| Objective: Based on the preliminary construction of the theoretical framework of the pathogenesis of coronary heart disease(CHD)"phlegm and blood stasis combined",to further explore the evolution rules of traditional Chinese medicine(TCM)syndromes in different stages of CHD development,in order to enhance the predictability of the occurrence and development trend of coronary heart disease,to enhance clinicians' understanding of CHD.Methods: The sequential research method of "literature systematic review ? multi-layer cross-sectional survey ? prospective cohort study" was adopted.Study 1: With "CHD","syndrome differentiation","syndrome" and "syndrome type" as keywords,systematically search CNKI,Wanfang Data Resource System,VIP,Pub Med database,including clinical research documents of CHD TCM syndrome with clear syndrome differentiation type and relevant quantity or proportion.Through information extraction,standardization of syndrome name,and disease stage division,frequency statistics are carried out on TCM unit syndromes of different development stages of CHD(stable stage,active stage,post-intervention stage and end stage).Study 2: Using large sample,multi-center,multi-layer cross-sectional survey and prospective cohort study methods,collect TCM syndrome information of patients with common population,metabolic syndrome,stable phase of CHD,acute coronary syndrome(ACS),PCI/CABG,CHD and heart failure,and analyze the evolution law of TCM syndrome in different development stages of CHD by frequency statistics,correlation analysis methods and complex network visualization technology.Study 3: Focus on "phlegm and blood stasis syndrome" on the basis of study 3,and use objective quantitative syndrome differentiation scale to quantitatively analyze the evolution rule of phlegm and blood stasis syndrome of CHD.Results: Study 1: 1)80 studies covering 22 provinces,municipalities and autonomous regions,and 21361 patients with CHD were included.The top four TCM unit syndromes in frequency were blood stasis(54.98 %),qi deficiency(40.41 %),phlegm dampness(36.44 %)and yin deficiency(20.34 %),showing the trend of blood stasis > qi deficiency > phlegm dampness > yin deficiency > heat > qi stagnation > yang deficiency > toxicity > cold coagulation > excessive fluid > blood deficiency.2)The results of longitudinal comparison showed that phlegm dampness,blood stasis,qi deficiency and yin deficiency were the main syndromes in the stable stage of CHD.During the active period,the proportion of heat and internal toxicity increased.After interventional therapy,the ratio of blood stasis,heat and internal toxicity decreased,but qi deficiency,yang deficiency and qi stagnation increased significantly.At the end stage,blood stasis,excessive fluid,phlegm dampness,qi deficiency,yin deficiency and yang deficiency were the main symptoms.Study 2: 1)A total of 11383 cases of TCM syndrome cross-sectional investigation before,during and after CHD were completed.Among them,4093 cases were in the general population group,1475 cases in the metabolic syndrome group,3366 cases in the CHD stable phase group,704 cases in the ACS group,753 cases in the PCI/CABG group and 992 cases in the CHD heart failure group.Regarding the completion of prospective cohort study,the completion rate of all visits in stable CHD group,ACS group and PCI/CABG group exceeded 70%,with ACS group having the highest completion rate of 86.1%.2)in the pre-disease stage(metabolic syndrome group),the phlegm-dampness syndrome is "dominant"(accounting for about 60%),while the proportion of blood stasis syndrome rises to the second place(34.17%)compared with that of ordinary people.the sequence of each syndrome is phlegm-dampness(59.25%)> blood stasis(34.17%)> qi deficiency(29.97%)> yin deficiency(23.87%)> stasis heat(16.94%)> yang deficiency(5.57%)> spleen deficiency(5.27%)> qi stagnation(3.54%).The proportions of blood stasis syndrome and phlegm-dampness syndrome in the early stage and platform stage of the disease(stable stage group of CHD)are more than 50%,and the sequence of the first visit is blood stasis(66.47%)> phlegm-dampness(55.67%)> qi deficiency(24.39%)> yin deficiency(18.99%)> stagnation of heat(6.17%)> qi stagnation(5.86%)> yang deficiency(5.43%)> cold coagulation(1.93%).The proportion of blood stasis syndrome reached the peak in the fluctuation stage of disease(acute coronary syndrome group)(all three visits were about 90%).the order of the first visit was blood stasis(89.93%)> phlegm dampness(63.88%)> qi deficiency(28.35%)> qi stagnation(11.80%)> yin deficiency(6.91%)> cold coagulation(2.59%)> stasis heat(1.73%)> yang deficiency(1.01%).During the perioperative period(PCI/CABG group),the proportion of blood stasis syndrome(88.59% ? 