【作者】 杨海霞；

【导师】 洪永敦；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2009， 硕士

【摘要】 目的研究冠心病痰瘀证与多种因素的相关性,探求冠心病痰瘀证的客观实质,为临床研究和决策提供线索和依据。方法采集2006年2月—2009年2月在广州中医药大学第一附属医院心血管内科的住院病例,入选病例共163例,将冠心病患者分为痰瘀证组（87例）及非痰瘀证组（48例）,并设立正常组作为对照（28例）,完整收集病例资料,应用SPSS 17.0软件包建立数据库管理,对于计数资料,采用卡方检验,两两比较用卡方分割法;对于计量资料,两组资料比较采用T检验,三组资料比较采用单因素方差分析,若存在显著性差异,再进行多重检验进行两两比较。根据各观察指标的转换赋值表,进行Binary logistic回归分析,得出回归方程,并对回归模型进行似然比检验,评价模型的预测效果。结果1、痰瘀证为冠心病的主要证型,冠心病患者中痰瘀互结证占37.0%,瘀证占15.6%,痰证占11.9%,非痰瘀证占35.5%。2、三组之间性别及年龄构成无显著性差异（P＞0.05）;冠心病痰瘀证组的体重指数较其它两组高,痰瘀证组与正常组、痰瘀证组与非痰瘀证组之间两两比较,P值均小于0.05,有显著性差异。3、在高血压病史、糖尿病病史、血脂异常史方面,冠心病痰瘀证组与正常组、冠心病非痰瘀证组与正常组比较,均有显著性差异（P＜0.05）;冠心病痰瘀证组与非痰瘀证组在高血压病史、血脂异常史方面进行比较有显著性差异（P＜0.05）,两组在糖尿病病史方面进行比较无显著性差异（P＞0.05）。4、冠心病痰瘀证组与非痰瘀证组的症候计分比较具有显著性差异（P＜0.01）,痰瘀证组的症候计分较高。5、三组的白细胞总数、中性粒细胞百分比、空腹血糖及餐后2h血糖比较均无显著性差异（P＜0.05）。6、痰瘀证组的TC、TG、LDL均有不同程度的升高,HDL有所降低;痰瘀证组与正常组、痰瘀证组与非痰瘀证组在TC、TG、LDL水平进行比较均有显著性差异（P＜0.05）,而在HDL水平进行比较均无显著性差异（P＞0.05）。7、冠心病痰瘀证组与正常组在CRP、TNF-α、IL-6、MMP-9、SCD40L、ICAM-1水平方面比较均有显著性差异（P＜0.05）;与非痰瘀证组在CRP、TNF、IL-6、SCD40L、ICAM-1水平方面比较均有显著性差异（P＜0.05）。8、痰瘀证组与非痰瘀证组冠脉的病变支数比较具有显著性差异（P＜0.05）。9、对与冠心病痰瘀证相关的26项因素进行Binary Logistic回归分析,得出回归方程为:冠心病痰瘀证P=1/1+e⁽-（-19.213+1.051×血脂异常史+2.226×症候计分+0.740×BMI+1.215×TC+1.092×TG+0.672×CRP+2.182×IL-6+2.851×SCD40L+1.918×ICAM-1+0.803×冠脉病变支数）回归过程中各部分的似然比检验的P值均小于0.05,回归方程的总体预测准确率达94.0%。结论痰瘀证为冠心病的主要证型;在其相关的危险因素研究中,体重指数、高血压及血脂异常与冠心病痰瘀证的关系密切;冠心病痰瘀证组的症候计分较高,冠脉病变以多支病变为主,冠脉病变程度较重;血脂四项中TC、LDL水平的升高与冠心病痰瘀证的发病有密切的关系;炎症因子中CRP、TNF-α、IL-6、SCD40L、ICAM-1水平与冠心病痰瘀证的关系密切,此六项指标的升高对冠心病痰瘀证的影响较大;最终的Binary Logistic回归方程为:冠心病痰瘀证P=1/1+e⁽-（-19.213+1.051×血脂异常史+2.226×症候计分+0.740×BMI+1.215×TC+1.092×TG+0.672×CRP+2.182×IL-6+2.851×SCD40L+1.918×ICAM-1+0.803×冠脉病变支数）,该方程的总体预测准确率达94.0%,预测效果较好。更多还原

