The Study Of Distribution Of Chinese Medicine Syndromes In Coronary Heart Disease Angina And Relativity Between The Syndromes And Objective Indicators

ObjectiveThe aim of the study is to explore the syndrome distribution of coronary heart disease angina. And through relative researches of heart structure, heart function and the TCM syndrome patterns of coronary heart disease angina, trying to find some peculiar indexs and leading them to the TCM differentiation of coronary heart disease angina. These indexes which make the differentiation more practical can help unify the differentiation standard and provide reliable basis for clinical trearment.MethodsCollecting281patients with coronary heart disease angina in Guangzhou University of Chinese Medicine Second School of Clinic Medicine from March2012to February2013. Taking the clinical symptoms, tongue Picture, pulse condition of these patients with coronary heart disease angina as the dialectical basis, dividing the patients by differentiation standard, comfirming the syndrome distribution of coronary heart disease angina. Selecting randomly some patients from each syndrome pattern as the study group, in addition, selecting20healthy Persons as control group, all subjects received cardiac structral and functional examination with Doppler ultrasonic cardiogram a week before the treatment. Analyzing the relationship of heart structure, heart function and the TCM syndrome patterns of coronary heart disease angina.ResuItsThis study shows that The TCM dialectical types of281patients with coronary heart disease angina were distributed as follow:103patients with qi deficiency and phlegm and blood stasis syndrome,39patients with phlegm-stasis blocking collateral syndrome,38patients with qi-deficiency and blood-stasis syndrome,28patients with phlegm stagnation of qi stagnation syndrome,25patients with qi deficiency and phlegm stasis syndrome,24patients with qi stagnation and blood stasis syndrome,13patients with heart yang deficiency syndrome,11patients with qi and yin deficiency syndrome. The patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome are older than the other patients, and disease course of the patients with the two syndromes are also longer than that of the other patients.The results of comparison of echocardiography index between patients with coronary heart disease angina group and healthy control group show that, the12cardiac structure and function indexes of the patients with coronary heart disease angina are all inferior to the healthy control group, and the difference has statistical significance. The results of comparison of cardiac structure and function indexes between patients with different syndromes of coronary heart disease angina shows that, the data of cardiac indexes of IST and LVPWT in patients with phlegm stagnation of qi stagnation syndrome and phlegm-stasis blocking collateral syndrome are higher than the patients of other syndromes with coronary heart disease angina. The data of cardiac indexes of LVEDd and LVESd in patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome are higher than the patients of other syndromes with coronary heart disease angina. The data of cardiac indexes of E and E/A in patients with heart yang deficiency syndrome and qi deficiency and phlegm stasis syndrome are lower than the patients of other syndromes with coronary heart disease angina, the data of cardiac indexes of A in patients with heart yang deficiency syndrome and qi deficiency and phlegm stasis syndrome are higer than the patients of other syndromes with coronary heart disease angina. The data of cardiac indexes of LVRT in patients with phlegm stagnation of qi stagnation syndrome and qi deficiency and phlegm stasis syndrome are higer than the patients of other syndromes with coronary heart disease angina. Compared with patients with qi and yin deficiency syndrome、phlegm stagnation of qi stagnation syndrome、phlegm-stasis blocking collateral syndrome and qi deficiency and phlegm and blood stasis syndrome, patients with heart yang deficiency syndrome has lower FS. The data of cardiac index of FS in patients with qi-def iciency and blood-stasis syndrome is lower than that of patients with qi and yin deficiency syndrome、phlegm stagnation of qi stagnation syndrome、qi stagnation and blood stasis syndrome、 phlegm-stasis blocking collateral syndrome and qi deficiency and phlegm and blood stasis syndrome. The data of cardiac index of FS in patients with phlegm-stasis blocking collateral syndrome is higer than that of patients with phlegm stagnation of qi stagnation syndrome、qi stagnation and blood stasis syndrome and qi deficiency and phlegm stasis syndrome. Compared with patients with qi and yin deficiency syndrome、phlegm stagnation of qi stagnation syndrome、phlegm-stasis blocking collateral syndrome and qi deficiency and phlegm and blood stasis syndrome, patients with heart yang deficiency syndrome has lower LVEF. The data of cardiac index of LVEF in patients with qi-def iciency and blood-stasis syndrome is lower than that of patients with qi and yin deficiency syndrome、phlegm stagnation of qi stagnation syndrome、qi stagnation and blood stasis syndrome、phlegm-stasis blocking collateral syndrome and qi deficiency and phlegm and blood stasis syndrome. The data of cardiac index of LVEF in patients with phlegm-stasis blocking collateral syndrome is higer than that of patients with phlegm stagnation of qi stagnation syndrome、qi stagnation and blood stasis syndrome and qi deficiency and phlegm stasis syndrome.The results of correlation analysis between the common syndromes of coronary heart disease angina and cardiac ultrasonography detection indexes show that, qi deficiency and phlegm and blood stasis syndrome has positive relationship with echocardiography index SV, and shows negative correlation with IST, A. Phlegm stagnation of qi stagnation