR=1.609）、肌钙蛋白降低（OR=1.467）、心电图ST-T改变（OR=1.374）、甘油三酯升高（OR=0.681）。9.冠心病恢复期证候的影响因素：①心气虚证：彩超左室大（OR=1.529）、总胆固醇降低（OR=0.705）、HDL-C无变化（OR=0.668）；②阳虚气滞证：X线右房大（OR=3.933）、肺动脉瓣返流（OR=0.350）、暴食（OR=1.604）、暴怒（生气）（OR=0.719）；③气阴两虚证：肌钙蛋白呈倍数升高（OR=2.710）、心电图ST-T改变（OR=1.297）、X线左室大（OR=0.724）、X线右房大（OR=0.368）。结论：1.通过因子分析总结出冠心病的主要证候要素有气滞、寒邪、痰饮、瘀血、心阳虚、心气虚、心阴虚、肺气虚、脾气虚、脾阳虚、肾阳虚、肾阴虚，病位证素涉及心、肝、脾、肺、肾。2.冠心病的证候特征为：①发病早期：气滞心胸证和气阴两虚证；②发作期：气滞痰阻证、心阳不振证、寒凝心脉证和瘀血阳微证；③缓解期：肝脾不调证、心肾阳虚证和心肺气虚证；④恢复期：心气虚证、阳虚气滞证和气阴两虚证。3.通过因子分析和Logistic回归分析得到冠心病各阶段主要证候要素和证候的主症、次症、兼症，建立了症状与证候相关的统计模型，揭示了主症、次症、兼症与证候的相关度和特异性。从方法学角度验证了因子分析和Logistic回归分析是中医证候研究的有效方法，构建并完善了冠心病证候的量化标准，为冠心病病证诊断的规范化、客观化研究提供依据。4.建立冠心病中医证候与实验室客观指标及其他相关因素的统计模型，筛选出对某一证候独具特异性的客观指标及影响因素，是对冠心病中医证候从定位、定性上升到客观实验室指标、自然环境、情志变化、心理因素的系统研究和评价，体现中医学整体综合的思维观以及重视精神层面、外部环境影响证候的认知观，有利于全面揭示冠心病中医“证”的相对稳定而又可重复的规律和本质，推动证候研究的客观化发展进程。更多还原

【Abstract】 Purpose：Starting from syndrome characteristics of dynamic space-time, throughthe large sample and multi-center clinical expert questionnaires, we collectedfour diagnostic methods information and objective indicators of coronary heartdisease (CHD) in four phases that were early onset period, paroxysm period,remission period and recovery period.And then we can clear the coronary heartdisease (CHD) syndrome factors, syndrome features and the intrinsic combinationrules of syndromes in each phase,compare and verify the main syndrome factorsand characteristics in different statistical methods and To further explore thecorrelations of coronary heart disease (CHD) syndromes and objective indicatorsin the four stages.That may build and perfect the objective criteria of coronaryheart disease (CHD) disease-syndrome diagnosis.Material and method：On the earlier stage,we had done lots of basic work,suchlike using the TCM(Traditional Chinese Medicine) and western medicine clinicalguides and advices about coronary heart disease for diagnostic criteria.Afterthe foundation work we decide to make the the clinical expert questionnairebasing on large literature studies and experts’ advices, the theory of modernpsychological measurement, decision-making with structural ways and the scalestudy methods.The clinical expert questionnaire of coronary heart diseasesyndrome factors，syndrome features，syndrome pathology evolution rules wasdeveloped after three rounds Delphi method to modify, add, delete and adjustthe content of the questionnaire repeatedly, which in order to ensure the itemsand contents of questionnaire response clinical symptoms and signs of coronaryheart disease accurately. Before the large sample of clinical expertsinvestigation, we check and examine the questionnaire the reliability and validity, whose evaluated results were excellent, so we begin to do the surveyin many centers.At last,we collected1218qualified the clinical expertquestionnaires in total.The whole questionnaires consist of41hospitals on sixregions where were the Northeast (Shenyang), North of China (Beijing), Northwest(Lanzhou, Xining), Southeast (Guangzhou), Southwest (Chongqing), South of China(Shanghai). we use the computer equipment to establish the Access questionnairedatabase, input qualified questionnaire and second check,then establish theclinical expert questionnaire three-dimensional structured correlationdatabase.According to the clinical expert questionnaires of coronary heartdisease (CHD) syndrome factors，syndrome features，syndrome pathology evolutionrules,we got the four diagnostic methods information that included with cardinalsymptoms, secondary symptoms,other organs’ symptoms(spleen and stomach, liverand gallbladder, kidney and bladder,lung), tongue-appearances and colour offace), pulse condition,lab