| Purpose: Guided by the holistic view of TCM and the theory of differentiation of symptoms and treatments,and proceeding from the dynamic temporal and spatial attributes of syndromes,this subject collects and collates the information of four TCM diagnoses and the data of laboratory physical and chemical indicators in four clinical stages of coronary heart disease complicated with heart failure by means of a large sample and multi-center questionnaire of clinical frontline experts,and summarizes and verifies the four clinical stages of coronary heart disease complicated with heart failure.In order to further clarify the correlation between TCM syndromes and laboratory physicochemical indicators in four clinical stages of coronary heart disease complicated with heart failure,and to standardize and guide the application of objective diagnostic criteria for coronary heart disease complicated with heart failure in clinic.Materials and Methods: This study used the syndrome factors of coronary heart disease(CHD)combined disease and syndrome characteristics and evolvement law of clinical syndrome pathogenesis expert questionnaire(coronary heart disease with heart failure parts),collection,filtering and sorting the coronary heart disease with heart failure of four clinical stage of TCM four diagnostic information and laboratory index of physical and chemical inspection,set up the national six regions,a total of 51 hospitals,1504 qualified questionnaires of three-dimensional structured relational database.SPSS 20.0 statistical software was used to conduct factor analysis and Logistic regression analysis of the four diagnostic information of TCM in the four clinical stages of CHD complicated with heart failure,so as to summarize and verify the main syndrome elements,syndrome characteristics and internal combination rules of the four clinical stages of CHD complicated with heart failure.On this basis,descriptive analysis and Logistic regression analysis were conducted on the laboratory physical and chemical indicators in the four clinical stages of CHD complicated with heart failure,so as to determine the correlation and specificity between the TCM syndromes in each stage of CHD complicated with heart failure and the laboratory physical and chemical indicators.Result: 1.The data of the relevant four diagnostic information in the questionnaire of coronary heart disease complicated with heart failure were screened,and the variables with the highest frequency and lowest frequency were selected according to the clinical stage of the disease.(1)the variable of symptoms and signs with the highest frequency before heart failure stage was shortness of breath after fatigue(73.47%),and the lowest was shortness of breath with suffocation in the chest,and even pent up at night(20.28%).The maximum pulse value was white coating(76.46%)and the minimum was thin coating(20.48%).(2)in the preclinical stage,the most frequent symptom and sign variable was self-conscious abdominal distension and no distension(63.03%),and the lowest was five upset fever(20.00%).The highest pulse variable was tongue fat(53.99%)and the lowest pulse slip(20.08%).(3)in clinical stage,the most frequent symptom and sign variable was lower limb edema(80.52%),and the lowest was pawl pain(20.08%).The highest pulse variable was ecchymosis(49.87%)and the lowest pulse generation(20.01%).(4)in the final stage,the most frequent symptom and sign variable was systemic edema(82.65%),and the lowest was loose stool(20.68%).The highest pulse value was dark tongue color(63.70%),and the lowest was pulse acceleration(20.81%).2.The data of related laboratory physical and chemical indexes in the questionnaire of coronary heart disease complicated with heart failure were screened,and the variables with the highest frequency of examination were selected according to the clinical stage of the disease.(1)pre-failure stage: electrocardiogram was normal(37.68%),cardiac shadow enlargement(31.65%),left atrial enlargement(29.39%),maximum oxygen consumption(> 20ml/ min·kg)(63.06%),cardiac index 2.5(30.04%),normal ventricular volume(80.59%),normal white blood cell(86.26%),ph 7.35-7.45(86.09%),BNP < 100 pg/ml(71.08%).