| ObjectiveAnalysis of coronary artery disease(CAD)with type 2 diabetes mellitus(T2DM)patients with Qi deficiency and blood stasis with collaterals resistance(Qixuxueyuluozu,QXXYLZ),Qi and Yin deficiency with collaterals resistance(Qiyinilangxuluozu,QYLXLZ),hot poison with collaterals resistance(Reduneishengluozu,RDNSLZ)and Yin and Yang deficiency with collaterals resistance(Yinyangliangxuluozu,YYLXLZ)on the associated element distribution,clinical features and risk factors of acute cardiac syndrome(ACS).Analysis of CAD with T2 DM patients with QXXYLZ,QYLXLZ,RDNSLZ and YYLXLZ on the difference of coronary artery lesions.Clinical research on unstable angina(UA)with T2 DM patients with hot poison with collaterals resistance,taking Xinling pills,Tongxinluo capsules and secondary prevention of CAD in clearing heat and removing toxicity and expelling wind and dredging collaterals and enriching qi and activating blood.MethodsRetrospective study: Enroll inpatient with CAD and T2 DM in cardiovascular department and endocrine department of Dongzhimen Hospital from Sep 1th 2015 to Dec 1st 2017.Design a questionnaire and record their clinical and TCM information and syndrome with hierarchical cluster analysis,and summary the classification characters of QXXYLZ,QYLXLZ,RDNSLZ and YYLXLZ syndrome.Analysis relationships between the syndrome and clinical features,risk factors,blood lipid levels and blood glucose levels with single factor analysis and Logistic regression.Analysis influence factors on ACS in patients with CAD and T2 DM and compare the difference in QXXYLZ,QYLXLZ,RDNSLZ and YYLXLZ syndrome.Cross sectional analysis: Enroll inpatient with CAD diagnosed with coronary angiography in cardiac catheterization room of Dongzhimen Hospital from Sep 1th 2016 to Jun 1st 2018,dividing into CAD with T2 DM group and CAD group.Analysis characteristic and difference of coronary artery lesions in QXXYLZ,QYLXLZ,RDNSLZ and YYLXLZ syndrome,in terms of coronary artery Gensini Score(GS),coronary artery lesion number and coronary artery morphology.Divide patients into ACS and non-ACS,and analysis the relationship between coronary artery characters and ACS.Intervention study: Enroll inpatient with UA and T2 DM in cardiovascular department of Dongzhimen Hospital from Sep 1st 2017 to Oct 31 st 2018,with random assignment into experimental group and control group,by mean of random number table,single blind to the patient.The experimental group take Xinling pills and Tongxinluo capsules with Western Medicine therapy,while only Western Medicine therapy for control group within two months.Observe the change of angina syndrome score,change of RDNSLZ syndrome score,fasting blood glucose,glycosylated hemoglobin A1c(Hb A1c)and blood lipid levels.Analysis the variable trend of the syndrome,with clearing heat and removing toxicity and expelling wind and dredging collaterals and enriching qi and activating blood therapy.ResultsRetrospective study: There were totally 669 patients with CAD and T2 DM enrolled with 85 kinds of symptom appearing 21375 times.The most frequent syndrome was breath hard(82.66%),chest distress(78.77%),dim tongue(67.86%)and thin pulsing(54.71%).The most frequent basic syndrome was blood stasis(24.82%)and qi deficiency(24.64%).Based on the hypothesis of endogenous collateral wind,combined the hierarchical cluster analysis results with clinical experience and consensus standards,we divided 542 pts into four syndromes: QXXYLZ 149pts(27.5%),QYLXLZ 138pts(25.5%),RDNSLZ 118pts(21.8%)and YYLXLZ 137pts(25.3%).The main performances of QXXYLZ syndrome were crushing pain on the front of heart,radiating to the shoulder,chest distress,spontaneous,dim and swelling tongue with petechia,blue and distention sublingual collaterals,white coating and wiry or irregular pulse.The main performances of QYLXLZ syndrome were chest distress,breath hard,fatigue,dry mouth,pale tongue,less and dry coating,thin or deep pulse.The main performances of RDXYLZ syndrome were colic angina,head pain,heating,yellow or red urine,ozostomia,bitter mouth,constipation,dim and red tongue,yellowish and greasy coating and slim and rapid pulse.The main performances of YYLXLZ were soreness and weakness of waist and knees,extreme chilliness,tinnitus,palpitation,diuresis,legs edema,thin tongue with white coating and weak pulse.Single factor analysis showed that smoking rate of RDNSLZ higher than QYLXLZ,total cholesterol(TC)and triglyceride(TG)and low-density lipoprotein cholesterol(LDL-C)of QXXYLZ lower,Hb A1 c of RDNSLZ and YYLXLZ higher,the difference was statistically significant(P<0.05).Logistic regression showed that TC and Hb A1 c were prospective factors of QXXYLZ,smoking was prospective factor of QYLXLZ,and risk factors of RDNSLZ were smoking(P<0.05,OR=1.793)and TC(P<0.05,OR=1.744).542pts with CAD and T2 DM consisted of 245 pts with ACS and 297 pts with non-ACS.Single factor analysis showed that age of ACS group was elder,rate of smoking,coronary revascularization(CRV),hypertension,hyperlipemia were higher,level of TC,LDL-C,FBG was higher than non-ACS.T2 DM course of non-ACS was longer,rate of diabetic retinopathy and diabetic neuropathy were higher,the difference was statistically significant(P<0.05).Logistic regression showed that TCM classification were relevant factor of ACS that probability of ACS in QYLXLZ was slimmer.Age(P=0.000<0.05,OR=2.554),smoking(P=0.011<0.05,OR=1.665),CRV(P=0.009 <0.05,OR=1.903),hypertension(P=0.015<0.05,OR=1.741)and T2 DM course were also risk factors of ACS in patients with CAD and T2 DM.Logistic regression showed that ACS risk factors of QXXYLZ pts with CAD and T2 DM were age(P=0.021<0.05,OR=2.674),smoking(P=0.012<0.05,OR=2.927),CRV(P=0.044<0.05,OR=2.583)and hypertension(P=0.036<0.05,OR=2.555),that of QYLXLZ was age(P=0.000<0.05,OR=7.909),that of RDNSLZ were hypertension(P=0.030<0.05,OR=3.105)and FBG(P=0.026<0.05,OR=3.149),and that of YYLXLZ were age(P=0.015<0.05,OR=2.847)and FBG(P=0.006<0.05,OR=3.381).Cross sectional analysis: There were 210 patients with CAD enrolled,including 100 pts with T2 DM.CAD and T2 DM group had higher Gensini Score(Z=2.094,P=0.036<0.05)and Grading than that of CAD group.Logistic regression showed that risk factors of CAD combined with T2 DM including number of coronary artery lesion vessels,diffuse coronary artery lesion(P=0.001<0.01,OR=3.258),hypertension(P=0.003<0.05,OR=2.621)and hyperlipemia(P=0.003<0.05,OR=2.621).Based on the TCM syndrome,100 pts with CAD and T2 DM were divided into 4 groups: 30 pts in QXXYLZ,24 pts in QYLXLZ,23 pts in RDNSLZ and 23 pts in YYLXLZ.Coronary artery severity differed in each group.GS and rate of GS high level of RDNSLZ were higher than that of QXXYLZ and QYLXLZ(P<0.05).Number of coronary artery lesion vessels and rate of diffuse coronary artery lesion of YYLXLZ were higher than that of QXXYLZ and QYLXLZ(P<0.05).Logistic regression showed that diffuse coronary artery lesion was protective factor of QXXYLZ.GS grading was risk factor of RDNSLZ.Number of coronary artery lesion vessels(P=0.046<0.05,OR=1.594)and diffuse coronary artery lesion(P=0.011<0.05,OR=6.685)were risk factors of YYLXLZ.The 100 pts with CAD and T2 DM were divided into 2 groups: 55 pts with ACS and 45 pts without ACS.GS and number of coronary artery lesion vessels of ACS group were higher than that of non-ACS(Z=2.720,P=0.007<0.05).Single factor analysis showed that patients in QYLXLZ were susceptibly suffering ACS than YYLXLZ(c2=7.982,P=0.005<0.008).Logistic regression showed that risk factors of ACS differed in each syndrome,which in QXXYLZ were smoking(P=0.011<0.05,OR=3.060)and stroke(P=0.041<0.05,OR=9.723),which in QYLXLZ was left circumflex artery lesion(P=0.009<0.05,OR=14.667),which in RDNSLZ was number of coronary artery lesion vessels(P=0.029<0.05,OR=1.594),and which in YYLXLZ was CRV(P=0.039<0.05,OR=2.962).Intervention study: There were 60 patients with UA and T2 DM enrolled,consisting of 30 pts in experimental group and 30 pts in control group randomly.The experimental therapy was Xinling pills and Tongxinluo capsules,combined with regular Western Medicine,while only Western Medicine therapy for control group.After the treatment,the angina clinical total effective rate(c2=5.192,P=0.023<0.05)and the RDNSLZ syndrome effective rate(c2=21.696,P=0.000<0.05)of experimental group was higher than that of control group.The total score and single score of chest distress,constipation and yellowish and greasy coating symptoms,and the level of TC,LDL-C and FBG decreased significantly than that of control group(P<0.05).There was no statistically significant in cardiovascular disease risk factors and number of coronary artery lesion vessels for effective and invalid patients(P>0.05).There was no adverse event during the experimental course.ConclusionBased on the hypothesis of endogenous collateral wind,patients with CAD and T2 DM could be divided into four syndrome: Qi deficiency and blood stasis with collaterals resistance,Qi and Yin deficiency with collaterals resistance,hot poison with collaterals resistance and Yin and Yang deficiency with collaterals resistance.The fundamental pathogenesis is Qi deficiency and blood stasis,and Qi and Yin deficiency.The significant pathological change is cardiac collateral stasis.Cardiovascular risk factors differ from each syndrome.Blood lipid level of QXXYLZ and QYLXLZ is lower.Smoking and TC level are the independent risk factors of RDNSLZ.TCM syndrome differentiation is the relevant factor of ACS attacks in patients with CAD and T2 DM,while patients in QYLXLZ are unsusceptible to ACS.Other risk factors contain age,smoking,CRV,hypertension and T2 DM course.Risk factors of ACS differ from each syndrome while age and hypertension are common factors.Coronary artery severity of patients with CAD and T2 DM is heavier than that with CAD,taking into consideration 3 main parameters: the higher GS,the more coronary artery lesion vessels,and the frequent diffuse coronary artery.Number of coronary artery lesion vessels,diffuse coronary artery,hypertension and hyperlipemia are the independent risk factors of ACS in patients with CAD and T2 DM.Coronary artery severity differs from each syndrome,which in RDNSLZ is heavy in terms of Gensini Score,and which in YYLXLZ is heazy in terms of number of coronary artery lesion vessels and diffuse coronary artery.Xinling pills and Tongxinluo capsules can relieve much of the angina and other symptoms and pull down the level of TC and HBG,for patients in RDNSLZ syndrome with UA and T2 DM.The therapy of clearing heat and removing toxicity,expelling wind and dredging collaterals and enriching Qi and activating blood has significant clinical effect and adequate safety.Chest distress,constipation and yellowish and greasy coating symptoms are significant indicators for RDNSLZ patients with CAD and T2 DM. |
PDF Full Text Request