| Objective:1.Understand the patients with acute myocardial infarction(mi)within 1 week of the incidence of acute stress disorder,analysis summary of patients with acute myocardial infarction complicating acute stress disorder epidemiological characteristics,laboratory results,coronary angiography results,etc.,discussion is helpful to the early diagnosis of acute myocardial infarction complicating acute stress disorder and confirmed factors,provide theoretical basis for early clinical diagnosis.2.By investigating the distribution of TCM syndromes and syndrome elements in patients with acute myocardial infarction complicated with acute stress disorder,a database was established to explore the main pathogenesis and syndrome types of acute myocardial infarction complicated with acute stress disorder,providing theoretical basis for clinical syndrome differentiation legislation and drug use and further in-depth research.3.Analyze and summarize the relationship between early diagnosis and diagnosis of acute myocardial infarction complicated with acute stress disorder and TCM syndrome elements,providing a theoretical basis for TCM clinical diagnosis and treatment.Methods:Epidemiological survey method:1152 patients with acute myocardial infarction hospitalized in Beijing Anzhen Hospital affiliated to Capital Medical University,Beijing Oriental Hospital affiliated to Beijing University of Chinese Medicine,and the Third Affiliated Hospital of Beijing University of Chinese Medicine were selected from March 2021 to March 2022.The survey used face-to-face questionnaires and data mining analysis of hospitalization data.First,baseline data including gender,age,height,weight,marriage,body mass index,living alone,education level,average monthly family income,smoking history,alcohol abuse history,disease history and medication history were recorded.Subsequently,acute Stress Disorder Scale(ASDS)and Stanford Acute Stress Response Questionnaire(SASRQ)were used for assessment and diagnosis.Information of TCM four diagnosis was collected,and related blood routine(including hypersensitive C-reactive protein),electrocardiogram,liver and kidney function,echocardiography,coronary angiography and PCI were recorded.Statistical methods:The measurement data were expressed as the mean soil standard deviation X±S,and the qualitative data were described by frequency and percentage.Chi-square test was used to compare the composition percentage between groups.Normal test was carried out for measurement data,and independent sample T-test was used for inter-group comparison of measurement data conforming to normal distribution,while non-parametric test of independent sample was used for inter-group comparison of measurement data not conforming to normal distribution.Multivariate logistic regression analysis.All tests were bilateral(P<0.05)and the difference was statistically significant.Factor analysis method was used to extract syndrome elements and statistic the distribution characteristics of syndrome elements.Results:1.Demographic information:In this study,1152 AMI patients were included,including 19 cases with incomplete information and 2 cases with death.A total of 1131 patients were included,with a total response rate of 98.18%.Among them,352 cases(31.12%)were complicated with ASD,and 3 cases of renal failure were excluded,a total of 349 cases were included.A total of 782 patients in the AMI group as the control group met the inclusion criteria;Male patients with AMI complicated with ASD accounted for 78.51%;The onset age is more than 50～69 years old,accounting for 82.51%;Patients with a BMI of 25～28 accounted for 54.73%;68.77%of families with monthly income below 10,000 yuan;Divorced and widowed patients accounted for 7.45%;Bachelor degree or above accounted for 43.84%.2.General Information:Among the patients with AMI complicated with ASD included in this study,the prevalence of basic diseases from high to low was hypertension,type 2 diabetes,cerebral infarction,old myocardial infarction and heart failure,among which hypertension accounted for 50.83%.The frequency of drug use from high to low was:antiplatelet drugs,antihypertensive drugs,antiglycemic drugs,lipid-lowering drugs,among which,antiplatelet drugs accounted for 75.62%,lipid-lowering drugs accounted for 15.96%;Patients with smoking history accounted for 50.43%;Patients with drinking history accounted for 32.95%.3.Comparison of baseline data between the two groups:There was no significant difference in age,gender,past medical history,smoking and alcohol history between the two groups(P>0.05).Male patients were the majority in