Coronary Heart Disease Patients With Stable Chinese Medicine Syndrome Evolution Studies

CHD is the most dangerous killer who fatally imperils the human health. To reduce the incidence and mortality of CHD is always a hotspot and focus in modern medical research area. TCM Syndrome, which a response to pathogeny in vitro and in vivo, is a comprehensive reaction in a certain stage (time point) of disease process. Syndrome is always as a dynamic process, throughout occurrence, development, transition of CHD. Investigation on the evolvement principle of TCM Syndrome of CHD would redound to cognize the pathogenesis evolvement and transition of CHD, improve TCM clinical syndrome differentiation ability, and to be great significance in early recognize and intervene the high-risk patients and reducing the occurrence of cardiovascular events further.This paper consists of two different parts:literatures review and clinical research.Literatures review:In this part, the retrospective analyse of the status quo of investigations on evolvement principle of TCM Syndrome, focus on the research of CHD, congestive heart failure, viral myocarditis and so on, concluded that the recent researches mostly design as the cross-sectional survey, longitudinal study, retrospective study, etc. Some academic progress acquired by comparing the TCM syndromes constitute ratio in different time points, stages of the disease, in patients of different disease phases, or proportion of a certain TCM syndrome, and the syndrome transition probability method to investigate the evolvement principle of TCM Syndrome, and show a positive effect in improving the clinical syndromes differentiation ability and treatment effect. Altogether, such a study focus on the patients of stable CHD with a recent thrombotic cardiovascular event is vacant. Meanwhile, since TCM syndrome is a high dimensional, dynamic, nonlinear and complex system, further study may give priority to longitudinal studys, which based on the multi-timepoints dynamic observation, make full use of multi-disciplinary method, such as multivariate statistical analysis and modern data mining, and analysis inosculate the TCM theory and clinical practical. Clinical research:Objective:All the patients of stable coronary artery disease divided in two groups, event group and non event group, based on the thrombotic cardiovascular events occurred in 6 months to 1 year after recruit or not. clinical data collection is real-time and dynamic, in different time points under the schedule, observed syndromes factors distribution characters of the subjects in enrollment,6 months and 1 year, to investigate the evolvement principle of TCM Syndrome of patients of stable CHD and the thrombotic cardiovascular event.Method:In this study,9 TCM Syndrome factors, which are Cold Coagulation, Qi Stagnation, Sputum Turbidity, Phlegm Heat, Blood Stasis, Qi Deficiency, Yang Deficiency, Yin Deficiency, Accumulated Toxin were extracted based on the TCM diagnostic information of patients with stable CHD. In the scheming three time points (enrollment,6 months,1 year), analyze the syndromes factors distribution of the all, event group and non event group subjects of stable CHD, observed the syndromes factors distribution characters of the event group and non event group subjects, calculate its frequency distribution, and apply Multifactor dimensionality reduction (MDR) and complex network data mining method to explore the syndrome evolvement of the stable CHD patients and their thrombosis cardiovascular events.Result:1333 patients were observed,37 cases in events group and 1296 cases in non events group. It is found that Phlegm Turbidity, Blood Stasis, Qi Deficiency and Accumulated Toxin were the basic syndrome features of stable CHD, the constitute ratio of single syndrome of CHD patients show a various descend trend over time. At the enrollment point, relatively, events group show a higher Qi Deficiency and Accumulated Toxin proportion, a lower Sputum Turbidity proportion (P<0.05 or P<0.01); After 6 months, events group show a higher Qi Deficiency, Accumulated Toxin and Qi Stagnation proportion (P<0.05 or P<0.01). MDR results indicate that Accumulated Toxin at the enrollment point, the interaction effects between the Qi Deficiency and Blood Stasis after 6 months positive correlate to the cardiovascular events, reflect a TCM syndromes evolvement principle that the Accumulated Toxin results in Blood Stasis and the Toxin waste Qi. The results of complex network indicate that when the node is 8, the key node of the network image of cardiovascular events subjects are Accumulated Toxin and Qi Deficiency in enrollment visit and Qi Deficiency and Blood Stasis at 6 months visit. These results reflect the transform of Accumulated Toxin, Qi Deficiency and Blood Stasis, are consistent with MDR results.Conclusion:Blood Stasis, Phlegm Turbidity, Qi Deficiency and Accumulated Toxin are the key TCM syndromes of the stable CHD patients, while Accumulated Toxin and Qi Deficiency are the TCM syndrome features of the subjects with cardiovascular events. TCM syndromes of the stable CHD patients evolve continually over time. The Accumulated Toxin results in Blood Stasis, the Accumulated Toxin and Blood Stasis entwist together, the Toxin waste Qi, the Qi Deficiency results in Blood Stasis may be the key pathogenesis and the TCM Syndrome evolvement principle of patients with cardiovascular events, which worth while a further research.