85.90% ? 81.20% ? 77.95%)and phlegm-dampness syndrome(62.25% ? 56.89% ? 52.19% ? 51.52%)gradually decreased,while the proportion of qi deficiency syndrome(29.72% ? 35.57% ? 38.25% ? 39.56%)and yang deficiency syndrome(2.25% ? 2.46 ? 2.76 ? 2.86)gradually increased with the extension of visit time.In the final stage of the disease(CHD and heart failure group),qi deficiency syndrome keeps rising and exceeds half for the first time,reaching 51.61%.the sequence of each syndrome is blood stasis(69.25%)> qi deficiency(51.61%)> phlegm dampness(43.45%)> yin deficiency(18.04%)> water drink(14.42%)> yang deficiency(12.00%)> stagnation heat(1.71%)> qi stagnation(1.51%).3)Syndrome manifestations of patients with CHD are mostly "mixed with excess and deficiency",showing the evolution rule of "mixed with excess and deficiency,dominated by excess and deficiency" in the early stage and platform stage of CHD,the "dominant combination of excess and deficiency" in ?ACS stage,the "declining trend of combination of excess and deficiency" after ?PCI/CABG operation,and the "rising combination of deficiency and excess and deficiency with prominent manifestation" in heart failure stage.4)"Phlegm and Blood Stasis Combined" Ratio: 12% of ordinary people;22% in metabolic syndrome group;38% in stable stage group of CHD;ACS group 59%;The proportion of "phlegm and blood stasis" after PCI/CABG surgery showed a downward trend with the extension of visit time(59% one week before surgery ? 52% two weeks after surgery? 45% one month after surgery ? 43% six months after surgery);34% of patients with CHD and heart failure.5)During the follow-up period of 6 months for patients with stable CHD,the risk of cardiovascular events for patients with depression-heat syndrome is 2.45 times(95% CI: 1.310~4.587)that for patients with yin deficiency syndrome,and 1.77 times(95% CI: 1.128~2.776)that for patients with non-yin deficiency syndrome.In the first 6 months of ACS patients,the yang deficiency syndrome rate in cardiovascular event group was significantly higher than that in non-cardiovascular event group(OR=21.82,95% CI: 3.866~123.100).Study 3: 1)The ratio of phlegm-dampness syndrome was significantly higher than that of the general population(65.1%,1.78 times higher than that of the general population)in the early onset of CHD,and the increase rate(28.5 percentage points)exceeded the difference between any other two adjacent stages.It was only 13.5 percentage points lower than that of the heart failure group with the highest ratio of phlegm-dampness syndrome in the whole development of CHD,confirming the theory of "early humidification of CHD".The evolution law of the integral range of phlegm-dampness syndrome in different development stages of CHD: 4.38-4.65 points for the general population,7.38-7.89 points for metabolic syndrome patients,8.96-9.29 points for patients with stable CHD,9.31-10.03 points for ACS patients and 9.52-10.16 points for patients with CHD and heart failure,showing the evolution trend of general population < metabolic syndrome < stable CHD < ACS < CHD and heart failure.With the extension of visit period,the score of phlegm-dampness syndrome in PCI/CABG group decreased gradually,reaching 9.04 points,7.91 points,7.13 points and 6.24 points respectively at 1 week before operation,2 weeks after operation,1 month after operation and 6 months after operation.2)When the metabolic syndrome develops into CHD,the proportion of blood stasis syndrome increases significantly.Among them,the stable stage group of CHD is 41.6 percentage points higher than the metabolic syndrome group,and the proportion of blood stasis syndrome in the former(63.5%)is 2.9 times higher than that in the latter.When the patient's condition fluctuates in stable phase of CHD and develops into ACS,the proportion of blood stasis syndrome continues to rise and reaches a peak(78.9%).When the disease stabilizes again and eventually develops into heart failure with the prolongation of the disease course,the proportion of blood stasis syndrome decreases slightly(69.2%),which is between the stable phase of CHD and ACS phase.The evolution rule of blood stasis score range in different stages of population: 1.71-1.91 