冠心病中医辨证分型与冠状动脉造影所见相关性比较研究

目的：了解冠心病（CHD）患者冠状动脉造影所反映的冠状动脉病变程度与中医辨证分型之间的相关性。方法：对73例患者采用1990年修订的“冠心病中医辨证标准”进行辨证分型，并与冠状动脉造影所见进行比较分析。结果：冠状动脉单支病变29例（39．73％），双支病变9例（12．33％），三支病变35例（47．95％）。冠状动脉窄狭程度：轻度54支，中度38支，重度31支，完全阻塞29支，总计病变血管数为152支（69．41％），无病变血管数67支（30．59％）。中医辨证分型表明：具标实征象者73例（100％），其中血瘀征象者73例（100％）；兼痰浊者39例（54．4％）；兼气滞者16例（21．0％）；兼容凝者7例（9．6％）。具有明显本虚征象者63例（86．3％），其中气虚者57例（78．1％）；阳虚者18例（24．7％）；阴虚者28例（38．4％）；阳脱者5例（6．8％）。73例冠心病患者中均有不同程度的血瘀表现，其中以舌质的血瘀表现较为突出。80．8％的患者有不同程度的心绞痛，74．0％的患者存在口唇、齿龈颜色暗红、紫暗或淡暗现象。冠心病中医辨证分型血瘀证候积分的相互比较，表明寒凝血瘀和阳脱血瘀为血瘀重症，气滞血瘀和阴虚血瘀为血瘀轻症，阳虚血瘀、痰浊血瘀和气虚血瘀的血瘀程度亦较重。寒凝患者的血管病变支数最多，气滞和阴虚患者的血管病变支数较少，气滞和阴虚患者的冠状动脉狭窄程度较轻，阳脱和阳虚患者冠状动脉的狭窄程度较重。结论：冠状动脉血管病变支数越多，狭窄程度越重，血瘀症候积分值越大，血瘀程度越重。

Relationship between Coronary Arteriography and Syndrome Differentiation Type of TCM

Objective: To understand the relationship between the coronary arteriography (CA) reflected degree of coronary artery lesion and the TCM Syndrome Differentiation type (TCM SDT). Methods: Patients TCM SDT were differentiated adopting the standard of Syndrome Differentiation for coronary artery diseases revised in 1990, and the comparison of TCM SDT with the findings in CA was carried out. Results: CA examination showed that 29 patients (39.73%) were of one artery lesion, 9 patients (12.33%) two artery lesion and 35 patients (47.95%) three artery lesion; the stenosis degree of them were: 54 arteries were mild stenosis, 38 moderate stenosis and 31 severe stenosis; 29 arteries were completely occluded, the sum total of affected artery was 152 (69.41%), and the other 67 arteries (30.59%) had no lesion. TCM SDT showed that all the 73 patients had secondary Excess Syndrome, among them 73 patients (100%) with blood stasis Syndrome, 39 patients (53.4%) with Phlegm Turbid Syndrome, 16 (21.0%) with Qi stagnation Syndrome and 7 (9.6%) with Cold condensation Syndrome. 63 patients (86.3%) with obvious primary Deficiency Syndrome, among them, 57 (78.1%) were Qi Deficiency, 18 (24.7%) Yang Deficiency, 28 (38.4%) Yin Deficiency and 5 (6.8%) Yang collapse. All patients had blood stasis of various degrees, manifesting on tongue proper prominently. In the 80.8% patients who had angina pectoris, 74.0% had their mouth, lips and gum dark red, dark purple or light dark in color. The comparison between TCM SDT and Blood Stasis score revealed that patients of Cold condensation blood stasis Syndrome and Yang collapse blood stasis Syndrome were serious. Patients of Qi stagnation blood stasis Syndrome and Yin Deficiency blood stasis Syndrome were mild cases, while patients of Phlegm Turbid blood stasis Syndome and Qi Deficiency blood stasis Syndrome were moderate severity cases. The number of affected artery in Cold condensation patients was the most, and in Yin Deficiency patients was the least. The coronary artery stenosis degree in patients of Qi stagnation and Yin Deficiency were milder than in those of Yang collapse and Yang Deficiency patients. Conclusion: The more the number of arterial lesion, the severer the degree of stenosis and the higher the blood stasis score, then the more serious the degree of stasis.