节点文献
冠心病稳定期中医证候特点的研究
【作者】 张琳；
【导师】 徐浩；
【作者基本信息】 北京中医药大学 ， 中西医结合内科， 2009， 硕士
【摘要】 本论文主要包括文献综述和临床研究两个部分。文献综述:目的分析近10余年冠心病中医证候分布特点,为临床辨治提供参考依据。方法以“冠心病AND证”为关键词就1994-2008年在国内正式期刊上公开发表的冠心病辨证治疗及辨证分型的文献进行统计分析,采用证候要素分析研究冠心病的证候特点。结果符合入选要求文献95篇,入选病例14210例。冠心病总体证候及冠心病心绞痛证候分布涉及8个证候要素,频率由高至低依次为:血瘀、气虚、痰浊、阴虚、气滞、阳虚、寒凝、热蕴,其中血瘀、气虚、痰浊、阴虚、气滞、阳虚6个证候要素检出率大于10%。南、北方患者主要证候要素(包括痰浊)分布未见明显差异。结论:近10余年冠心病常见证候要素依次为:血瘀、气虚、痰浊、阴虚、气滞、阳虚、寒凝、热蕴,反映了冠心病本虚标实的病机,南、北方患者未见明显差异。与上一10年间比较,痰浊、热蕴患者有所增加。今后应加强对冠心病不同人群的证候分布比较分析及证候动态演变规律的研究。临床研究:目的分析冠心病稳定期患者中医证候分布特点及规律,为临床辨治提供参考依据。方法对既往有陈旧心梗病史或经冠脉造影检查确诊的346例冠心病稳定期患者进行横断面调查。中医辨证分型参照中国中西医结合学会心血管学会1990年10月修订的“冠心病中医辨证标准”进行,分为血瘀、痰浊、气滞、寒凝、气虚、阳虚、阴虚7个证候要素。采用列联表分析及Logistic多元回归分析方法,结合性别、年龄、既往史、个人史(饮食特点、烟酒嗜好、性格类型、职业性质等)、家族史等对冠心病稳定期患者总体人群及不同亚组人群的证候特点进行分析。结果1、一般资料分析:346例冠心病稳定期患者中,男性254人,女性92人,男女比例大于2:1;平均年龄60.82±9.616岁,以中老年人为主;有冠心病家族史者126人,占36.4%;合并高脂血证患者260人,占75.1%;合并高血压的223人,占64.5%;合并糖尿病的121人,占35.0%;有吸烟史的196人,占56.6%;肥胖患者(体重指数＞28)63人,占18.2%,A型性格278人,占80.3%。2、常见症状的分布特点:对346例冠心病患者所有主症、兼症进行统计,结果显示,最常见10个症状依次为:眼花＞乏力＞气短＞胸闷＞耳鸣＞口干欲饮＞心悸＞腰酸＞头晕＞胸痛。3、舌、脉象特点分析:大部分患者都表现为舌质暗红/淡暗/淡紫/紫暗/青紫,几乎所有患者都有舌下络脉异常,表现为脉形粗胀或曲张,脉色青紫或紫红。绝大多数患者有胖大/齿痕舌,在此基础上多有腻苔或裂纹。脉象以弦脉、沉脉多见,两者均为191例,占55.2%;其次是滑脉146例,占42.2%、细脉111例,占32.1%、弱脉31例,占9.0%、数脉15例,占4.3%;较少出现的脉象是涩脉5例、缓脉5例、结脉2例和其他脉象3例。4、中医辨证分型情况:346例冠心病稳定期患者涉及7个证候要素,频率由高至低依次为:血瘀(94.2%)、气虚(45.4%)、痰浊(39.0%)、阳虚(34.4%)、阴虚(15.0%)、气滞(7.2%)、寒凝(0.3%),且多为2证或3证相兼,其中以气虚血瘀、阳虚血瘀、痰浊血瘀、气虚痰浊血瘀、阳虚血瘀痰浊为多见。5、中医证候分布特点及规律:冠心病稳定期患者辨证血瘀者以老年人和有冠心病家族史的病人居多;辨证痰浊的多有高脂血症、吸烟史或经常劳累过度;辨证痰热的多合并高脂血症;辨证气滞的嗜食甜食者多;辨证气虚的以劳累性心绞痛居多;辨证为阴虚的大多有心梗史;而辨证阳虚的大多有糖尿病家族史,并与职业性质相关,按辨证阳虚的风险大小依次为脑力体力兼有＞体力劳动为主＞脑力劳动为主。结论综合冠心病稳定期患者症状及舌脉特点,中医证候以本虚标实为特点,且多为复合证候,标实证候要素以血瘀、痰浊多见,其次为气滞、寒凝,本虚证候要素以气虚、阳虚为主,其次为阴虚。不同人群的证候分布有其特点和规律,对冠心病稳定期患者的临床辨治具有一定参考价值,值得深入研究。
【Abstract】 In this paper,including literature review and clinical research in two parts.Literature Review:Objective:To analyse coronary heart disease(CHD)over the past 10 years the distribution of the characteristics of traditional Chinese medicine(TCM) syndromes,in order to provide reference for the Clinical Diagnosis and Treatment.Method:With“coronary heart disease AND syndrome”for the words on the years 1994-2008 in the domestic official journal published the treatment of CHD and syndrome differentiation-based statistical analysis of the literature,use the syndrome factor to analyse characteristics of CHD syndromes.Results:Selected in line with the requirements of 95 documents,14,210 cases of selected cases.The syndromes of the distribution of Overall and angina pectoris syndrome of CHD related 8 syndrome factors,frequency of high to low as follows: blood stasis,Qi deficiency,phlegm turbidity,Yin deficiency,Qi stagnation,Yang deficiency,cold coagulation and heat,in which blood stasis,Qi deficiency, phlegm turbidity,Yin deficiency,Qi stagnation,Yang deficiency syndromes six factors of the detection rate of greater than 10%.South,North syndromes in patients with major factors(including phlegm turbidity)no significant difference in the distribution.Conclusion:Over the past 10 years,CHD syndromes common factors were as follows:blood stasis,Qi deficiency,phlegm turbidity,Yin deficiency,Qi stagnation,Yang deficiency,cold coagulation and heat,reflecting the pathogenesis of CHD is root insufficiency and surface hyperactivity.South, patients with no significant difference in the north.And the last 10 years, compared with phlegm turbidity,heat implies an increase in patients.Should be strengthened for future CHD syndromes in different populations and comparative analysis of the distribution of the dynamic evolution Syndrome research.Clinical Research:Objective:To analyze the patients with stable CHD syndromes of TCM and the law of distribution,in order to provide reference for the Clinical Diagnosis and Treatment.Method:Of the past have a history of old myocardial infarction or coronary angiography in 346 cases of diagnosed CHD patients with stable cross-sectional survey.TCM Syndrome Differentiation in the light of the Chinese Society of Cardiovascular Institute of Integrated Traditional and Western Medicine in October 1990 revised“TCM standard CHD”,and is divided