Clinical Study On Distribution Regularity And Related Factors Of TCM Syndromes Of Aspirin Resistance In Patients With Coronary Heart Disease

Objective:To analyze the occurrence,TCM Syndrome Distribution and related risk factors of aspirin resistance in patients with coronary heart disease,so as to provide clinical evidence for patients to availably prevent aspirin resistance.Methods:A total of 230 patients who met the inclusion criteria and were hospitalized in the Geriatrics and Heart Disease departments of Inner Mongolia Institute of Traditional Chinese Medicine from January 2021 to December 2021 were collected.All selected patients were treated with standard dose aspirin（100mg/time,once a day）and tested by PL-12 multi parameter platelet function analyzer after 7 days of continuous medication.According to the maximum platelet aggregation rate measured by the instrument,they were divided into groups:the maximum platelet aggregation rate(MAR_AA)induced by arachidonic acid（AA）<55%is the aspirin sensitivity group,and MAR_AA≥55%is the aspirin resistance group.Collect the basic data such as the patient’s name,course of disease,body mass index,past history,number of coronary artery lesions and Gensini score（to evaluate the score of the location and degree of vascular stenosis observed during coronary angiography or the sum of the scores of coronary artery stenosis at each segment）,as well as the results of blood routine,blood lipid,fasting blood glucose and other laboratory tests;Record the symptoms,signs,tongue coating and pulse of the patient,and judge the doctor of traditional Chinese medicine syndrome types of the patient.To study the occurrence of AR in coronary heart disease,compare the basic data and relevant laboratory indicators between the two groups,and discuss the distribution of TCM syndromes and correlative risk factors of AR in patients with coronary heart disease.Results:1.General results show that:A total of 230 patients with coronary heart disease were included in this study,including 60 patients in AR group,aged（71.50±9.83）years;170 cases in group AS,aged（69.19±10.56）years.There was no significant difference in age,sex,history of essential hypertension,history of stroke and BMI between AR group and AS group（P>0.05）.The course of disease,history of type 2 diabetes mellitus,multi vessel disease and Gensini score in AR group were higher than those in AS group（P<0.05）;2.The results of laboratory data show that there is no significant difference between AR group and AS group in white blood cell number,red blood cell number,hemoglobin,platelet number,creatinine,cholesterol,triglyceride,high-density lipoprotein,lipoprotein A and low-density lipoprotein in children（P>0.05）.Group AR fasting blood glucose,mean platelet volume,uric acid,low density lipoprotein and homocysteine all higher than group AS（P<0.05）;3.This experiment included 24 observation indexes,and 9 statistically significant indexes were selected by single factor analysis:course of disease,type 2 diabetes mellitus,vascular disease variables,Gensini score,mean platelet volume,uric acid,low density lipoprotein,fasting blood glucose and homocysteine.The results showed that the independent of AR were:low-density lipoprotein cholesterol（OR:4.698,95%CI:2.692-8.196,P<0.001）,fasting blood glucose（OR:2.741,95%CI:1.769-4.248,P<0.001）,urinary acid（OR:1.006,95%CI:1.000-1.011,P=0.044）and homocysteine（OR:1.107,95%CI:1.036-1.183,P=0.003）;4.ROC curve analysis:Taking AR group as the positive sample and as group as the negative sample in this study,independent risk factors or indicators（low density lipoprotein,uric acid,fasting blood glucose,homocysteine）obtained from multi-factor analysis were used to establish the ROC curve analysis model,and the predictive value of low mdensity lipoprotein was higher,with the area under the curve above 0.8,the critical value of 3.5mmol/L,and the sensitivity and specificity above 0.6;5.According to the data of TCM syndrome types,60 cases（26.1%）of 230 patients developed AR.There were 42 cases of heart blood stasis syndrome and 19 cases of AR（45.2%）;There were 26 cases of qi deficiency and blood stasis syndrome,10 cases of AR（38.5%）;There were 34 cases of Qi and Yin deficiency syndrome,9 cases of AR（26.5%）;There were 33 cases of qi stagnation and blood stasis syndrome,8 cases of AR（24.2%）;There were 24 cases of deficiency of yin and Yang of heart and kidney,4 cases of AR（16.7%）;There were 39 cases of phlegm turbid internal obstruction and 6 cases of AR（15.4%）;There were 24 cases of heart kidney yang deficiency syndrome,and AR accounted for 3 cases（12.5%）;There were 8 cases of cold coagulation heart pulse syndrome and 1 case of AR（12.5%）.Byx²test,the probability of resistance in heart blood stasis syndrome（45.2%）was apparently higher than that in other TCM syndrome types,and the difference was statistically significant.Conclusions:This study observed that patients with coronary heart disease still had AR after regular oral administration of effective dose aspirin.The incidence of AR was 26.1%,which was in line with the incidence of AR at home and abroad;The levels of fasting blood glucose,uric acid,homocysteine and low-density lipoprotein cholesterol were independently related to the occurrence of AR,and low-density lipoprotein cholesterol could predict the occurrence of AR,the optimal critical value was 3.5mmol/L,which had high sensitivity and specificity;The doctor of traditional Chinese medicine syndrome types of AR in patients with coronary heart disease is as follows:Cariac blood stasis syndrome（45.2%）>Syndrome of qi deficiency and blood stasis（38.5%）>Qi deficiency and yin deficiency syndrome（26.5%）>Qi stagnation and blood stasis syndrome（24.2%）>Heart and kidney yin deficiency syndrome（16.7%）>Phlegm turbid internal obstruction syndrome（15.4%）>Cold coagulation heart pulse syndrome（12.5%）、Yang deficiency syndrome of heart and kidney（12.5%）.