syndrome has positive relationship with echocardiography indexes E、LVRT, and shows negative correlation with A、SV. Qi stagnation and blood stasis syndrome has negative correlation with LVRT、SV. Phlegm-stasis blocking collateral syndrome has positive relationship with echocardiography indexes LVPWT、E、CO、FS, and shows negative correlation with LVEDd、LVRT. Qi-deficiency and blood-stasis syndrome has positive relationship with echocardiography indexes LVESd、E/A, and shows negative correlation with LVPWT、LVRT. Qi deficiency and phlegm stasis syndrome has positive relationship with echocardiography index LVRT,and shows negative correlation with E/A.ConelusionTraditional Chinese medicine believes that,pathogenesis of coronary heart disease angina contains two respects:deficiency in origin and excess in superficiality. Deficiency in origin contains qi deficiency, yin deficiency and yang deficiency. Excess in superficiality contains qi stagnation, phlegm stasis and blood stasis. This study shows the largest proportion of coronary heart disease angina patients is the patients with qi deficiency and phlegm and blood stasis syndrome. This result consistent with the basic characteristics of the pathogenesis of qi deficiency、phlegm and blood stasis. In addition, chronic diseases injury Yang and form blood stasis, the study also shows that patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome are older than the other patients, and disease course of the patients with the two syndromes are also longer than that of the other patients.The results of comparison of echocardiography index between patients with coronary heart disease angina group and healthy control group show that, the12cardiac structure and function indexes of the patients with coronary heart disease angina are all inferior to the healthy control group, this means that all types of patients with coronary heart disease angina have phenomenon of cardiovascular remodeling. From the results of comparison of cardiac structure and function indexes between patients with different syndromes of coronary heart disease angina, we can find that, different TCM syndrome types in patients with coronary heart disease angina have different features and performance in cardiovascular remodeling.The left ventricular wall of patients with phlegm stagnation of qi stagnation syndrome and phlegm-stasis blocking collateral syndrome is more thick than patients with other ayndromes remarkably. The extent of left ventricular density of patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome is more evident than patients with other syndromes. The left ventricular diastolic function of the patients with heart yang deficiency syndrome and qi deficiency and phlegm stasis syndrome is inferior to the left ventricular diastolic function of patients with other syndromes evidently. In addition, compared with the patients with coronary heart disease angina of most of the other syndromes, the condition of systolic dysfunction of patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome is more obvious. Previous studies have suggested that, the change of cardiac structure and function is associated with the severity of disease and the course of disease. Comprehensive the results, we can find that the manifestation of cardiovascular remodeling of patients with heart yang deficiency syndrome and qi-def iciency and blood-stasis syndrome is more obvious than that of patients with other syndromes. Therefore, we believe that the patients with heart yang deficiency syndrome and qi-deficiency and blood-stasis syndrome have more seriours coronary artery disease, the condition of the patients with these two syndromes is also seriours, the patients are in the advanced or erminal stage of coronary heart disease angina.The results of correlation analysis between the common syndromes of coronary heart disease angina and cardiac ultrasonography detection indexes show that, qi deficiency and phlegm and blood stasis syndrome of coronary heart disease angina is closely related to cardiac indexes SV,IST, A, when the SV value is larger, the IST, A value are smaller, the possibility of the diagnosis of patients with Qi deficiency and blood stagnation syndrome is greater. Qi stagnation and blood stasis syndrome of coronary heart disease angina is closely related to cardiac indexes LVRT、SV, when the LVRT、SV value are smaller, the possibility of the diagnosis of patients with Qi stagnation and blood stasis syndrome is greater. Phlegm-stasis blocking collateral syndrome of coronary heart disease angina is closely related to cardiac indexes LVPWT、 E、CO、 FS、LVEDd、LVRT, when the LVPWT、E、 CO、FS value are higer, the LVEDd. LVRT value are lower, the possibility of the diagnosis of patients with Phlegm-stasis blocking collateral syndrome is higer. Qi-deficiency and blood-stasis syndrome of coronary heart disease angina is closely related to cardiac indexes LVESd、E/A、LVPWT、LVRT,when the LVESd、E/A value are larger, the LVPWT、LVRT value are smaller, the possibility of the diagnosis of patients with qi-deficiency and blood-stasis syndrome is greater. Qi deficiency and phlegm stasis syndrome of coronary heart disease angina is Closely related to cardiac indexes LVRT、E/A, when the LVRT value is larger, the E/A value is smaller, the possibility of the diagnosis of patients with qi deficiency and phlegm stasis syndrome is higer. Therefore, We can draw a conclusion that there is obvious correlation between the common syndromes of coronary heart disease angina and cardiac ultrasonography detection indexes. These cardiac structure and function indexes can provide objective basis for clinical differentiation of coronary heart disease angina, became a basis of differentiation beside the four methods of diagnosis of TCM, and make for better treatment according to syndrome differentiation in TCM of coronary heart disease angina.