(2)pre-clinical stage: st-t change(30.26%),cardiac shadow enlargement(30.25%),left atrial enlargement(15.89%),plate maximum oxygen consumption(58.74%),cardiac index 2.5 (24.92%),left ventricular ejection fraction(59.76%),normal leukocyte(74.09%),SB 21.3-24.8(74.53%),BNP 100-400 pg/ml(55.96%).(3)clinical stage: st-t change(30.55%),cardiac image enlargement(20.57%),EF value < 50%(24.98%),maximum oxygen consumption of the plate(10-15 ml/ min·kg)(59.10%),cardiac index < 2.5(22.71%),decreased left ventricular ejection fraction(86.44%),electrolyte disturbance(69.84%),ph < 7.35,BNP 100-400 pg/ml(47.88%).(4)final stage: st-t change(26.20%),cardiac shadow increase(15.89%),EF value < 50%(17.21%),maximum oxygen consumption of the plate < 10 ml/(min·kg)(54.15%),left ventricular macrotrophy(23.85%),left ventricular ejection fraction decreased(83.70%),electrolyte disorder(63.23%),AB < SB(62.74%),BNP 400 pg/ml(79.35%).3.Factor analysis was used to summarize the syndrome elements of coronary heart disease with heart failure in four clinical stages.In the pre-clinical stage,syndrome elements mainly involve heart,liver and spleen,and syndrome elements mainly include qi deficiency,Yang deficiency,blood stasis and phlegm decoction.In clinical stage,syndrome elements mainly involve heart and kidney,and syndrome elements mainly include Yang deficiency,qi deficiency and blood stasis.At the end stage,the syndrome elements mainly involve heart,spleen and kidney.4.By means of factor analysis and Logistic regression analysis,the syndrome characteristics of 13 syndromes in the four clinical stages of coronary heart disease complicated with heart failure and the internal combination rules of the syndromes were summarized.Pre-heart failure stage:(1)deficiency of the heart and spleen is positively correlated with shortness of breath after fatigue(OR=1.719),palpitation(site heart)(OR=1.566),fatigue(OR=1.438),and negatively correlated with edema of the lower limbs(OR=0.688),retention of water in the gastrointestinal tract(OR=0.734),and retention of water in the muscle surface of the limbs(OR=0.022).(2)the deficiency of blunt inverse inverse certificate and have qualities such as the rib in the mind(OR = 1.540),shortness of breath(OR = 1.521)after fatigue,heart palpitations diagnosis(parts)(OR = 1.349)were positively correlated,and heart palpitations with nerves(OR = 0.841),chests are annoyed within such as full(OR = 0.760),chest xi(OR= 0.659),the chest of thermophilic(OR = 0.857),chest tightness as smothering OR oppressed pain,shortness of breath(OR = 0.544)with chest is very stuffy,midnight to suppress wake(OR = 0.551),complexion dull grooves(OR = 0.685)showed a negative correlation;Preclinical stage:(1)the syndrome of qi and Yin deficiency was positively correlated with fever of five nerves(OR=3.440),fear accompanied by fear(OR=1.772),palpitation accompanied by severe insomnia(OR=1.556),palpitation accompanied by anxiety(OR=1.442),shortness of breath accompanied with chest tightness,OR night evocation(OR=1.436).It was negatively correlated with chest tightness(OR= 0.528),suffocation OR pain(OR= 0.528),palpitations associated with subcardiac emptiness(OR=0.468),and inability to recline in a semi-recumbent position(OR= 0.424).(OR=5.098),fatigue(OR=3.967)and palpitation(OR=1.812).It was negatively correlated with palpitation(OR=0.294).(3)the syndrome of non-regulation of liver and spleen is positively correlated with the symptoms of fullness(OR=3.030),hypochondria(OR=2.148),and self-conscious abdominal distension(OR=1.452).It was negatively correlated with self-conscious qi from oligothorax(OR=0.943),and qi from rib to heart(OR= 0.911).