Study On The Syndrome Characteristics Of Syndromes Of Coronary Heart Disease With Angina Pectoris And The Correlation Between Syndrome And Coronary Artery Disease

Coronary heart disease (CHD) is a common disease which could seriously endanger people’s health. The morbidity has a tendency to increase year by year. Angina Pectoris is the most common clinical type. In recent years, percutaneous coronary intervention (PCI) is applied to diagnose and treat CHD, also coronary angiography (CAG) is the gold standard of diagnosis. The comprehensive application of the therapeutic methods further improves the prognosis. Traditional Chinese Medicine (TCM) achieved remarkable results in the treatment of CHD.Objective:This study aimed at preventing and treating Angina Pectoris. We analyzed the distribution and peculiarity of TCM Syndrome of Angina Pectoris and explored the correlation of Angina Pectoris TCM syndrome and the characteristics of the lesion of coronary artery from CAG so as to investigate the TCM pathogenesis and control measures of it, which could contribute to the study on syndrome and its objective-unified standard establishment and clinical application of integrated traditional Chinese and western medicine in treatment.Method:1.141 in-patients with CAG examination and complete medical records at the department of cardiology in Guang’anmen Hospital, China Academy of Chinese Medical Sciences (from Sep.2012 to May 2014) as research objects.2. CAG would be done by Judkin’s method.3. Within 48 hours after CAG, the collections of information, medical history of relative diseases, signs and TCM syndromes would be finished; Within 1 week before or after CAG, all the related laboratorial examination would be done, then made the diagnosis of western medicine, TCM syndromes and the risk factors according to the criteria.4. Statistical method:SPSS 19.0 statistical software for statistical analysisResults:1.General condition of CHD group: ①The sex ratio was 1:1. The distribution of age was from 38 to 94, average 72.80±10.59. And 56.7% of the patients were during 60-80 years old, the average age of female patients were higher than male patients. ②Relative diseases incidences:hypertension (85.6%), diabetes (47.7%), hyperlipemia (58.9%), overweight or obese(55.6%) and carotid plaque (66.7%). ③The differences of the incidences of related diseases, the age and BMI were obvious as compared with non-CHD group (P<0.05 or P<0.01), whereas no significant difference between gender distribution (P>0.05); namely hypertension, diabetes, hyperlipemia, overweight or obese, carotid plaque and BMI (over 25) all belong to the risk factors of CHD in this research. Among them, the logistic regression analysis indicated that age, overweight or obesity and the incidence of diabetes were the closest factors.2.TCM syndrome distribution of CHD group: ①Single-factor Syndromes:Blood Stasis Syndrome (63.3%)> Phlegm Dampness Syndrome (62.2%)> Qi Deficiency Syndrome (55.6%), the incidences were significantly higher than non-CHD group (P<0.05 or P<0.01). ② Complex Syndromes:Qi Deficiency+Yin Deficiency+Blood Stasis+Phlegm Dampness Syndrome (17.8%)> Blood Stasis+Phlegm Dampness Syndrome (11.1%)> Qi Deficiency+ Yin Deficiency+Phlegm Dampness Syndrome (10.0%). ③Combination Syndromes:Double Syndrome (41.1%)> Triple Syndrome (28.9%)> Quadruple and more Syndrome (21.1%)> Single Syndrome (8.9%), and Phlegm Dampness was the main syndrome in Single Syndromes (37.5%), Phlegm Dampness+Blood Stasis in Double Syndromes (27.0%), Qi Deficiency+ Yin Deficiency+Phlegm Dampness in Triple Syndrome (34.6%) while Qi Deficiency+Yin Deficiency+Blood Stasis+Phlegm Dampness in Quadruple and more Syndrome (84.2%). ④ Deficiency or Excess Syndrome:Deficiency with Excess Syndrome (66.7%)> Excess Syndrome (20.0%)> Deficiency Syndrome (13.3%). ⑤Blood Stasis Syndrome:Blood-stasis group (63.3%) was more than non-blood-stasis group (36.7%). ⑥ubtypes of blood-stasis group:Phlegm-blood Stasis (36.8%)> Qi Deficiency and Blood Stasis (33.3%)> Yang Deficiency and Blood Stasis (17.5%)> Qi Stagnation and Blood Stasis (7.0%)> Others (5.3%). 