冠心病稳定期“瘀毒”临床表征的研究

作者	单位
徐浩	中日友好医院全国中西医结合心血管病中心
曲丹	北京中医药大学
郑峰	北京中医药大学
史大卓	中国中医科学院西苑医院
陈可冀	中日友好医院全国中西医结合心血管病中心；中国中医科学院西苑医院

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中文摘要:

目的在"瘀毒致变"假说基础上,以随访是否发生心血管事件为依据,探索冠心病稳定期患者"瘀毒"临床表征。方法选择经冠脉造影确诊的冠心病且处于症状稳定期的患者254例,详细记录临床资料并随访1年,对随访心血管事件与个人史、体质特点、既往史、家族史、症状、体征、证候、实验室指标等进行单因素分析和Logistic多元逐步回归分析。结果254例患者中,随访期间失访2例,无死亡及急性心肌梗死患者,3例行介入治疗,25例因不稳定性心绞痛住院。Logistic多元逐步回归分析显示:脉涩或结代、胸骨后疼痛、平素咽痛及头痛是随访心血管事件的重要影响因素(P<0.05)。超敏C反应蛋白(hs-CRP)≥3mg/L也显示有增加随访心血管事件发生的趋势(P=0.094)。结论胸骨后疼痛、头痛、脉涩或结代(血瘀征象)及平素经常咽痛、hs-CRP增高(提示机体有慢性炎症反应,是"毒"的征象)可考虑作为冠心病稳定期患者"瘀毒"临床表征,进一步扩大样本完善"瘀毒"临床表征将为应用活血解毒法干预高危患者提供依据,值得深入研究。

英文摘要:

Objective To explore the clinical manifestations of "blood-stasis and toxin" (BST) in patients with stable coronary heart disease (CHD) on the basis of "BST Causing Catastrophe" hypothesis, by analyzing the occurrence of acute cardiovascular events (ACEs) in a one-year follow-up period. Methods Two hundred and fifty-four CHD patients in stable stage, whose diagnosis confirmed by coronary arteriography, were followed-up for one year with their clinical data recorded detailedly. The relationship between the occurrence of ACEs and personal history, body constitution, past history of illness, family history, clinical symptoms, physical signs, syndrome types and laboratory indexes were analyzed by single-variate and multivariate logistic stepwise regression method. Results During the follow-up period, two cases out of the 254 patients were lost, no case of death or acute myocardial infarction was seen, three cases underwent percutaneous coronary intervention, and 25 cases were hospitalized for unstable angina. Multivariate logistic regression analysis showed that hesitant or intermittent pulse, retrosternodynia, usual pharyngodynia and headache were the most important influencing factors for occurrence of ACEs (P<0.05). High-sensitivity C-reactive protein (hs-CRP)≥3 mg/L also indicated a predictive trend for ACEs occurrence, although logistic analysis showed no statistics difference (P=0.094). Conclusion Retrosternodynia, headache, hesitant or intermittent pulse, usual pharyngodynia and increased hs-CRP might be taken as the clinical manifestations of BST, which provides a basis for applying Chinese medicine intervention (activating blood circulation and detoxifying) on high-risk CHD patients. Further demonstration is needed.

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