both groups,accounting for 78.51%and 78.52%in AMI combined with ASD group and AMI control group,respectively.The prevalence of basic diseases from high to low were hypertension,type 2 diabetes,cerebral infarction(old),old myocardial infarction,heart failure.Patients with smoking history accounted for 45.56%～46.54%;Drinking history of patients accounted for:48.47%～50.43%;4.Comparison of myocardial infarction sites between the two groups:There were 69 STEMI patients in AMI combined with ASD group(19.77%).There were 662 cases in the control group,accounting for 84.64%,P<0.001,the difference was statistically significant.The prevalence of patients with extensive anterior wall myocardial infarction,anterior wall myocardial infarction and inferior wall myocardial infarction in the two groups was compared,P>0.05,the difference was not statistically significant;5.Comparison of Killip grading and GRACE score between the two groups:In the admission Killip grade Ⅰ and Ⅱ,the proportion of patients in the control group was 65.86%and 24.38%,respectively,which were higher than that in the AMI group(P<0.05),and the difference was statistically significant.In the admission Killip classification Ⅲ and Ⅳ,the proportion of patients in the control group was 7.9%and 1.86%,respectively,which were lower than that in the AMI group(P<0.05),with statistically significant differences.In GRACE score of admission,the score of patients in control group(126.29±33.68)was lower than that in AMI combined with ASD group(137.58±33.59),P<0.05,the difference was statistically significant.6.Comparison of blood routine and hypersensitive C-reactive protein between the two groups:Analysis of hemoglobin,platelet and lymphocyte test data between the two groups showed no statistical significance(P>0.05).Analysis of white blood cell and hypersensitive C-reactive protein test data of the two groups showed that AMI combined with ASD group was higher than control group,P<0.05,the differences were statistically significant.7.Comparison of liver function,creatinine clearance rate,blood glucose and blood lipid between the two groups:Analysis of aspartate aminotransferase,alanine aminotransferase,triglyceride,total cholesterol,high density lipoprotein cholesterol and creatinine clearance between the two groups showed that,P>0.05,there was no statistical significance;Blood glucose,low density lipoprotein cholesterol and other test data analysis of the two groups showed that AMI combined with ASD group was higher than AMI control group,P<0.05,the differences were statistically significant.Comparison of myocardial enzymes and cardiac ultrasound between the two groups:Analysis of troponin I,creatine kinase isoenzyme and other test data between the two groups showed that there was no statistical significance(P>0.05).B-type natriuretic peptide test data analysis of the two groups showed that AMI combined with ASD group(1124±42.76)was higher than AMI control group(976±41.59),P<0.05,the differences were statistically significant;Analysis of ejection fraction,left ventricular endomomial diameter and left ventricular endomomial diameter of the two groups showed that the AMI combined with ASD group was lower than the AMI control group,P<0.05,the differences were statistically significant.Comparison of the number of stent implantation between the two groups:After implantation of 1 stent,there was 1 case(0.86%)in AMI combined with ASD group,which was lower than that in AMI control group(341 cases(43.55%),P<0.05,the difference was statistically significant.Two stents were implanted,123 cases(35.4%)of AMI combined with ASD were lower than 335 cases(42.78%)of AMI control group,P<0.05,the difference was statistically significant.After implantation of 3 stents,222 cases(63.61%)of AMI combined with ASD were implanted,which was higher than 106 cases(13.54%)of AMI control group,P<0.05,the difference was statistically significant.Multivariate Logistic regression analysis of AMI patients complicated with ASD:The results showed that the order of influence degree was GRACE score,hypersensitive C-reactive protein,number of stent implantation,number of disease,ejection fraction and Killip grade.See Table 11 for details.Extraction results of factor loading coefficient and syndrome elements.AMI patients with ASD mainly involve 7 syndrome elements including blood stasis,qi stagnation,Yin deficiency,qi deficiency,Yin deficiency,blood deficiency and phlegm-heat.The disease is characterized by deficiency and solid,and the disease is mainly located in the heart and liver,with spleen,kidney and lung.Characteristics of disease distribution:The