摘要
目的探讨颈动脉狭窄的中医证候分布及其冠心病的危险因素。方法回顾性分析2015年1月至2016年12月中国中医科学院西苑医院经超声诊断为颈动脉硬化患者的临床资料,统计颈动脉狭窄程度,收集患者一般资料、西医诊断、中医证候诊断、脑钠肽(BNP)等,根据西医诊断记录疾病。分析颈动脉不同狭窄程度的中医证候分布及其与BNP、冠心病的关系。结果最终纳入557例颈动脉狭窄患者,其中轻度狭窄437例、中度狭窄98例、重度狭窄22例。证候分布方面,重度狭窄组痰瘀互结证的比例高于轻度狭窄组[40.91%(9/22)比16.25%(71/437)],中度狭窄组痰浊内阻证的比例高于轻度狭窄组[13.27%(13/98)比5.95%(26/437)](P<0.05)。中度和重度狭窄组不稳定型心绞痛比例高于轻度狭窄组,重度狭窄组心力衰竭、冠心病的比例高于轻度狭窄组(P<0.05)。轻度狭窄组入院时BNP≥400 ng/L的比例为14.97%(50/334),中度狭窄组为31.51%(23/73),重度狭窄组为20.00%(4/20),中度狭窄组BNP升高的比例高于轻度狭窄组(P<0.01)。多因素Logistic回归分析结果显示,颈动脉重度狭窄、BNP水平升高是颈动脉狭窄患者发生冠心病的独立危险因素(OR=3.854,95%CI 1.355~10.961,P=0.011;OR=2.067,95%CI 1.230~3.475,P=0.006)。结论颈动脉狭窄程度加重与痰瘀互结证密切相关,颈动脉重度狭窄的冠心病风险最高,颈动脉重度狭窄、BNP升高是颈动脉狭窄患者发生冠心病的独立危险因素,可能为冠心病的早期预防与诊治提供依据。
Objective To analyze the distribution of traditional Chinese medicine(TCM)syndromes of carotid artery stenosis and its risk factors for coronary heart disease.Methods A retrospective analysis of clinical data of patients diagnosed with carotid atherosclerosis by ultrasonography in Xiyuan Hospital of China Academy of Chinese Medical Sciences from Jan.2015 to Dec.2016 was conducted.We collected the information of carotid artery stenosis degree,general information,western medicine diagnosis,TCM syndrome diagnosis and brain natriuretic peptide(BNP)level,and the diseases were recorded according to western medicine diagnosis.Then distribution of TCM syndromes of carotid artery stenosis,and its relationship with BNP level and coronary heart disease were analyzed.Results Finally,557 patients with carotid artery stenosis were included,including 437 cases of mild stenosis,98 cases of moderate stenosis,and 22 cases of severe stenosis.In terms of syndrome distribution,the proportion of phlegm-stasis cementation in the severe stenosis group was higher than that in the mild stenosis group[40.91%(9/22)vs 16.25%(71/437)],and the proportion of phlegm-turbid internal resistance in the moderate stenosis group was higher than that in the mild stenosis group[13.27%(13/98)vs 5.95%(26/437)](P<0.05).The proportions of unstable angina in the moderate and severe stenosis group were higher than that in the mild stenosis group,and the proportion of heart failure and coronary heart disease in the severe stenosis group was higher than that in the mild stenosis group(P<0.05).The rate of BNP≥400 ng/L upon admission was 14.97%(50/334)in the mild stenosis group,31.51%(23/73)in the moderate stenosis group,20.00%(4/20)in the severe stenosis group,and the proportion of elevated BNP levels in the moderate stenosis group was higher than that in the mild stenosis group(P<0.01).Multivariate Logistic regression analysis showed that the carotid artery severe stenosis and high BNP level were independent risk factors of coronary heart disease in carotid artery stenosis patients(OR=3.854,95%CI 1.355-10.961,P=0.011;OR=2.067,95%CI 1.230-3.475,P=0.006).Conclusion The aggravating degree of carotid artery stenosis has close relationship with phlegm-stasis cementation syndrome.Carotid artery severe stenosis links to the highest risk of coronary heart disease,and carotid artery severe stenosis and high BNP level are independent risk factors of coronary heart disease in carotid artery stenosis patients,which may provide basis for the early prevention,diagnosis and treatment.
作者
关晶波
袁蓉
丛伟红
GUAN Jingbo;YUAN Rong;CONG Weihong(Department of Ultrasonography,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China;Cardiovascular Laboratory,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China;National Clinical Research Center for Chinese Medicine Cardiology,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China)
出处
《医学综述》
2021年第1期189-193,198,共6页
Medical Recapitulate
基金
中国中医科学院基本科研业务费自主选题项目(ZZ11-061)。
关键词
颈动脉粥样硬化
颈动脉狭窄
中医证候
冠心病
危险因素
Carotid atherosclerosis
Carotid artery stenosis
Traditional Chinese medicine syndromes
Coronary heart disease
Risk factors
