Study On Relationship Between Coronary Angiographic Features And Syndrome Differentiation Type Of Traditional Chinese Medicine In Patients With Coronary Heart Disease And Abnormal Glucose Metabolaism

Objective:To observe and dicuss the differentiation proportions of Traditional Chinese Medicine syndrome type in coronary heart disease with abnormal glucose metabolism in patients (including Diabetes Mellitus, Impaired Glucose Tolerance, Impaired Fasting Glucose regulation) we initially study correlation beween different abnormal glucose metabolism and the degree of pathologic changes of coronary artery,as well as different syndromes of traditional Chinese medicine.Which provides an objective basis different syndrome for coronary heart disease.Methods:Collecting hospital admitted inpatients with CHD in cardiology department of Jiangsu Province Hospital of Traditional Chinese Medicine and after coronary angiography confirmed 104 cases of coronary heart disease patients from Jan 2009～Jan 2010,whom were divided into diabetic and non-diabetic group,which according to OGTT results were divided into different groups(Previous diagnosis of diabetes,18 cases; byOGTT,5 cases of newly diagnosed cases of Diabetes; 28 patients with Impaired Glucose Tolerance; 17 cases of Impaired Fasting Glucose; 36 cases with Nomal GlucoseTolerance.). Coronary angiography:according to A Judkins method,TCM diagnostic criteria,referring to the State Drug Administration revised "Guiding Principles of Chinese Medicine Clinical Research new drugs" in 2002,which will be divided into Heart blood stagnation, Qi deficiency and Blood stasis, Qi stagnation Blood stasis, Obstruction of cardiac vessels Chill stagnate, Qi and Yin Deficiency, Heart and kidney Yin Deficiency, Yang Qi deficiency Syndrome decline, etc.Result:1. In this study, pathologic changes of coronary artery of which in patients is more serious(including Diabetes mellitus;Impaired Glucose Tolerance;Impaired Fasting Glucose),com mpared to the Nomal GlucoseTolerance.Compared with the NGT patients,IGT,IFG,DM patients suffered more from multiple vessel lesions, which more concentrated in the two-vessel or three more lesions, the number of pathologic changes of the coronary artery, single-vessel lesions> double vessel lesions>triple vessel lesions,the former accounts for44.2%, which gain statistic significance(X2=21.518,P=0.001＜0.001),howeverwhich have not gained statistic signific ance,inthe degree of pathologic changes of the coronary artery of CHD(X2=9.035,P=0.172>0.05 );Referring to the degree of pathologic changes, There are statistic significances between IFG group and DM group(P<0.05), about the number of pathologic changes of the coronary artery,the NGT group have statistic significance,compared to abnormal glucose metabiaism group.(P<0.05).2. In the affected blood vessel, LM, LAD, LCX, RCA of DM, IGT, IFG three groups are involved. Special stenosis location:LAD>LM>LCX>RCA, involving all CHDpatients,however, the special stenosis positions mostly locate at LAD. There are notno significant correlation between special stenosis location and CHDwith different abnormal glucose metabiaism group. (X2=10.514,P=0.931>0.05).compaired to the NGT,the others mostly showed the diffuse stenosis in CAG. The DM patients with coronary heart disease mainly show Heart blood stasis, Qi and Yin deficiency, Qi deficiency and Blood stasis syndromes; in IGT patients, Heart blood stasis, Obstruction of cardiac vessels with phlegm type are the most common; in IFG patients with blood stasis, qi stagnation phlegm obstruction are more common,following by qi stagnation.According to chi-square testing,the TCM syndromes don't show statistic significances, including to DM, IGT, IFG three groups(P>0.05). by variance analysis of variance,there are no difference in the TCM syndromes of IGT and IFG (P> 0.05).3. In coronary artery stenosis degree:DM, IGT, IFG three groups show different TCM syndromes:Heart blood stagnation type>Obstructionof cardiac vessels type>Qi deficiency and blood stagnation type> Qi stagnation and Blood stasis type> Chill stagnate,yet Moderate to serious coronary artery lesion is more common. viewing fromTCM syndromes, The patients with CHD,who chiefly belong to Heart blood stagnation type and Obstructionof cardiac vessels type in TCM,mostly showed the moderate to serious stenosis,which different account for73.9%,77.0%; who chiefly belong to Qi deficiency and blood stasis mostly showed mild stenosis;thoug-h chi-square test,there is no more difference among six TCM syndromes,involing DM, IGT, IFG three groups (P>0.05). Anomalous branches,referring to DM, IGT, IFG three groups:patients with triple vessel lesion mainly show Heart blood stagnation type,who account for43.5%, double vessel lesions for 30.4%.with qi deficiency and blood stagnation type type, triple vessel lesions >single-vessel lesions> double vessel lesions;with qi stagnation and blood stasis type, double vessel lesions for44.4%;obstruction of cardiac vessels type:triple vessel lesions for53.8%.qiand yin deficiency:double vessel lesions>single-vessel lesions>triple vessel lesions.by chi-square test single-vessel lesions,double vessel lesions, triple vessel lesions almost have the equal probability (P>0.05). But the blood stasis syndrome,compared to the other fiveTCM syndrome, a statistically significant(△P<0.001);Qi and blood stasis,Chill statistically significant between the stagnant card (*P<0.05).Blood stasis syndrome with Gensini points in the highest, followed by obstructionof cardiac vessels type analysis of variance, blood stasis in patients with coronary artery score based than the other syndromes, and five other syndromes were significantly different (P<0.05).Conclusion:1. The frequency of disturbed glucose metabolism is considerably high in inpatients with coronary heart disease,and postprandial hyperglycemia is more common. The prevalence of abnormal glucose metabolism would be obviously underestimated by measuring fasting plasma glucose only.the are extensive and serious,which are positively correlated with glucose,and this phenomenon performes outstandingly in impaired glucose tolerance period.therefore,all patient withCHD should be tested by OGTT.2. DM,IGT,IFGpatients suffered more from multiple vessel lesions,severe coronary artery stenosis,complete occlusions,diffuse lesions, Compared with the NGT patients. there is a degree of relevance between coronary artery lesions and number of d coronary artery stenosis and Chinese medicine symptoms,as the severity of disease as well as a wide range of diseases,who are more vulnerable to phlegm and blood stasis syndrome.3.the main syndrome of CHD with DM is heart blood stagnation,qiand yin deficiency,qi deficiency blood stagnation; the main syndrome of CHD with IGT:heart blood stagnation type,obstructionof cardiac vessels type; the main syndrome of CHD with IFG, blood stagnation,qi stagnation and blood stasis,obstructionof cardiac vessels type, "stasis", "sputum", "deficiency" syndrome is showed in all CHD patients. as the more common, the merger phlegm and blood stasis syndrome of vascular lesions was significantly higher than combined with other syndromes. More severe vascular disease are more vulnerable to obstructionof cardiac vessels type, trip lesions shows obstructionof cardiac vessels,it prompts with the extent of disease increases, more sputum of patients with coronary heart disease stasis syndrome, "stasis" is of coronary heart disease syndromes Chest specific elements.4. there is a degree of relevance between IFG and IGT, about vascular lesion,distribution of syndrome...