(4)dampness obstruction and palpitation accompanied by the heart under the rupiman(OR=1.832),the neck pulse Ben from the tension and the corresponding pulse in the virtual(OR=1.720),water fluid retention under the pressure(OR=1.408)presented a positive correlation;(5)the syndrome of kidneysthenia Yin stopping is positively correlated with the weakness of waist and knee(OR=2.133),limb sleepiness(OR=1.389),chills(OR=1.619),lower limb edema(OR=1.910),and limb insensibility(OR=1.596).With not easy to fall asleep(OR=0.745),morpheus is easy to wake up,fall asleep hard after awoken(OR=0.983),much dream(OR=0.521),palpitation accompanies by hand to protect a bosom to be fond of press(OR=0.731),labial color is light(OR=O.527),lack of power(OR=0.634),little mei companion is frightened palpitation(OR=0.821),bosom is fond of press(OR= 0.507)show negative correlation;Clinical stages:(1)patients with qi-deficiency and lack of syndromes are positively correlated with weakness(OR=11.981),fatigue(OR=2.214),urgency of breathing and wheezing(OR=1.149),shortness of breath with suffocation in the chest,even nocturnal apnea(OR=1.569),and fear of heart palpitations with anxiety(OR=1.351).It is negatively correlated with great sweating(OR=0.715),severe pain in the chest and back,cold face,grey limbs(OR=0.738),chest tightness(OR=0.734),abdominal distension,no appearance distension(OR=0.54),chest distension(OR=0.546),lip grey(OR=0.906),shortness of breath(OR=0.51),and distension(OR=0.786).(2)stop drinking and obstruction of collaterals syndrome and abdominal distension,according to such as sac wrapped water,even shaking sound(OR=1.761),the heart under the ruppie full,according to the hard(OR=1.603),water fluid stay limbs muscle surface(OR=1.523),flank pain,such as acupuncture(OR=1.392)positive correlation;There was a negative correlation between qi with self-rib thrust against the heart(OR=0.684)and conscious qi with self-shaoabdominal upthrust(OR=0.631).There was a positive correlation between kidney deficiency and eyelid edema(OR=2.323),weakness of waist and knee(OR=2.062),and facial edema(OR=1.75).It was negatively correlated with pallor(OR=0.883),full diet(OR=0.411),and little OR no urine(OR=0.583).(4)cold Yin obstruction of collaterals syndrome is positively correlated with water fluid retention on the muscle surface of limbs(OR=2.091),chest pain(OR=2.195),chest thermophilia(OR=1.722),palpitation(part of the body)(OR=1.672),chest pleasure(OR=1.543),flank pain(OR=2.187)and chillness(OR=1.365).It was negatively correlated with palpitation(OR=0.639),five upset fever(OR=0.477),cough at night OR day,and more cough sputum with thin volume(OR=0.489).End stage:(1)Yang syndrome of asthma and apoplexy is positively correlated with frequent cough,pink foam-like sputum(OR=1.982),general edema(OR=1.596),sweating profuseness,such as beads and oils(OR=1.474),and lethargy(OR=1.360).It was negatively correlated with adverse urination associated with palpitation(OR=0.637).(2)water qi ling heart(shooting the lung)syndrome and shortness of breath with suffocation in the chest,OR=4.231),palpitation with xia PI man(OR=2.109),body edema(OR=1.845),palpitation with upset(OR=1.732),difficulty in falling asleep(OR=2.531)were positively correlated.It was negatively correlated with latent rib pain(OR=0.853),bulges(OR=0.652),tepidity(OR=0.634)and indifference(OR=0.472).5.Logistic regression analysis was used to determine the correlation between the 13 syndromes in the four clinical stages of CHD with heart failure and the laboratory physical and chemical indicators.Pre-heart failure stage:(1)deficiency of heart and spleen was positively correlated with increased ventricular volume(OR= 5.168),flatting oxygen consumption(10-15ml/(min·kg)(OR=2.737),thickened pulmonary vascular branches(OR= 2.314),increased cardiothoracic proportion(OR= 1.909),and no abnormal electrocardiogram(OR= 1.718).Is negatively correlated with Sat O2 < 90%(OR=0.101).It was negatively correlated with no abnormalities in electrocardiogram(OR=0.582),increased cardiothoracic proportion(OR=0.524),thickened pulmonary vascular branches(OR=0.432),10-15ml/(min·kg)oxygen consumption in treadmill exercise(OR=0.365),and increased ventricular volume(OR=0.193).Pre-clinical stage:(1)there was A positive correlation between qi and Yin deficiency syndrome and E/A < 1(OR=2.236);It was negatively correlated with right ventricular enlargement(OR= 0.381),elbow vein pressure exceeding 1.4k Pa(OR= 0.269),normal ventricular volume(OR=0.15),and elevated ventricular volume(OR= 0.139).(2)qi deficiency and blood stasis were positively correlated with po230-60(OR=5.781)and widening of superior vena cava(OR=2.959).It was negatively correlated with liver pressure increasing by 0.1~ 0.2kpa(OR=0.017)after 0.5 ~ 1 minute.