points for general population,2.88-3.29 points for metabolic syndrome patients,7.94-8.31 points for patients with stable CHD,9.98-10.75 points for ACS patients and 8.78-9.48 points for patients with CHD and heart failure,showing the evolution trend of general population < metabolic syndrome < stable CHD < CHD and heart failure < ACS.With the extension of visit period,the score of blood stasis syndrome in PCI/CABG group showed a downward trend of "fast before slow"(8.95?6.53?5.96?5.46).3)If the diagnosis of phlegm-dampness syndrome and blood stasis syndrome is simultaneously satisfied as the judgment standard of phlegm-blood stasis syndrome,the phlegm-blood stasis syndrome accounts for more than 50% of contemporary CHD patients.Among them,51.2%,64.7% and 57.2% of the patients with stable CHD,ACS and heart failure due to CHD have phlegm and blood stasis syndrome.The evolution rule of the integration range of Phlegm-Dampness & Blood Stasis Syndrome in each stage population: 6.06-6.43 points in the general population group,10.29-11.00 points in the metabolic syndrome group,16.92-17.48 points in the stable CHD group,19.36-20.61 points in the ACS group,and 18.33-19.46 points in the CHD and heart failure group.The evolution rule of the integration range of phlegm and blood stasis syndrome is 4.48-4.72 points in the general population group,7.19-7.63 points in the metabolic syndrome group,10.80-11.08 points in the stable phase group of CHD,11.50-12.05 points in the ACS group,and 11.38-11.89 points in the heart failure group of CHD.No matter the combination form of "phlegm-dampness syndrome and blood stasis syndrome" or the independent dialectical standard of "phlegm-blood stasis syndrome",the points of phlegm-blood stasis syndrome in different development stages of CHD show the evolution trend of common people group < metabolic syndrome group < CHD stable stage group < CHD heart failure group < ACS group.With the extension of visit period,the points of phlegm and blood stasis syndrome in PCI/CABG group showed a downward trend.Conclusion: Study 1: The occurrence and development of CHD may have the evolution rule of syndrome,namely "phlegm","blood stasis" and "deficiency" run through all the time,the "heat" increase in active phase,the overall change from excess to deficiency in post-intervention phase,and the signs of blood stasis,water drinking and deficiency of both qi and yin increase significantly at the end stage.Study 2: Generally speaking,CHD has 8 common syndromes in different stages of development,including 5 types of excess syndromes such as blood stasis,phlegm-dampness,qi stagnation,cold coagulation,stagnation of heat,and 3 types of deficiency syndromes such as qi deficiency,yin deficiency,and yang deficiency.Among them,the excess syndrome is mainly phlegm-dampness and blood stasis,and the deficiency syndrome is mainly qi deficiency and yin deficiency.The distribution characteristics of the syndrome in each stage are closely related to the pathological changes of the disease itself."Phlegm and Blood Stasis Combined" is the most prominent combination form of compound syndrome in the pre-disease stage(metabolic syndrome),early disease stage and platform stage(stable stage of CHD)and disease fluctuation stage(acute coronary syndrome),while "Qi deficiency and blood stasis" is common in the final stage of disease(CHD and heart failure)."Heat of phlegm and blood stasis" leads to aggravation of blood stasis or further generation of toxic and pathogenic factors to damage heart collaterals,which may be the key link of cardiovascular events in patients with stable CHD.Study 3: The phlegm-dampness score in the pre-disease stage of CHD is significantly increased.Early detection and control of phlegm-dampness syndrome may be an important starting point for prevention of CHD.Blood stasis syndrome is still one of the typical clinical features of CHD,and is also the most direct factor affecting the change of disease condition.Coronary intervention therapy can significantly improve blood stasis score within 6 months after operation.Phlegm and blood stasis are the basic pathogenesis of CHD and run through all the time.Objective quantification of phlegm and blood stasis points is helpful for clinical differentiation and curative effect evaluation of phlegm and blood stasis,and the differentiation criteria of different forms of phlegm and blood stasis have good differentiation. |
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