objective indicators(Electrocardiogram，X-ray ofheart，Color Vascular Ultrasonography of heart，Myocardial enzymology，Troponin，Coronary arteriography，Lipid，Blood viscosity raised) and other relevantfactors(inducing factors of coronary heart disease(CHD), change ofemotional,season of easy to fall ill). By means of SPSS16.0statistical software,we describe the coronary heart disease (CHD) four diagnostic methodsinformation,lab objective indicators and other relevant factors with frequencyand distribution in early onset period, paroxysm period, remission period andrecovery period.After factor analysis and Logistic regression analysis, we getthe the main syndrome factors, syndrome characteristics,the correlations andrisks between coronary heart disease (CHD) syndromes and objective laboratoryindexes, inducing factors, emotional factors, susceptible seasons in fourphases.Results：1. In early onset period, the highest frequency of occurrence is symptom variableof slight edema, that accounted for74.55%. The lowest is symptom variable of frequent asthma that accounted for20.11%. The thin white of tongue coating whoseaccounted for65.76%appears most among tongue and pulse variables, and deeppulse accounted for27.26%is the least. In paroxysm period, the highestfrequency of occurrence is symptom variable of chest tightness as smotheringor oppressed pain, that accounted for87.27%. The lowest is symptom variableof constipation that accounted for20.44%. The tongue purple or dark whoseaccounted for58.62%appears most among tongue and pulse variables, and stifftongue accounted for20.69%is the least. In remission period, the highestfrequency of occurrence is symptom variable of little chest pain, that accountedfor84.32%. The lowest is symptom variable of slight activities can feel shortof breath that accounted for20.28%. The thin white of tongue coating whoseaccounted for51.15%appears most among tongue and pulse variables, and weekpulse accounted for20.20%is the least. In recovery period, the highestfrequency of occurrence is symptom variable of dull pain on chest, that accountedfor81.03%. The lowest is symptom variable of epigastric pain that accountedfor20.44%. The thin white of tongue coating whose accounted for68.56%appearsmost among tongue and pulse variables, and Teeth marks tongue accounted for23.48%is the least.2.The highest frequency of occurrence about objective laboratory indicators:①Early onset period: ECG（Electrocardiogram）ST-T changed（48.77%），NormalX-ray performance（75.45%），No abnormal cardiac structure and blood flow(ColorVascular Ultrasonography)（58.70%），No change of myocardial enzymology（79.89%），No change of troponin（74.55%），CAG（Coronary arteriography) stenosis0-25%（47.87%）， TC (Total cholesterol) raised（83.83%），Triglycerides raised（90.72%），LDL-C（Low density lipoprotein cholesterol）raised（77.50%），HDL-C（High density lipoprotein cholesterol）raised（63.05%），Blood viscosity raised（67.98%）；②Paroxysm period: ECG（Electrocardiogram）ST-T changed（77.59%），Protruded aortic arch（47.13%），Decrease of left ventricular compliance(ColorVascular Ultrasonography)（70.69%），Multiples raised of myocardial enzymology（60.51%），Multiples raised of troponin（55.58%），CAG（Coronary arteriography) stenosis76-90%（48.85%），High TC (Total cholesterol)（79.39%），High triglycerides（86.12%），High LDL-C（Low density lipoprotein cholesterol）（73.32%），HighHDL-C（High density lipoprotein cholesterol）（59.93%），Blood viscosity raised（90.80%）；③Remission period: ECG（Electrocardiogram） ST-T changed（55.25%），Normal X-ray performance（51.81%），Decrease of left ventricular compliance(ColorVascular Ultrasonography)（65.85%），Myocardial enzymology mildly elevated（43.92%），No change of