| ObjectiveBased on a large sample,multi-center clinical epidemiological cross-sectional survey data,common spleen-stomach syndromes of coronary heart disease(CHD)in the stable phase were explored,and the influencing factors of behavior and lifestyle of different spleen-stomach syndromes were analyzed.MethodCarried out a large sample,multi-center clinical epidemiological cross-sectional survey for data collection.Modes of data analysis that combine classic statistical methods with modern unsupervised statistical learning methods were adopted.Analyzed four-diagnosis information and behavior and lifestyle data from 3366 patients with stable coronary heart disease of 42 clinical research units in 23 provinces across the country.Study Ⅰ:Data measurement was conducted using a questionnaire independently developed by the research group,including 150 items of symptom information such as chest tightness and fatigue,30 items of tongue information,and 13 items of pulse information,a total of 193 items.EpiData 3.1 software was used to establish the database.After strict and standardized data entry and cleaning,frequency statistics were carried out on the above 193 items of four-diagnosis information data,and a total of 168 items of four-diagnosis information with a frequency greater than 5%were selected for analysis.The two-step latent tree model in the latent structure method was used to establish the latent structure model of CHD in the stable phase,and latent variables related to the spleen and stomach in the model were synthetically clustered.The syndrome differentiation rules of the spleen and stomach syndrome of CHD were established according to the clustering results by automatic software operation.According to these rules,3366 CHD patients in the stable phase were differentiated.Study Ⅱ:According to the syndrome differentiation results of the spleen-stomach syndrome in Study 1,stable CHD patients with and without spleen-stomach syndrome were selected to analyze the difference in their behavior and lifestyle.Data were evaluated using the behavior and lifestyle survey scale independently developed by the project team.EpiData 3.1 was used to establish the database.After strict and standardized data entry and cleaning work,the data in the database was analyzed.Firstly,the chi-square test,t-test,and non-parametric test were used for single factors analysis.Then the indicators with statistical differences were included in the logistic regression equation.Multinomial logistic regression was used to explore the influencing factors of behavior and lifestyle of the spleen and stomach syndrome in the stable phase of CHD.ResultStudy Ⅰ:Based on the analysis of 168 four-diagnosis Information data from 3366 patients with CHD in the stable stage,including symptoms,tongue,and pulse,the latent structure model of CHD in the stable period was established.A total of 46 latent variables were generated.The Bayes Information Criterion(BIC)score was-263252.44.Combining graphs of latent structure,model mutual information(MI)and cumulate mutual information(CMI),tables of latent class probabilities,and conditional probabilities,the 46 latent variables were interpreted from the perspective of TCM.The results showed that the 12 latent variables Y7,Y16,Y17,Y26,Y27,Y28,Y29,Y30,Y31,Y3,Y42,and Y45 were related to spleen and stomach,and Y18,Y20 was the possible tongue information of spleen and stomach syndrome.Then the symptoms of these latent variables were combined,and it was found that the main spleen-stomach syndromes in patients with stable CHD included spleen qi deficiency syndrome,phlegm dampness syndrome,and stomach heat burning syndrome.Three kinds of spleen and stomach syndromes in patients with stable coronary heart disease were classified by comprehensive clustering,the structure models of spleen qi deficiency syndrome,phlegm dampness syndrome,and stomach-heat hyperactivity syndrome in stable coronary heart disease were obtained.The syndrome differentiation rules of each syndrome were established by computer processing:①coronary heart disease(CHD)temper deficiency syndrome-mental fatigue(5.6),fatigue(5.5),weak breath or unwillingness to speak(4.4),low voice feebleness(4.4),easily tired(3.0),shortness of breath(2.8),drink cold discomfort,even diarrhea(2.6),dizziness(2.5),anorexia(2.5),defecate dry pond(2.5),three or more colds in a year(2.4),sleepy after meals(2.2),loose stools(1.2),little or no tongue coating(0.4),thready pulse(0.1),the threshold value is 17.6,According to the above syndrome differentiation rules,3366 patients with stable CHD were discriminated.It was found that there were 1987 patients with this syndrome,accounting for 59.03%of the total population.