【Abstract】 Objective To study dependablity of the multiple factor and phlegm blood stasis syndrome（PBSS） of coronary heart disease（CHD）,to explore the substance of the objective evidence of Phlegm and blood stasis of coronary heart disease, to provide clues and evidence for the research and decision for clinicalMethod To Collect data of in-patient cases of cardiovascular endemic area in First Affiliated Hospital Guangzhou University of Traditional Chinese Medicine from January 2008 to March of 2009,A total of 163 cases is selected,which be divided into in group of PBSS（87 cases） and group of nonphlegm and blood stasis syndrome（NPBSS）（48 cases）,And the normal group（28 cases）,to collection completely information of cases,to establish of database management with software packages SPSS17.0,For count data,using chi-square test,Data for between each two groups,should be compared with chi-square partitioning;the measurement data,which between the two groups was compared using T test,and which for three sets of data wan used one-way ANOVA.if there was a significant difference,for Data for between each two groups,should be carried on the multiple examinations.According to each observation target evaluation table,all data was carried on Binary the logistic regression analysis.Then we can obtain the regression equation,the regression model should be carried on the likelihood ratio examination,and be evaluated for model forecast effect.Result1.The Phlegm and blood stasis is the main Syndrome of CHD.In patient of CHD, the phlegm stasis tiescard account for 37.0%mutually,the stasis accounts card for 15.6%,the phlegm card accounts for 11.9%,the non-phlegm stasis card accounts for 35.5%.2.Three groups of sexes and age structure were non-significance difference （P＞0.05）.coronary disease phlegm stasis group’s body weight index was higher compared with other two groups.The data was compared between the group of PBSS with the normal group,and group of PBSS with the group of NPBSS,the two P value is smaller than 0.05.The results have the significance difference.3.For hypertension medical history,diabetes medical history,blood fats unusual history,the result has the significance difference（P＜0.05） between group of PBSS of CHD with the normal group,and group of PBSS of CHD compares with the normal group.4.For hypertension medical history,blood fats unusual history,the result has the significance difference（P＜0.05） between group of PBSS of CHD with the group of nPBSS of CHD.and has no significance difference for diabetes medical history.5.The group of PBSS of CHD has the significance difference with group of NPBSS of CHD in aspect of symptom scoring comparison（P＜0.05）.The group of PBSS scoring is higher.6.The results of three group of comparison have not the significance difference（P＞0.05）,in comparison in white blood cell total,neutral granular cell percentage,empty stomach blood sugar and meal,blood sugar.7.The comparison between group of PBSS of CHD with the normal group in aspect of the Level of CRP,TNF,IL-6,MMP-9,SCD40L and ICAM-1 was different obviously （P＜0.05）,which between group of PBSS of CHD with group of NPBSS of CHD had no significance difference in aspect of the Level of CRP,TNF,IL-6,SCD40L and ICAM-18.The result by comparison group of PBSS of CHD with t group of NPBSS of CHD in the count of crown arteries which have pathological change had the significance difference（P＜0.05）.9.The twenty-sixfactors related with phlegm stasis card of coronary disease were carried on the Binary Logistic regression analysis,then the regression equation is obtains,that is of the phlegm stasis of cardoronary disease P =1/1+e^{-（-19.213+1.051×history of blood fat abnormality +2.226×symptom sores +0.740×BMI +1.215×TC+1.092×TG+0.672×CRP+2.182×IL-6+2.851×SCD40L+1.918×ICAM-1+0.803×count of pathological crown arteries）} The P value for likelihood ratios to examine of all parts in the process of regression analysis was smaller than 0.05.The overall rate of accuracy to predicted by the regression equation reached 94.0%.Conclusion Phlegm and blood stasis is the main Syndrome of CHD.In research to its hazard factors,the body weight index,hypertension and the blood fats are exceptionally closed with group of PBSS of CHD.Symptom scoring of group for PBSS is higher.Coronary artery pathological change of PBSS is by multi-pathological changes primarily,which coronary artery’s pathological change degree is heavier.The morbility of PBSS of CHD has closed relationship with the rised level of TC、LDL in blood fats four items.PBSS of CHD has closed relationship with the level of CRP、TNF、IL-6、SCD40L、ICAM-1 in Inflammation factorsHorizontal elevation of that six indexes has the important influence with the PBSS of CHD.The final Binary Logistic regression equation for PBSS of CHDis: P=1/1+e^{-（-19.213+1.051×history of blood fat abnormality+2.226×symptom sores +0.740×BMI +1.215×TC+1.092×TG+0.672×CRP+2.182×IL-6+2.851×SCD40L+1.918×ICAM-1+0.803×count.of pathological crown arteries）} The overall rate of accuracy to predicted by the regression equation reached 94.0%.Which forecast effect is good.更多还原