troponin（45.24%），CAG（Coronary arteriography) stenosis51-75%（44.33%），High TC (Total cholesterol)（79.72%），High triglycerides（88.10%），High LDL-C（Low density lipoprotein cholesterol）（74.14%），HighHDL-C（High density lipoprotein cholesterol）（61.74%），Blood viscosity raised（60.92%）；④Recovery period：ECG（Electrocardiogram） ST-T changed（42.45%），Normal X-ray performance（51.81%），Decrease of left ventricular compliance(ColorVascular Ultrasonography)（58.46%），No change of myocardial enzymology（77.09%），No change of troponin（76.03%），CAG（Coronary arteriography) stenosis26-50%（39.08%），TC (Total cholesterol)reduced （65.76%），Triglycerides reduced（72.25%），LDL-C（Low density lipoprotein cholesterol）reduced（62.48%），HDL-C（High density lipoprotein cholesterol） reduced（55.50%），No change ofblood viscosity（44.91%）.3.The highest frequency of occurrence about other relevant factors(inducingfactors of coronary heart disease(CHD), change of emotional,season of easy tofall ill):①Early onset period: Overwork（83.99%）,Anxiety（dysphoria）（60.76%）,Winter（81.86%）；②Paroxysm period: Overwork（83.58%）,Fear（66.58%），Winter（89.33%）；③Remission period: Overwork（77.50%），Anxiety（dysphoria）（51.31%）,Winter（59.03%）；④Recovery period：Overwork（79.89%），Melancholy（42.12%），Winter（57.64%）.4.Main syndrome factors of coronary heart disease in the four stages (early onsetperiod,paroxysm period,remission period and recovery period) are qi stagnation,cold pathogen, phlegm and fluid retention, static blood, phlegm and retainedfluid, blood stasis, deficiency of heart yang, deficiency of heart qi，deficiencyof heart yin，deficiency of lung qi，deficiency of spleen qi，deficiency of spleen yang，deficiency of kidney yang，deficiency of kidney yin.The locating syndromefactors are heart，liver，spleen，lung，kidney.5.In the early onset phase, the syndrome features of coronary heart disease (CHD)are heart pain with syndrome of qi stagnating in chest and syndrome of deficiencyof both qi and yin，the frequency of syndromes are50.19%and49.81%. In theparoxysm phase, the syndrome features of coronary heart disease (CHD) aresyndrome of qi stagnation and phlegm blockade，syndrome of debilitated heartyang，heart pain with syndrome of yang deficiency and cold congelation andsyndrome of static blood and yang debility，the frequency of syndromes are21.80%，47.33%，13.71%and16.42%.In the remission phase, the syndrome features ofcoronary heart disease (CHD) are syndrome of disharmony between liver and spleen，syndrome of yang deficiency of heart and kidney and syndrome of qi deficiencyof heart and lung，the frequency of syndromes are20.20%，19.25%and60.55%.In the recovery phase, the syndrome features of coronary heart disease (CHD)are syndrome of deficiency of heart qi，syndrome of yang deficiency and qistagnation and syndrome of deficiency of both qi and yin，the frequency ofsyndromes are23.93%，40.52%and35.55%.6.There are so many affecting factors in coronary heart disease (CHD) earlyperiod.They are Aortic valvular regurgitation(Color Vascular Ultrasonography)（OR=2.702）, Aortic valvular sclerosis(Color Vascular Ultrasonography)（OR=1.632），No change of blood viscosity（OR=1.304），Aortic calcification(ColorVascular Ultrasonography)（OR=0.751），CAG（Coronary arteriography) stenosis0-25%（OR=0.748），No change of HDL-C（High density lipoprotein cholesterol）（OR=0.657），Pulmonary valve regurgitation(Color Vascular Ultrasonography)（OR=0.268），Overwork（OR=1.675），Overeating greasy food（OR=1.567），Depression（OR=1.347），Engorgement（OR=0.699），Sad（OR=1.872），Others（OR=1.827），Worry too much（OR=1.524），Anxiety（dysphoria）（OR=1.446），Panic（OR=0.711），Long summer（OR=1.624）and Spring（OR=1.299）in syndrome of qi stagnating inchest.And Pulmonary valve