冠心病稳定型心绞痛痰瘀互结证中医证候量表评价研究

目的]探索冠心病稳定型心绞痛痰瘀互结证患者、气阴两虚证患者与健康人中医证候评价量表异同。方法]通过多中心、小样本、精细化临床研究,纳入7家临床单位124例受试者,因未完成访视脱失7例,最终纳入受试者117例,其中冠心病痰瘀互结证患者38例,在西医常规治疗的基础上加服丹蒌片治疗,气阴两虚证患者39例,在西医常规治疗的基础上加服通脉养心丸治疗,健康人40例不予干预。比较冠心病患者0、4、8、12周、健康人第0周《冠心病痰瘀互结证中医证候评价量表》评分情况。结果] 1)冠心病痰瘀互结证患者第4、8、12周时,各症状评分及舌下脉络青紫情况较0周不同程度降低(P0.05或P0.01)。2)冠心病气阴两虚证患者第4、8、12周时,各症状评分较0周有所下降(P0.05或P0.01)。3)与健康人比较,冠心病痰瘀互结证患者各项评分具有统计学差异(P0.01),冠心病气阴两虚证患者各症状评分及舌质紫暗、舌下脉络青紫、脉弦、脉涩情况具有统计学差异(P0.05或P0.01),冠心病两组患者各时点比较,部分指标及舌脉情况存在不同程度差异。4)冠心病痰瘀互结证患者0、8周时,身重、口黏腻、苔腻、脉滑、舌有瘀斑瘀点聚为一类,脉弦、舌质紫暗、舌下脉络青紫、脉涩、口唇青紫、面色晦暗聚为一类;冠心病气阴两虚证患者0、8周时,胸闷、胸痛、身重、口黏腻、口唇青紫、面色晦暗聚为一类,舌有瘀斑瘀点、舌质紫暗、脉涩聚为一类。结论]冠心病稳定型心绞痛痰瘀互结证与气阴两虚证患者经治疗后,《冠心病痰瘀互结证中医证候评价量表》中相关症状表现均有所改善,且不同证型的表现不同。《冠心病痰瘀互结证中医证候评价量表》可以为进一步临床诊断冠心病稳定型心绞痛痰瘀互结证提供一定参考。

Comparative study on TCM syndrome evaluation scale of phlegm and blood stasis syndrome in coronary heart disease with stable angina pectoris

Objective] To explore the similarities and differences of traditional Chinese medicine (TCM) syndrome evaluation scale between patients with and phlegm and blood stasis syndrome,qi and yin deficiency syndrome in coronary heart disease (CHD) stable angina pectoris and healthy people.Methods] Through a multi-center,small sample and refined clinical study,124 subjects in 7 clinical units were included in the study and 7 cases were lost,finally 117 subjects were included,including 38 cases of phlegm and blood stasis syndrome patients with conventional Western treatment and traditional Chinese medicine Danlou Tablets,39 cases of qi and yin deficiency syndrome patients with Western treatment and Chinese medicine Tongmai Yangxin Pills,and 40 cases of healthy people without intervention. The scores of TCM syndrome evaluation scale of coronary heart disease with phlegm and blood stasis syndrome were evaluated at different time points in different groups and groups. Coronary heart disease patients were detected at 0th,4th,8th and 12th week,respectively,and at the 0th week,the level of healthy people was detected.Results] 1)At the 4th,8th and 12th week of CHD with phlegm and blood stasis syndrome,the scores of each symptom and sublingual vein bruise were significantly lower than those of 0th week (P<0.05 or P<0.01). 2) At the 4th,8th and 12th week of CHD patients with qi and yin deficiency syndrome,the score of each symptom decreased compared with 0th week (P<0.05 or P<0.01). 3) Compared with healthy people,there were significant differences in scores among patients with CHD of phlegm and blood stasis syndrome (P<0.01). Patients with CHD of qi and yin deficiency syndrome were significant differences in scores of each symptom and dark purple tongue (P<0.05 or P<0.01). CHD in two groups at different time points,some indicators and tongue existed different degrees of difference. 4) Patients with CHD,phlegm and blood stasis syndrome 0th,8th weeks,weight,mouth sticky,greasy moss,slippery pulse,tongue ecchymosis clustered together,while pulse string,dark purple tongue,pulse astringent,purple lips,dark complexion clustered together. CHD qi and yin deficiency syndrome patients at 0th,8th weeks,chest tightness,chest pain,weight,mouth sticky,lips purple,dull complexion,tongue stasis,dark purple tongue,astringent pulse clustered together.Conclusion] Patients with CHD phlegm and blood stasis syndrome,qi and yin deficiency syndrome showed improvement in the TCM syndrome evaluation scale indicators after treatment,and two syndromes showed different presentation. It suggested CHD phlegm and blood stasis syndrome TCM syndrome evaluation scale can provide a reference for clinical diagnosis and treatment of CHD patients with stable angina pectoris of phlegm and blood stasis syndrome.