3.Blood-stasis group and non-blood-stasis group of CHD:①There were no significant differences between the general condition, the related medical history of these two groups(P>0.05), which meant comparable. ②oth the groups had the largest proportion of patients who were in NYHA class Ⅱ (P>0.05); the NYHA class (mean) of blood-stasis group was higher than the one in non-blood-stasis group. Also, patients with UA were the main part of the two groups (P> 0.05), the majority of the UA patients were men while the majority of the stable angina (SA) patients were women. ③ The difference of hypercoagulable state distribution between the two groups was not obvious (P>0.05). When compared with non-blood-stasis group, the values of R, K, Angle, MA of thrombelastogram (TEG) and the levels of APTT, FIB, FDP, D-Dimer in blood-stasis group showed statistically significant differences (P<0.05, P<0.01) except the PLT level (P>0.05); all the values, levels in blood-stasis group were higher than the ones in non-blood-stasis group except APTT. ④There were significant differences between the groups related lipid values. Compared with non-blood stasis group, blood-stasis group was higher in LDL-C, TC, TG while lower in HLD-C (P<0.05, P<0.01).⑤ The level of cTnl and CRP in blood-stasis group were significantly higher than the ones in non-blood-stasis group (P<0.05).4.CAG results of TCM syndromes: ①Combination Syndromes: The syndrome distribution had no specific correlation with the degree of stenosis or the number of diseased coronary artery (P>0.05). Single-vessel lesions were common in both Double and Triple Syndrome; double-vessel and multi-vessel lesions were the main pathological changes of coronary artery in Double Syndrome. Mild-moderate stenosis, severe stenosis and occlusive lesion were the common type of coronary artery in Double Syndrome, Triple Syndrome and Quadruple and more Syndrome, respectively. The Gensini score of each Combination Syndrome from low to high were Single, Double, Triple, Quadruple and more; and the differences were significant (P<0.05). ②Deficiency or Excess syndrome:There was a direct correlation between the syndrome distribution and the degree of the coronary artery lesion including the degree of stenosis, the number of diseased artery and the Gensini score (P<0.05). Deficiency with Excess Syndrome was the most common syndrome of each type of pathological changes. Excess Syndrome was only found in double-vessel and multi-vessel lesions. The degree of stenosis was higher, the higher the proportion of Excess Syndrome was while the lower the proportion of Deficiency Syndrome was. The Gensini score from low to high were respectively from Deficiency Syndrome, Excess Syndrome and Deficiency with Excess Syndrome. ③Blood Stasis Syndrome:The differences between the syndrome distribution and the degree of the coronary artery lesion including the degree of stenosis, the number of diseased artery and the Gensini score were significant (P<0.05 or P<0.01). The average number of the diseased artery in blood-stasis group was evidently higher when compared with the other group (P<0.01). Multi-vessel lesions were easily found in blood-stasis group while it was relatively less in the other group. Severe stenosis and occlusive lesion were common in blood-stasis group while mild-moderate stenosis in non-blood-stasis group. The Gensini score of blood-stasis group was obviously higher than the one in non-blood-stasis group. ④Subtypes of blood-stasis group:The differences between the subtype distribution and the lesion degree of coronary were not obvious (P>0.05).Conclusions:1. Qi Deficiency and Blood Stasis Syndrome was the basic TCM syndrome of CHD and the common combination syndromes were Phlegm Dampness Syndrome and Yin Deficiency Syndrome. Deficiency with Excess Syndrome was the basic pathogenesis of CHD. 2. The patients of CHD Blood Stasis Syndrome were abnormal in hemorheology with staying at a relatively hypercoagulable and dyslipidemia state, as well relatively more severe degree of the coronary artery lesion, higher risk of thrombosis, bigger possibility of cardiovascular events such as severe acute myocardial infarction, worse quality of life and prognosis as distinguishing features.3. CAG results of TCM syndromes: ①Combination Syndromes:The more types of Single-factor Syndromes it had, the more complex the condition and the severer the degree of coronary artery lesion was. ②Deficiency or Excess Syndrome:In Deficiency with Excess Syndrome, the number of diseased artery was relatively big and the degree of stenosis was relatively severe. Blood stasis and phlegm dampness were the main pathogenic factor of Excess Syndrome. When compared with Deficiency Syndrome, Excess Syndrome was more easily to cause lesion and the degree of stenosis was relatively severe. ③The coronary lesions of blood-stasis syndrome was relatively heavy and static blood is the material basis for the cause of coronary artery stenosis. ④The differences of the degree of coronary artery lesion between the subtypes were rather small. Besides the static blood, the deficiency of Qi, phlegm and dampness were also the pathogenic factors.