into blood stasis, phlegm turbidity,Qi stagnation,cold coagulation,Qi deficiency,Yang deficiency and Yin deficiency 7 factors of a syndrome.Using crosstabs analysis and Logistic multiple regression analysis method,combined with gender,age,past history, personal history(diet characteristics,tobacco and alcohol habits,personality types, professional nature,etc.),family history of CHD in patients with stable stage the overall population and different population sub-group of syndromes characterized by the analysis.Results:1,the general data analysis:346 cases of patients with stable CHD,male 254, female 92,male to female ratio greater than 2:1;the average age of 60.82±9.616 years old,mainly in middle-aged and elderly;have a family history of CHD 126 persons,accounting for 36.4%;the combined 260 patients with Hyperlipidemia disease,accounting for 75.1%;of 223 people with Hypertension,accounting for 64.5%;of 121 people with Diabetes,accounting for 35.0%;a smoking history of 196,accounting for 56.6%;obese patients(body mass index(BMI)＞28)63 people, accounting for 18.2%,A-type character of 278,accounting for 80.3%).2,the distribution of common symptoms:patients with CHD of 346 cases of all the main disease,and disease statistics,results showed that the 10 most common symptoms were:dizziness＞weak＞shortness of breath＞chest tightness＞Tinnitus＞dry mouth for drink＞palpitations＞lumbar acid＞vertigo＞chest pain.3,tongue,pulse characteristics of analysis:the majority of patients were manifested as tongue dark red/short dark/faint purple/dark purple/black purple, almost all have the sublingual venae with abnormal performance for the rough-shaped bulging veins or varicose,black purple or purple colored veins.The vast majority patients with obese large/teeth marked tongue,on the basis of this, many have greasy moss or crack.In pulse,string pulse and under pulse are common,both of which are 191 cases,accounting for 55.2%;Slippery pulse followed by 146 cases,accounting for 42.2%,111 cases of a minor pulse, accounting for 32.1%,31 cases of weak pulse,accounting for 9.0%,15 cases of fast pulse,accounting for 4.3%;less appears is 5 cases of not smooth pulse,5 cases of relief pulse,2 cases of node clock pulse and other kind of pulses three cases.4,the situation of TCM Syndrome Types:346 cases of stable CHD patients involving 7 syndrome factors,the frequency of high to low as follows:blood stasis (94.2%),Qi deficiency(45.4%),phlegm turbidity(39.0%),Yang deficiency (34.4%),Yin deficiency(15.0%),Qi stagnation(7.2%),cold coagulation(0.3%), and most patients have 2 or 3 syndromes,with Qi deficiency and blood stasis, Yang deficiency and blood stasis,phlegm turbidity and blood stasis,qi deficiency phlegm turbidity and blood stasis,Yang deficiency phlegm turbidity and blood stasis is often.5,the law and distribution of the characteristics of TCM syndromes:in patients with stable CHD and blood stasis have the elderly and patients with a family CHD history of the majority;phlegm heat syndrome of many Hyperlipidemia disease, smoking history or frequently overwork;Qi stagnation syndrome combined with sweet preferable;Qi deficiency syndrome exertion angina in the majority;Yin deficiency syndrome most have myocardial infarction history;and the most Yang deficiency syndrome have Diabetes family history and the relevant to the nature of professional,according to the size of the risk of Yang deficiency followed by a combination of mental strength＞mainly manual＞mainly mental.Conclusion:Comprehending stable CHD patients with symptoms and characteristics of the tongue and pulse,the TCM Syndrome is characterized by root insufficiency and surface hyperactivity,and more complex syndromes, surface hyperactivity factors to blood stasis,phlegm turbidity often,followed by Qi stagnation,cold coagulation,the root insufficiency factors of Qi deficiency, Yang deficiency,followed for the Yin deficiency.Syndromes of different distribution of population has its own characteristics,and to patients with stable CHD clinical diagnosis and treatment has a certain reference value,it is worth in depth study.