The Correlation Analysis Of Different TCM Syndromes With Lipoprotein(a) And Prognosis Of Coronary Heart Disease

ObjectiveBy collecting the medical records of patients with coronary heart disease(CHD)and performing statistical analysis,observe the distribution characteristics of the syndromes,analyze the correlation between syndromes、Lp(a)levels、the incidence of MACE events and other laboratory indicators,and explore the ability of Lp(a)predicting the occurrence of MACE in CHD patients with different syndromes.MethodsA retrospective study included 216 patients with CHD diagnosed in the Cardiology Clinic of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2018 to December 2019.The gender,age,Basic illness,information of four Traditional Chinese Medicine clinics,Lp(a)levels,MACE occurrence within 30 days,white blood cell count(WBC),red blood cell count(RBC),hemoglobin(Hb),platelet count(PLT),red blood cell distribution width(RDW),glycosylated hemoglobin(HbAlc),triglyceride(TG),Total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),apolipoprotein A1(Apo-A1),apolipoprotein B(Apo-B),creatine Kinase(CK),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),creatinine(Cr),alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),Glomerular filtration rate(eGFR)were collected.The collected data was divided into 5 groups according to the Syndromes.Compare the differences between them,delineate the ROC curve,use logistic regression method for analysis.Results1.Among the 216 CHD patients included in the study,the proportions of syndromes from high to low are:phlegm and blood stasis mutual obstruction syndrome(25%),qi deficiency and blood stasis syndrome(24.5%),qi stagnation and blood stasis syndrome(21.8%),spleen and kidney yang deficiency syndrome(16.7%),liver and kidney yin deficiency syndrome(12%).2.CHD patients with different TCM syndromes have no statistically significant differences in gender,age,hypertension,diabetes or smoking history(P>0.05),and the differences in hyperlipidemia are statistically significant(P=0.017)),which is mainly reflected between the Qi stagnation and blood stasis syndrome and the other four syndromes.3.The differences in Lp(a)level and MACE incidence of CHD patients with different TCM syndromes are statistically significant(P<0.05),which are mainly reflected in the higher Lp(a)level of phlegm and blood stasis syndrome than Qi deficiency and blood stasis syndrome,The incidence of MACE events of phlegm and blood stasis mutual obstruction syndrome and spleen-kidney yang deficiency syndrome are higher than that of qi deficiency and blood stasis syndrome.4.The differences in RBC,Hb,TC,and ALT of CHD patients with different TCM syndromes are statistically significant(P<0.05).Further analysis show that the RBC level of phlegm and blood stasis mutual obstruction syndrome is higher than that of liver and kidney yin deficiency syndrome(H=10.290,P=0.043),Hb level is higher than liver and kidney yin deficiency syndrome(H=12.143,P=0.021),TC level of Qi deficiency and blood stasis syndrome is higher than Qi stagnation and blood stasis syndrome(H=10.223,P=0.036),The ALT level of liver and kidney yin deficiency syndrome is lower than that of phlegm and blood stasis mutual obstruction syndrome(H=12.687,P=0.004),and the differences in other laboratory indexes are not statistically significant.5.The Lp(a)level of the MACE event group is higher than that of the no MACE event group,and the difference is statistically significant(Z=-6.762,P<0.05).6.There are no statistically significant differences between Lp(a)level and different gender,age,combined hypertension,and combined diabetes(P>0.05).7.Using the receiver operating characteristic curve(ROC)to calculate the area under the curve(AUC),in the overall sample of CHD patients,Lp(a)can better predict the incidence of MACE events,and the prediction effect is better(AUC=0.836,P<0.05).Lp(a)has the strongest predictive ability in phlegm and blood stasis mutual obstruction syndrome(AUC=0.902),followed by spleen and kidney yang deficiency syndrome(AUC=0.869)>liver and kidney yin deficiency syndrome(AUC=0.829)>qi deficiency and blood stasis syndrome(AUC=0.792),and at the best cut-off position,its specificity is the highest,but its sensitivity is not as good as the other three groups.AUC value is not statistically significant in Qi stagnation and blood stasis syndrome(P=0.111).8.The occurrence of MACE was used as the dependent variable,and the binary logistic regression analysis was performed.The independent variables entered into the equation are combined hyperlipidemia,TCM syndrome types,gender,age,and Lp(a)level.Conclusion1.In this research,Phlegm and blood stasis mutual obstruction syndrome is the most common,followed by the syndrome of Qi deficiency and blood stasis,and Qi stagnation and blood stasis syndrome.2.The Lp(a)level of patients with phlegm and blood stasis mutual obstruction syndrome is higher than that of qi deficiency and blood stasis syndrome.3.The incidence of MACE events in patients with phlegm and blood stasis mutual obstruction syndrome and spleen-kidney yang deficiency syndrome are higher than that of qi deficiency and blood stasis syndrome.4.The Lp(a)level of the MACE event group is higher than that of the no MACE event group.5.Lp(a)can better predict the incidence of MACE in CHD patients.The predictive ability of Lp(a)in each syndrome type from strong to weak is phlegm and blood stasis mutual obstruction syndrome,spleen and kidney yang deficiency syndrome,liver and kidney yin deficiency syndrome,qi deficiency and blood stasis syndrome.The predictive ability is not statistically significant in Qi stagnation and blood stasis syndrome.6.Combined hyperlipidemia,TCM syndromes,gender,age,Lp(a)can all be used as risk factors for the incidence of MACE events.7.The RBC level,Hb level and ALT level of phlegm and blood stasis mutual obstruction syndrome are higher than those of liver and kidney yin deficiency syndrome,and the TC level of qi deficiency and blood stasis syndrome is higher than that of qi stagnation and blood stasis syndrome.