regurgitation(Color Vascular Ultrasonography)（OR=3.728），No change of HDL-C（High density lipoprotein cholesterol） （OR=1.522），CAG（Coronary arteriography) stenosis0-25%（OR=1.336），Aorticcalcification(Color Vascular Ultrasonography)（OR=1.332），No change of bloodviscosity（OR=0.767），Aortic valvular sclerosis(Color Vascular Ultrasonography)（OR=0.613），Aortic valvular regurgitation(Color Vascular Ultrasonography)（OR=0.370），Engorgement（OR=1.43），Depression（OR=0.743），Overeating greasyfood（OR=0.638），Overwork（OR=0.597），Panic（OR=1.406），Anxiety（dysphoria）（OR=0.692），Worry too much（OR=0.656），Others（OR=0.547），Sad（OR=0.534），Spring（OR=0.77），Long summer（OR=0.616）are the affecting factors with syndromeof deficiency of both qi and yin.7. The affecting factors are different from four syndromes in paroxysm phase.X-ray Right atrium hypertrophy (RAH)（OR=4.436），Myocardial enzymology reduced（OR=3.788），Blood viscosity reduced（OR=2.396），High TC (Total cholesterol)（OR=1.898），No change of troponin（OR=1.763），No change of myocardial enzymology（OR=1.752），CAG（Coronary arteriography) stenosis51-75%（OR=1.523），Aorticvalvular regurgitation(Color Vascular Ultrasonography)（OR=0.649），ECG（Electrocardiogram）Q wave or QS wave（OR=0.473），X-ray right ventricularhypertrophy（OR=0.420），Intemperance（OR=0.687），Melancholy（OR=1.48），Panic（OR=0.519），Summer（OR=1.505）effect the syndrome of qi stagnation and phlegmblockade. CAG（Coronary arteriography) stenosis51-75%（OR=0.780），Normal X-rayperformance（OR=0.759），No change of troponin（OR=0.507），Myocardial enzymologyreduced（OR=0.472），Overwork（OR=1.405），Other emotional change（OR=0.148）effect syndrome of debilitated heart yang. Other CAG（Coronary arteriography)situations（OR=2.232），No abnormal cardiac structure and blood flow(ColorVascular Ultrasonography)（OR=2.129），CAG （Coronary arteriography) stenosis100%（OR=1.519），No change of blood viscosity（OR=0.461），Fat（OR=1.778），Overwork（OR=0.52），Other emotional change（OR=4.449），Spring（OR=0.716），Summer（OR=0.572）effect syndrome of yang deficiency and cold congelation. Rightventricular hypertrophy of color Doppler Ultrasound（OR=2.287），No change oftriglycerides(Color Vascular Ultrasonography)（OR=1.979）， ECG （Electrocardiogram）Q wave or QS wave（OR=1.397），Valvula tricuspidalis regurgitation(Color Vascular Ultrasonography)（OR=0.480），No abnormal cardiacstructure and blood flow(Color Vascular Ultrasonography)（OR=0.469），Triglycerides reduced（OR=0.392），Other CAG（Coronary arteriography) situations（OR=0.293），Other inducing factors（OR=0.311），Panic（OR=1.963），Worry toomuch（OR=0.64）effect syndrome of static blood and yang debility.8. The affecting factors are different from three syndromes in remission phase.High triglycerides （OR=1.829）， Mitral regurgitation(Color VascularUltrasonography)（OR=0.678），CAG（Coronary arteriography) stenosis0-25%（OR=0.646），X-ray left atrial enlargement（OR=0.600）effect syndrome ofdisharmony between liver and spleen. X-ray right ventricular hypertrophy（OR=0.395），Cold（OR=1.565），intemperance（OR=0.691） effect syndrome of yangdeficiency of heart and kidney. X-ray left atrial enlargement（OR=1.609），Troponin reduced（OR=1.467），ECG（Electrocardiogram） ST-T changed（OR=1.374），High triglycerides（OR=0.681）effect syndrome of qi deficiency of heart and lung.9. The affecting factors are different from three syndromes in remission phase.Left ventricular hypertrophy of color Doppler Ultrasound（OR=1.529），TC (Totalcholesterol) reduced（OR=0.705），No change of HDL-C（High density lipoproteincholesterol）（OR=0.668）effect syndrome of deficiency of heart qi. X-ray Rightatrium hypertrophy (RAH)（OR=3.933），Pulmonary valve regurgitation(ColorVascular Ultrasonography)（OR=0.350），Engorgement（OR=1.604），Frenzy（angry）（OR=0.719） effect