Abstract:

Objective　To explore the correlation between the degree of coronary artery stenosis in the dual source CT examination results of thoracic obstruction patients in the real world and the different types of traditional Chinese medicine (TCM) syndrome differentiation. Methods　This study collected general information, examination information, and diagnostic information of 431 patients with thoracic obstruction who underwent cardiac dual-source CT examination at Traditional Chinese Medicine Department, The First Affiliated Hospital of PLA Air Force Military Medical University from July 1, 2011 to December 31, 2021. Circulation software was used to analyze the stenosis site of coronary artery and the degree of intraluminal stenosis. The percentage of each stenosis lesion was recorded and measured. The age and gender of the patients and the distribution of TCM syndrome types were analyzed, and the relationship between thoracic obstruction syndrome types and the degree of coronary artery stenosis was explored. χ² test was used for statistical analysis. Results　A total of 431 patients were included, including 215 males and 216 females. The age range was concentrated between 22 and 81 years old, with an average of 57.28 years old. There were 45 cases <45 years old, 219 cases 45-60 years old, and 167 cases >60 years old. There were 89 cases (20.6%) of heart and blood stasis obstruction, 88 cases (20.4%) of phlegm turbidity obstruction, 65 cases (15.1%) of qi and yin deficiency, 57 cases (13.2%) of heart and kidney yang deficiency, 54 cases (12.5%) of qi stagnation and cardioplegia, 41 cases (9.5%) of heart and kidney yin deficiency, and 37 cases (8.6%) of cold coagulation heart meridian. There were 35 cases (8.1%) of grade 0 coronary artery stenosis, 94 cases (21.8%) of grade 1 stenosis, 111 cases (25.8%) of grade 2 stenosis, 101 cases (23.4%) of grade 3 stenosis, and 90 cases (20.9%) of grade 4 stenosis. Blood stasis obstruction and phlegm turbidity obstruction were more common in grade 3 and grade 4 stenosis of various empirical syndrome types, and were positively correlated with the degree of stenosis. There was no significant difference in the degree of stenosis of the cold coagulation heart meridian, while the qi stagnation heart chest syndrome was more common in grade 1-3 stenosis. The types of deficiency syndromes, including qi yin deficiency, heart kidney yin deficiency, and heart kidney yang deficiency, were mostly distributed in grade 1-2 coronary artery stenosis. The incidence rates of each syndrome type in different degrees of stenosis were statistically different (χ²=111.370, P<0.001). Conclusion　There is a clear correlation between various TCM syndromes and the degree of coronary artery stenosis in patients with thoracic obstruction.

Key words:

Thoracic obstruction, Cardiac dual source CT, Traditional Chinese medicine syndrome type, Degree of coronary artery stenosis

摘要：

目的　探究真实世界中胸痹患者心脏双源CT检查结果中冠状动脉狭窄程度与中医辨证分属不同证型的相关性。方法　收集2011年7月1日至2021年12月31日在中国人民解放军空军军医大学第一附属医院中医科进行心脏双源CT检查的431例胸痹患者一般资料、诊断及检查结果行回顾性分析，确定冠状动脉狭窄部位，测量并评价管腔的狭窄程度。分析患者的年龄和性别、中医证型分布情况，探讨胸痹各证型与冠状动脉狭窄程度之间的关系。采用χ²检验进行统计分析。结果　共纳入胸痹患者431例，其中男215例、女216例；年龄22～81岁，平均57.28岁；<45岁45例，45～60岁219例，>60岁167例。中医证型：心血瘀阻证89例（20.6%）、痰浊闭阻证88例（20.4%）、气阴两虚证65例（15.1%）、心肾阳虚证57例（13.2%）、气滞心胸证54例（12.5%）、心肾阴虚证41例（9.5%）、寒凝心脉证37例（8.6%），无正虚阳脱证患者。冠状动脉狭窄程度：0级（狭窄0%）35例（8.1%）、1级（狭窄1%～24%）94例（21.8%）、2级（狭窄25%～49%）111例（25.8%）、3级（狭窄50%～69%）101例（23.4%）、4级（狭窄70%～99%）90例（20.9%），无5级（狭窄100%）患者。实证证型中的心血瘀阻证、痰浊闭阻证以3、4级狭窄多见（且与狭窄程度呈正相关），气滞心胸证以1～3级狭窄多见，寒凝心脉证的各狭窄程度无明显差异。虚证证型中的气阴两虚证、心肾阳虚证、心肾阴虚证多分布于1～2级狭窄。不同狭窄程度的中医证型比较，差异有统计学意义（χ²=111.370，P<0.001）。结论　胸痹患者冠状动脉狭窄程度与各中医证型呈显著相关性。

关键词:

胸痹, 心脏双源CT, 中医辨证分型, 冠状动脉狭窄程度