factor score of each case was calculated by regression method,and the syndrome elements of the disease were determined by the loading coefficient with the highest absolute value.The distribution of syndrome elements of 349 patients with AMI combined with ASD was obtained.The results showed that blood stasis accounted for the highest proportion of syndrome elements of AMI combined with ASD(39.83%).The other were qi deficiency(18.62%),qi stagnation(13.75%),phlegm-heat(13.47%),Yang deficiency(6.88%),Yin deficiency(4.58%)and blood deficiency(2.87%),of which 67.05%were positive cases and 32.95%were deficiency syndrome.Distribution characteristics of disease location syndrome elements.The distribution of syndrome elements in 349 patients with AMI complicated with ASD showed that the centers of disease elements in PATIENTS with AMI complicated with ASD were comparable to liver,followed by spleen,lung and kidney.Correlation analysis of different TCM syndromes and risk factors in AMI patients with ASD showed that:The GRACE scores of the blood stasis,qi stagnation,qi deficiency and phlegm-heat syndrome groups were all higher than 140 points,and the differences were statistically significant compared with those of the non-blood stasis,qi stagnation,qi deficiency and phlegm-heat syndrome groups(P<0.05).Compared with blood stasis and non-blo-od stasis,qi stagnation and non-qi stagnation,phlegm-heat and non-phlegm-heat syndrome groups,the hypersensitive C-reactive protein was significantly higher than the control group(P<0.05).Compared with non-qi deficiency,blood stasis and non-blood stasis,qi stagnation and non-qi stagnation,the number of stents was significantly higher than the control group(P<0.05).The left ventricular ejection fraction of blood stasis and non-blood stasis,qi deficiency and non-qi deficiency,Yang deficiency and non-yang deficiency were significantly lower than those of control group(P<0.05).Conclusion:1.Incidence of AMI complicated with ASD:About 1/3 of AMI patients were complicated with ASD in the first week of course.2.Risk prediction:Among the factors related to AMI combined with ASD,hypersensitive C-reactive protein,GRACE score,number of underlying diseases,number of stent implantation,left ventricular ejection fraction and Killip grade can be used as risk predictors of AMI combined with ASD.GRACE score,hypersensitive C-reactive protein,number of stent implantation and left ventricular ejection fraction had high predictive value for AMI complicated with ASD.3.Main pathogenesis of AMI combined with ASD:AMI combined with ASD patients mainly involve 7 kinds of syndrome elements,including blood stasis,qi stagnation,Yin deficiency,qi deficiency,Yang deficiency,blood deficiency and phlegm turbidity.The disease location syndrome is mainly heart and liver,with spleen,kidney and lung.The basic pathogenesis is heart and pulse stasis,liver stagnation and qi stagnation.4.Relationship between GRACE score and disease syndromes:Patients with disease syndromes including blood stasis,qi stagnation,blood deficiency and phlegm turbidity had higher GRACE scores than patients without blood stasis,qi stagnation,blood deficiency and phlegm turbidity,respectively.From high to low according to GRACE score,blood stasis,qi stagnation,blood deficiency,phlegm turbidity.5.Relationship between hypersensitive C-reactive protein and pathological syndromes:the value of hypersensitive C-reactive protein in patients with pathological syndromes including blood stasis,phlegm turbidity and qi stagnation was higher than that in patients without blood stasis,phlegm turbidity and qi stagnation,respectively.Blood stasis,phlegm turbidity and qi stagnation were ranked from high to low according to the measurement value of hypersensitive C-reactive protein.6.The relationship between the number of stent implantation and pathological syndromes:the number of pathological syndromes in patients with qi deficiency,blood stasis and qi stagnation was higher than that in patients without qi deficiency,blood stasis and qi stagnation,respectively.According to the number of stent implantation from high to low,the order was qi deficiency,blood stasis,qi stagnation.7.Relationship between left ventricular ejection fraction and pathological syndromes:the pathological syndromes of patients with Yang deficiency,blood stasis and qi stagnation were lower than those without Yang deficiency,blood stasis and qi stagnation,respectively.The left ventricular ejection fraction was measured from low to high,followed by Yang deficiency,blood stasis and qi stagnation. |
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