The Characteristics Of TCM Syndromes In Patients With Symptoms Of Chest Pain After Percutaneous Coronary Intervention

BackgroundCoronary heart disease (CHD)is a common disease which is seriously harmful to people's health.In our country, the morbidity and mortality of CHD gradually increased in the past 30 years. With the developing of percutaneous coronary intervention (PCI), the mortality of CHD has declined markedly. However, CHD is only for the local performance of atherosclerosis.Patients after PCI despite taking bigeminal drugs on anti-platelet aggregation and other drugs, there are still many patients with recurrent chest pain, part of them with restenosis (RS) after the reexamine of Coronary angiography (CAG), this serious effects the effect of PCI. The results show that, Blood Activating Method of TCM has some effect in improving the relapse rate in patients with angina and can prevent or reduce the rate of restenosis after PCI. But Blood Activating Method has not been universally successful. Suggesting that not only blood stasis leads to restenosis, but also there are other factors involved. The long-term syndrome analysis of TCM in patients after PCI is currently on a relatively small survey, the majority is to compare the perioperative changes in the TCM syndrome. But, the stress of perioperative and other factors may affect the result that may not be used to guide the treatment of patients after PCI. The investigation of the TCM Syndromes of chest pain after PCI will be done to ascertain the characteristics of the TCM syndromes.ObjectivesOn the one hand to approach the characteristics of TCM syndromes in patients with symptoms of chest pain after PCI, in order to find some of the rules used to guide clinical treatment. On the other hand to analysis the similarities and differences among the IRS group and the new site Stenosis group and the non-progress group after PCI. At last, Line regression analysis to identify the related risk factors of in-stent restenosis (IRS).MethodsThe objects of research are 143 in-patients who have been reexamined by CAG after PCI at the Guangdong Provincial Hospital. Selected symptoms according to the TCM criteria of CHD develop symptoms questionnaire. Through direct surveys, We finish the collections of syndromes of TCM and history-taking within 48 hours after CAG. And we finish all kinds of related examination of laboratory within one week before or after CAG. Statistical method:Build the database of the clinical syndromes and informations through Epidata software and use the Statistical software of spss 13 for windows to analysis. The analysis of several factors use Binary-Logistic Regression(stepwise);The comparison of percentages between two groups use chi-square test.ResultDistribution of syndromes:The statistical analysis shows that the most common syndromes of the 143 patients are the blood stasis (86.0%of total)and the qi deficiency (74.1%of total)and the phlegm turbidity(53.1%of totle).In addition, The three most common deficiency-syndrome of the viscera are the heart deficiency (85.3%of total) and the kidney deficiency (71.3%of total) and the spleen deficiency (49.7%of Total).Combination of syndromes:The statistical analysis shows that the most common combination of syndromes among the 143 patients is the combination of three-syndromes (53. lof total). Besides, the combination of two-syndromes (35%of total) are also relatively common combination. The most common combination of the deficiency-syndrome of the viscera among the 143 patients is the combination of three-syndromes (46.2%of total). Besides, the combination of two-syndromes (43.4%of total) are also relatively common combination. The law of changes of syndrome-combination:the combination of qi deficiency and blood stasis is the basis of the changes, at the same time, phlegm turbidity and yin deficiency is the common syndromes of syndrome-combination.The heart deficiency is the basis of syndrome-combination of the deficiency-syndrome of the viscera. And mostly combine with the kidney and spleen deficiency. Through the test of Chi-square test, the percentages of the phlegm turbidity, the blood stasis, the cold accumulation, the heart deficiency, the spleen deficiency and the kidney deficiency of the IRS group are higher than that of the non-progress group (P<0.05), while the percentage of the qi stagnation and the liver deficiency is lower than that of the non-progress group (P<0.05). The percentages of the phlegm turbidity, the blood stasis, the heart deficiency, the spleen deficiency and the kidney deficiency of the new site stenosis group are higher than that of the non-progress group (P<0.05). While the same comparisons (except the yang deficiency and the kidney deficiency) between the group of IRS and the group of new position stenosis are not obviously different (P>0.05).Influential factors of causing IRS:Through the analysis of Binary-Logistic Regression(104 samples),we can see that the phlegm turbidity and the blood stasis and the cold accumulation (their relative degrees of danger respectively are 5.314 and 10.267 and 9.252)are the dangerous syndromes of RS. Besides, the spleen deficiency and the kidney deficiency (their relative degrees of danger respectively are 3.901.and 7.089) are the dangerous deficiency-syndromes of the viscera of RS. So we can see that peoples with the syndrome of phlegm turbidity or blood stasis or cold accumulation or spleen deficiency or kidney deficiency are more easier to cause RS. At the same time, with the appear of the phlegm turbidity, kidney deficiency or cold accumulation in IRS patients the Gensini points will increase, which indicates the degree of coronary stenosis will be more serious.The influential factors of syndromes of RS:Through the analysis of Binary-Logistic Regression(104 samples)we can draw the conclunsion:Smoking, the pathological degree of coronary artery, the length of stents, the high level of total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) and uric acid(UA), are the risk factors of IRS.ConclusionThe qi deficiency and the blood stasis is the basic syndromes combination of the patients after PCI. At the same time, phlegm turbidity and yin deficiency is the common syndromes of syndrome-combination. The main location of CHD after PCI is located in the heart. Frequently with the spleen and kidney related. Although heart deficiency can appear alone, combining with spleen deficiency or kidney deficiency or both spleen and kidney deficiency is more common.The blood stasis and cold accumulation and phlegm turbidity and the spleen deficiency and the kidney deficiency are the risk factors of IRS. The patiens with blood stasis or cold accumulation or phlegm turbidity or spleen deficiency or kidney deficiency is easier to suffer RS after PCI.The way to prevent and cure RS is mainly to prevent the syndrome of blood stasis, the qi deficiency, the heart and kidney deficiency appeared through the treatment of TCM. Under normal conditions, it is generally necessary for the patients after PCI to supplement qi, activate the blood circulation, restore normal coordination between heart and kidney. We should also prevent and cure the syndrome of phlegm turbidity and yang deficiency and cold accumulation besides above to prevent the aggravation of CHD and restenosis.PCI patients quit smoking, take prescribed medicine, strict control of blood lipids, low-purine diet and other measures to control risk factors is particularly important.