(3)ataxia of the liver and spleen is positively correlated with a 0.1-0.2kpa(OR=47.406),a decrease in leukocyte(OR=35.783)and a > 20ml/ min·kg(OR=8.873)increase in liver pressure after 0.5-1min.It was negatively correlated with decreased ventricular volume(OR=0.233),TCO2 > 32(OR=0.058),and BE <-3(OR=0.018).(4)dampness blocking gas syndrome was positively correlated with ventricular aneurysm(OR=4.46).It was associated with sinus tachycardia(OR=0.614),decreased leukocyte(OR=0.393),increased ventricular volume(OR=0.313),and treadmill exercise oxygen consumption(> 20ml/(min·kg)(OR=0.196).SB < 21.3(OR=0.023)was negatively correlated.(5)the syndrome of kidney-yang deficiency Yin stopping is positively correlated with right heart enlargement(OR=1.945),heart index < 2.5(OR=1.662),and right atrial size(OR=1.422).Was negatively correlated with neutropenia(OR=0.046).Clinical stage:(1)zong qi-deficiency syndrome was positively correlated with whole-heart enlargement(OR=1.969)and Sat O2 < 90%(OR=1.106);It was negatively correlated with high left ventricular voltage(OR=0.482)and E/A < 1(OR=0.403).(2)stop drinking and obstruction of collaterals syndrome was positively correlated with pleural effusion(OR=2.073);It was negatively correlated with Sat O2 < 90%(OR=0.803),wholehearted enlargement(OR=0.522)and EF < 50%(OR=0.369).There was A positive correlation between kidney deficiency syndrome and E/A < 1(OR=2.118).It was negatively correlated with the proportion of cardiothoracic enlargement(OR=0.589),cardiac index < 2.5(OR=0.333),and Sat O2 < 90%(OR=0.186).(4)cold Yin obstruction of collaterals syndrome and pulmonary interlobar lymphatic dilation(OR=2.422),wider superior vena cava(OR=1.687)positive correlation;It was negatively correlated with normal ventricular volume(OR=0.535).End stage:(1)Yang syndrome of dyspnea and apoptosis is positively correlated with electrolyte disturbance(OR=32.88),oxygen consumption of plate movement < 10ml/(min·kg)(OR=188.891),local paradoxical movement of ventricular wall movement(OR=8.582),PO2 < 30(OR=1.039),and ventricular wall movement enhancement(OR=1.015).It was negatively correlated with BNP > 400 pg/ml(OR=0.218)and pleural effusion(OR=0.055).(2)there was a positive correlation between the syndrome of water-qi ling heart(ejection lung)and pleural effusion(OR=18.216)and BNP > 400 pg/ml(OR=4.577).It was negatively correlated with enhanced ventricular wall movement(OR=0.126),local paradoxical movement of ventricular wall movement(OR=0.117),PO2 < 30(OR=0.056),electrolyte disturbance(OR=0.03),and flatbed exercise oxygen consumption < 10ml/(min·kg)(OR=0.005).Conclusion: 1 Through the factor analysis method can effectively discover the four clinical stage main coronary heart disease with heart failure syndromes elements,characteristics,and validate the preliminary study on coronary heart disease with heart failure can be divided into four stages 13 syndrome,but also reveals the disease of sex of disease syndrome factor mainly Yang deficiency,qi deficiency,blood stasis and phlegm retention,etc.,the main disease syndrome factor in heart,spleen,liver,kidney,lung,and so on.2.Factor analysis and Logistic regression analysis can be used to analyze and sort out the main symptoms,secondary symptoms,tongue images and pulse images commonly seen in clinical manifestations of CHD with heart failure in four stages,and establish a regression model between symptoms and signs and various TCM syndromes,so as to clarify the correlation between main symptoms and syndromes.It is proved that factor analysis and Logistic regression analysis are effective ways to study TCM syndrome.3.Logistic regression analysis was used to establish a regression model for the correlation between each syndrome type of coronary heart disease complicated with heart failure in the four clinical stages and laboratory physical and chemical indicators,so as to determine the specific diagnostic indicators corresponding to each syndrome type,which confirmed the correlation and specificity between the changes of TCM syndromes and laboratory physical and chemical indicators. |
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