②Phlegm dampness syndromes with coronary heart disease-body trapped(3.8),sticky and greasy in the mouth(3.8),distention and fullness(3.5),viscous stool(3.5),obesity(2.7),heaviness of head(2.5),analeptic(2.4),analeptic(2.3),the waist is plump and soft(2.0),plump and teeth-printed tongue(1.5),snoring(1.1),white slip tongue coating(1.0),the threshold is 11.5.According to the above rules of syndrome differentiation from 3366 patients with coronary heart disease(CHD)stabilization criterion,we found a total of 1267 patients,37.64%of the total population;③coronary heart disease hyperactivity of stomach-heat syndrome-gum pain(3.9),get hungry easily(3.5),prefer cold drink and cold water(3.4),pantothenic acid(3.0),heartburn(2.8),nausea(2.8),bleeding gum(2.7),feverish feeling in palms and soles(2.6),epigastric pain(2.5),bitter mouth(2.4),excessive skin sebum(2.4),dry mouth(2.2),bad breath(1.5),thirst with liking for fluids(1.4),red tongue(1.4),the threshold is 12.1.According to the above rules of syndrome differentiation from 3366 patients with coronary heart disease(CHD)stabilization criterion.A total of 915 patients had the syndrome,accounting for 27.18%of the total population.Study Ⅱ:According to the statistics,715 patients with stable CHD simply had the syndrome of spleen deficiency,190 patients with phlegm and dampness,136 patients with hyperactivity of stomach-heat syndrome,and 986 patients without the syndrome of the spleen and stomach.The results of single-factor analysis of behavior and lifestyle of four groups show that unbiased preference,prefer sweet,spicy,roast,and greasy,overall good eating habits,often overeat,picky,late meals,engage in physical labor,exercise regularly,do heavy physical activity per week,accumulated years of manual labor,daily heavy intensity physical activity time,days of moderate-intensity physical activity per week,daily sitting time,alcohol consumption,the form of alcohol(beer,wine,and liquor),tea consumption,types of tea(green tea,black tea,white tea,scented tea),number of cigarette per day,second-hand smoke exposure,a total of 28 statistically significant indexes.In these variables,often overeating,picky with food,accumulated years of manual labor,daily heavy intensity physical activity time,days of moderate-intensity physical activity per week,forms of alcohol(beer,wine,and liquor),types of tea(green tea,black tea,white tea,scented tea)have many missing values.By considering the data analysis accuracy,they will not be included in the above analysis.Only the rest of the 15 lifestyle factors had statistical significance.In addition,to control the effects of three potential confounders-gender,age,and the presence of stomach disease--they were included in the analysis along with 15 behavioral and lifestyle variables.Among them,"age" and "how many hours of sitting time per day"are continuous variables,while the rest are classified variables.Multivariate Logistic results showed that when gender,age,and gastric disease factors were controlled:(1)Compared with the group without spleen and stomach syndrome,sitting time(B=0.077,OR=1.080,95%CI:1.041-1.120,P<0.001),and prefer spicy(B=0.430,OR=1.537,95%CI:1.060-2.228,P=0.023)were signiffcantly positively correlated with the syndrome of spleen and stomach deficiency,indicating that patients with longer sitting time and prefer spicy were more likely to have the syndrome of spleen and stomach deficiency.However,good dietary habits(B=-0.3 86,OR=0.679,95%CI:0.473-0.976,P=0.036),regular physical exercise(B=-0.298,OR=0.742,95%CI:0.599-0.921,P=0.007)and tea drinking(B=-0.391,OR=0.676,95%CI:0.527-0.868,P=0.002)were significantly negatively correlated with the syndrome of spleen qi deficiency,indicating that stable CHD patients with good dietary habits,regular physical activity,and tea consumption were less likely to have spleen qi deficiency syndrome.