syndrome of yang deficiency and qi stagnation. Multiplesraised of troponin（OR=2.710），ECG（Electrocardiogram）ST-T changed（OR=1.297），X-ray Left ventricular hypertrophy（OR=0.724），X-ray Right atrium hypertrophy(RAH)（OR=0.368）effect syndrome of deficiency of both qi and yin.Conclusion：1.According to factor analysis,we summarized the main syndrome factors ofcoronary heart disease (CHD).They are qi stagnation, cold pathogen, phlegm andfluid retention, static blood, deficiency of heart yang, deficiency of heartqi，deficiency of heart yin，deficiency of lung qi，deficiency of spleen qi， deficiency of spleen yang，deficiency of kidney yang，deficiency of kidneyyin.The locating syndrome factors are heart，liver，spleen，lung，kidney.2. Combining with factor analysis and Logistic regression analysis,we concludethe coronary heart disease (CHD) syndrome features that check the clusteringanalysis results and prove the consistency from the angle of methodology.Thatcan enrich and perfect the syndromes diagnosis research on coronary heart disease(CHD),make them normalization and standardization.The syndrome features aredifferent from each phase. In the early phase, the syndrome features are syndromeof qi stagnating in chest and syndrome of deficiency of both qi and yin. In theparoxysm phase, the syndrome features are syndrome of qi stagnation and phlegmblockade，syndrome of debilitated heart yang，syndrome of yang deficiency andcold congelation and syndrome of static blood and yang debility.In the remissionphase, the syndrome features are syndrome of disharmony between liver and spleen，syndrome of yang deficiency of heart and kidney and syndrome of qi deficiencyof heart and lung. In the recovery phase, the syndrome features are syndromeof deficiency of heart qi，syndrome of yang deficiency and qi stagnation andsyndrome of deficiency of both qi and yin.3. Coronary heart disease By means of factor analysis and Logistic regressionanalysis, we got major syndrome factors of coronary heart disease（CHD）andthe primary symptoms, secondary symptoms and accompanied symptoms about12syndromes in the four stages. And then, we established statistics models ofsymptoms related to syndromes. Also revealed the relevance and specificitybetween syndromes and syndromes of their primary symptoms, secondary symptomsand accompanied symptoms. From the perspective of methodology, we tested andverifyed that application of combining factor analysis and Logistic regressionanalysis were the effective method on the research of syndromes in TCM. Thatstructured and optimized the quantitative criteria of coronary heart disease（CHD）syndromes. It provided the basis for the standardization andobjectification research on binding of disease and syndrome diagnosis ofcoronary heart disease（CHD）. 4. According to establishing statistics models with coronary heart disease（CHD）syndromes, objective laboratory indexes and other relevant factors, we singledout the objective indexes and influencing factors that distinct specificallyfrom a unique syndrome. The systematic research and evaluation were objectivelaboratory indexes, the natural environment, modern change and psychologicalfactors up from qualitative and location research of coronary heart disease（CHD）syndromes. That reflected overall and synthetical thought and cognitiveviews with attaching great importance to the spiritual level and externalenvironment impact syndromes. From the above, it is beneficial tocomprehensively reveal the rules and essence of syndrome which is relativelystable and repeatable, and then promote the objectification development processof syndrome research on coronary heart disease（CHD）.更多还原