| Objective: A diagnostic scale of integrated traditional Chinese and Western medicine for stable angina pectoris with qi stagnation syndrome of heart pulse in coronary heart disease was developed.It will provide a quantifiable diagnostic tool for standardized diagnosis and accurate differentiation.Methods:1.The database of cardio-pulse qi-stagnation syndrome of stable angina pectoris was established by computer literature retrieval.The symptoms,signs and physical and chemical indexes related to the diagnosis of cardio-pulse qi-stagnation syndrome of stable angina pectoris were counted,and the diagnosis items were normalized to form a diagnosis pool of cardio-pulse qi-stagnation syndrome of stable angina pectoris.2.Based on Delphi method,the expert questionnaire is developed.The specific steps are as follows:(1)Set up a research group;(2)Selecting experts by letter;(3)Prepare and issue two rounds of expert consultation questionnaires;(4)Statistically analyze the mean number,full score rate,coefficient of variation and grade sum of each diagnostic item,and determine the diagnostic items that need to be retained and excluded.3.The percentage method was used to assign weight to the selected core diagnostic items and determine the threshold value,and the diagnostic scale of integrated traditional Chinese and Western medicine for stable angina pectoris syndrome was initially developed.Results:1.China National Knowledge Network,Wanfang Data platform,VIP Chinese journal service platform and China biomedical literature database were searched,using the search terms:(1)Coronary heart disease,coronary artery disease,coronary artery disease,coronary atherosclerotic heart disease,stable angina pectoris,chest obstruction,heartache,heart-pulse qi stagnation syndrome,qi stagnation heart-pulse syndrome,qi stagnation cardiothoracic syndrome,qi stagnation syndrome;(2)Combination of traditional Chinese medicine,Western medicine and Western medicine;(3)Diagnosis,criteria,syndrome differentiation,syndromes and norms.The search type is: AND,OR.A total of 1169 literatures were searched.By referring to the 2018 Guidelines for the Diagnosis and Treatment of Stable Coronary Heart Disease and the 1990 Standards for TCM Differentiation of Coronary Heart Disease,the literature with clear symptoms,signs and syndroms of traditional Chinese and Western medicine was included,and the literature with repeated and unsubstantiated diagnostic criteria and case reports was excluded.1,089 literatures were excluded,80 were included,and 25 diagnostic items were extracted: Chest tightness,chest distension pain,induced or aggravated by emotional fluctuations,frequent sighing,belching,abdominal distension,fart,side chest distension,upset or depression,palpitation,shortness of breath,holding of breath,thin white tongue coating,thin and oily tongue coating,dark tongue,reddish tongue quality,pulse string,pulse string and pulse thin,single coronary artery lesions,descending ST segment and inversion of T wave in ECG,decrease of LVEF value,increase of LDL-C,s VCAM-1,increase of MMP-9,and MPO increased.2.According to the results of literature research,the first round of Delphi method expert questionnaire was developed.The questionnaire included 25 items,the questionnaire recovery rate was 100%,and the expert positive coefficient was 100%.According to the entry screening criteria of "mean ≥ 2.0,full score rate ≥ 25% or coefficient of variation ≤ 45%",8diagnostic items were excluded: Reddish tongue,thin and greasy tongue coating,common coronary artery disease,LDL-C increased,s VCAM-1increased,MMP-9 increased,MPO increased.The second round of Delphi method expert questionnaire included 17 diagnostic items,the questionnaire recovery rate was 100%,and the expert positive coefficient was 100%.According to the entry screening criteria of "mean ≥ 2.5,full score ≥ 30%or coefficient of variation ≤ 30%",6 diagnostic items were excluded: side chest fullness,abdominal distension,belching,farting,pulse string and thin,and LVEF value decreased.11 items of core diagnosis were determined: full chest tightness,chest pain,induced or aggravated emotional fluctuations,palpitations,shortness of breath,frequent sighing,upset or emotional depression,dark tongue,thin white tongue coat,pulse string,ST segment down and T wave inversion in ECG.3.The percentage method was used to assign weight and sort out the important diagnostic items of stable coronary heart disease and angina cardio-pulse qi stagnation syndrome.The items were divided according to main symptoms,secondary symptoms,tongue and pulse,and physical and chemical indicators,among which the items with high contribution degree were regarded as the main symptoms.The main symptoms of the scale were:full chest tightness,chest swelling pain;Secondary symptoms are: induced or aggravated by emotional fluctuations,frequent sighing,upset or emotional depression,palpitation,shortness of breath;Tongue pulse: pulse string,dark tongue,tongue coating thin white;The physical and chemical indexes were as follows: ST segment descending and T wave inversion were observed in ECG.Conclusion: The diagnostic scale for stable angina pectoris with integrated traditional Chinese and Western medicine was developed.The main symptoms were chest fullness(11 points)and chest distending pain(11points).Secondary symptoms were induced or aggravated by emotional fluctuations(10 points),frequent sighing(9 points),upset or emotional depression(9 points),palpitations(8 points)and shortness of breath(8points).The tongue pulse was string pulse(10 points),dark tongue(9points),and thin white tongue coating(7 points).The physical and chemical indexes were ST segment descending and T wave inversion in ECG(7points).The following conditions must be met at the same time:(1)Stable angina pectoris of coronary heart disease confirmed by coronary angiography;(2)Main disease ≥ 1 item + secondary disease ≥ 3 items +tongue and pulse ≥ 1 item;(3)Entries total score ≥ 50 points;(4)The diagnosis should include symptoms,tongue and pulse,and physical and chemical indicators.The development of the scale provides a quantifiable diagnostic tool for standardized diagnosis and accurate syndrome differentiation. |
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