(2)Compared with the group without spleen and stomach syndrome,those who prefer roasted(B=1.425,OR=4.159,95%CI:1.433-12.065,P=0.009),and greasy(B=0.593,OR=1.809,95%CI:1.072-3.054,P=0.027)were significantly positively correlated with the syndrome of phlegm dampness syndrome,which indicates that patients with preferences of roasted and greasy foods are more likely to have phlegm dampness syndrome;Tea drinking(B=-0.555,OR=0.574,95%CI:0.376-0.876,P=0.010)was significantly negatively correlated with the phlegm-dampness syndrome,indicating that patients with stable CHD who drank tea were less likely to have the phlegm-dampness syndrome.(3)Compared with the group without spleen and stomach syndrome,prefer spicy(B=0.712,OR=2.038,95%CI:1.123-3.699,P=0.019),engaged in physical labor(B=0.624,OR=1.867,95%CI:1.224-2.849,P=0.004)were significantly positively related to hyperactivity of stomach-heat syndrome,indicating that patients with stable CHD who prefer spicy and engaged in physical labor were more likely to have hyperactivity of stomach-heat syndrome.(4)When comparing groups of spleen qi deficiency syndrome with phlegm dampness syndrome,there was a significant positive correlation between those that prefer roasted(B=1.289,OR=3.630,95%CI:1.252-10.525,P=0.018)and greasy(B=0.621,OR=1,860,95%CIL1.086-3.187,P=0.024).The syndrome of phlegm-dampness in stable CHD indicates that compared with the syndrome of spleen qi deficiency,patients with stable CHD with excessive grease and roasting are more likely to have the syndrome of phlegm-dampness.Secondhand smoke exposure(B=-0.543,OR=0.581,95%CI:0.318-0.886,P=0.012)was significantly negatively correlated with the phlegm dampness syndrome in stable CHD,indicating that compared with the syndrome of spleen qi deficiency syndrome,stable CHD patients with secondhand smoke exposure were less likely to have the phlegm dampness syndrome.(5)When comparing groups of spleen qi deficiency syndrome and hyperactivity of stomach-heat syndrome,the patients with hyperactivity of stomach-heat syndrome often preferred sweet(B=0.766,OR=2.152,95%CI:1.099-4.211,P=0.025),engaged in physical labor(B=0.573,OR=1.774,95%CI:1.150-2.736,P=0.010),participated in regular exercise(B=0.544,OR=1.723,95%CI:1.115-2.663,P=0.014),drank alcohol(B=0.621,OR=1.861,95%CI:1.037-3.338,P=0.037)and consumed tea(B=0.603,OR=1.827,95%CI:1.169-2.856,P=0.008),this indicates that compared with the syndrome of spleen qi deficiency,patients with the above behavioral lifestyle in the stable phase of CHD were more likely to have the syndrome of burning stomach heat.(6)When comparing groups of stomach-heat hyperactivity syndrome and phlegm dampness syndrome,tea-drinking(B=0.767,OR=2.153,95%CI:1.231-3.767,P=0.007),and second-hand smoke exposure(B=0.630,OR=1.878,95%CI:1.085-3.249,P=0.024)was significantly positively related to the hyperactivity of stomach-heat syndrome.It shows that compared with phlegm dampness syndrome,the above behavior factors of patients with coronary heart disease(CHD)in stable period is more likely to have the syndrome of stomach-heat hyperactivity;those who prefer greasy food(B=-1.152,OR=0.316,95%CI:0.134-0.745,P=0.008)were significantly negatively correlated with the syndrome of hyperactivity of stomach-heat in stable CHD indicating that compared with the phlegm-dampness syndrome,stable CHD patients with heavy taste were less likely to have the hyperactivity of stomach-heat syndrome.Conclusion1.In the stable stage of CHD,there are mainly three syndromes related to the spleen and stomach,including spleen qi deficiency syndrome,phlegm and dampness syndrome,and hyperactivity of stomach-heat syndrome.2.Patients with the spleen-stomach syndrome in the stable phase of CHD have a significant correlation with different behavior and lifestyle factors such as diet,tea-drinking,physical activity,sitting time,and physical exercise.There are also significant differences in behavior and lifestyle habits among patients with the different spleen-stomach syndrome. |
