Study On Correlation Between Traditional Chinese Medicine Syndromes And Percutaneous Coronary Intervention Postoperative Heparin Induced Thrombocytopenia

Percutaneous coronary intervention(PCI)is one of the main methods for the treatment of coronary heart disease,there are still some complications affecting the short-term and long-term prognosis after opening the diseased vessels and resolving coronary stenosis including heparin induced thrombocytopenia(HIT),no reflow,contrast induced nephropathy,etc.PCI postoperative HIT refers to the acquired hypercoagulant syndrome,heparin inducing the body to produce related antibodies which cause platelets consumed in large quantities and platelet count decreasing in heparin anticoagulant therapy after surgery,HIT with thrombosis increases the risk of amputation or even death.HIT belongs to the category of "blood syndrome" in TCM which has a good effect on the treatment of "blood syndrome".However,there are few clinical reports on PCI postoperative HIT,and the research on TCM syndromes related to this disease is more limited,so the advantages of TCM syndrome differentiation for clinical guidance is hard to play.Therefore,based on the above problems,this study carries out the syndromic study of PCI postoperative HIT,which has certain practical significance.Objective:To analyze PCI postoperative HIT's risk factors and TCM syndrome characteristics through the retrospective study of patients after PCI in our hospital,so as to provide theoretical support of TCM syndrome differentiation and treatment of PCI postoperative HIT in the future.Methods:Patients who met the enrollment criteria after PCI were enrolled from Oct.2012 to Mar.2018 in our hospital.Patients who had PCI postoperative HIT were in case group and who did not have PCI postoperative HIT were in control group.We analyze the clinical characteristics of the PCI postoperative HIT,the characteristics of high-risk groups and the correlation between HIT and TCM syndromes.Results:Totally 1708 patients were enrolled in this study,there were 1182 males and 526 females.Patients' clinical diagnosis were listed as follow:260 patients had chest distress;721 patients had unstable angina;408 patients had acute STEMI;319 patients had acute NSTEMI.TCM syndromes were listed as follow:658 patients of Qi deficiency and blood stasis syndrome;240 patients of phlegm and blood stasis syndrome;221 patients of heart blood stasis syndrome;196 patients of Qi and blood deficiency syndrome;194 patients of Qi stagnation and blood stasis syndrome;83 patients of Yang asthenia syndrome;63 patients of cold congeal and blood stasis syndrome;53 patients of heart and kidney yin deficiency syndrome.Among the 1708 patients,43 patients had PCI postoperative HIT(case group).1665 patients who did not have PCI postoperative HIT were in control group.By comparing these two groups of patients,the results showed that several clinical factors were statistically significant(P<0.05),including:age,age-Classification,weight,body mass index,heart failure,previous history-hypertension,peripheral vascular disease,cerebrovascular disease,chronic kidney disease,anemia,hematocrit,creatinine and creatinine clearance.By comparing the CRUSADE score and GRACE score:CRUSADE total score,CRUSADE 2 Classification,CRUSADE 5 Classification,GRACE total score,GRACE 3 Classification had statistically significant(P<0.05).Among the 43 PCI postoperative HIT patients in disease group,TCM syndromes were listed as follow:17 patients of Qi and blood deficiency syndrome;12 patients of Yang asthenia syndrome;5 patients of Qi deficiency and blood stasis syndrome;5 patients of heart and kidney yin deficiency syndrome;2 patients of Qi stagnation and blood stasis syndrome;1 patient of phlegm and blood stasis syndrome;1 patient of heart blood stasis syndrome.Among the 23 patients in disease group who had HIT type I,TCM syndromes were listed as follow:15 patients of Qi and blood deficiency syndrome;3 patients of Qi deficiency and blood stasis syndrome;2 patients of Qi stagnation and blood stasis syndrome;1 patient of phlegm and blood stasis syndrome;1 patient of heart blood stasis syndrome;1 patient of heart and kidney yin deficiency syndrome.Among the 20 patients in disease group who had HIT type ?,TCM syndromes were listed as follow;12 patients of Yang asthenia syndrome;4 patients of heart and kidney yin deficiency syndrome;2 patients of Qi and blood deficiency syndrome;2 patients of Qi deficiency and blood stasis syndrome.Among the patients with HIT type ?,the proportion of Qi and blood deficiency syndrome was higher than that of the patients without HIT type ?,it had statistically significant(P<0.05).It can be concluded that there is a certain correlation between Qi and blood deficiency syndrome and the occurrence of HIT type ?.Among the patients with HIT type ?,the proportion of Yang asthenia syndrome was higher than that of the patients without HIT type ?,the difference was statistically significant(P<0.05),it had statistically significant(P<0.05).It can be concluded that there is a certain correlation between Yang asthenia syndrome and the occurrence of HIT type ?.Using single factor logistic regression method(a=0.10),several high risk factors were identified to have association with PCI postoperative HIT(P<0.05),including:age,heart failure,previous history-hypertension,peripheral vascular disease,cerebrovascular disease,chronic kidney disease,anemia,ST segment depression,TCM-Qi deficiency and blood stasis syndrome,heart and kidney yin deficiency syndrome,Qi and blood deficiency syndrome,Yang asthenia syndrome,CRUSADE 4 Classification with very high risk(score>50),CRUSADE 4 Classification with high risk(40-50),CRUSADE 4 Classification with medium risk(30-40),and GRACE 3 Classification with high risk(score>140).Next,univariate logistic regression analysis was used as a covariate to carry out multivariate logistic regression analysis.Patients with previous history-hypertension who had PCI postoperative HIT had OR value of 2.734 with 95%CI of(1.016,7.354);patients with applied intra-aortic balloon pump who had PCI postoperative HIT had OR value of 0.175 with 95%CI of(0.04,0.763);CRUSADE 4 Classification with very high risk(score>50)which had PCI postoperative HIT had OR value of 20.434 with 95%CI of(5.606,74.476);CRUSADE 4 Classification with high risk(40-50)which had PCI postoperative HIT had OR value of 12.263 with 95%CI of(3.352,44.862);CRUSADE 4 Classification with medium risk(31-40)which had PCI postoperative HIT had OR value of 6.716 with 95%CI of(1.71,26.371).Previous history-hypertension,IABP and CRUSADE medium-high scores were independent risk factors for increased risk of PCI postoperative HIT.In addition,by analyzing the TCM syndromes.PCI postoperative HIT patients of Qi and blood deficiency syndrome had OR value of 12.668 with 95%CI of(5.418±29.619);PCI postoperative HIT patients of heart and kidney yin deficiency syndrome had OR value of 19.738 with 95%CI of(5.776,67.45);PCI postoperative HIT patients of Yang asthenia syndrome had OR value of 17.507 with 95%CI of(6.815,44.974).Qi and blood deficiency syndrome,Yang asthenia syndrome and heart and kidney yin deficiency syndrome have important effects on the incidence of PCI postoperative HIT.Conclusion:Qi and blood deficiency syndrome was significantly correlated with HIT type?,Yang asthenia syndrome was significantly correlated with HIT type?;Qi and blood deficiency syndrome,Yang asthenia syndrome,heart and kidney yin deficiency syndrome,previous history-hypertension,IABP and CRUSADE medium-high scores are major high-risk factors that were associated with PCI postoperative HIT.