中医脉图参数对高血压病患者发生冠心病的诊断价值研究

Study on diagnosis value of traditional Chinese medicine pulse parameters on coronary heart disease in hypertension

关键词:  高血压病  冠心病  脉图参数  预测价值

Key words:  hypertension  coronary heart disease  pulse figure parameter of traditional Chinese medicine  predictive value

摘要:

[目的] 探讨高血压病患者中医脉图参数与发生冠状动脉病变程度的关系，从而预测高血压病患者发生冠心病的风险。[方法] 选取自2015年5月—2022年1月在天津市人民医院心内科住院，并行冠状动脉造影检查的高血压病患者149例为研究对象，按冠状动脉造影结果分为非冠心病组（28例）、冠心病组（121例），其中冠心病组包括单支病变组（43例）、双支病变组（36例）、三支病变组（42例）。行冠脉造影前均用ZM-IIIc智能型中医脉象系统采集患者的脉图，分析脉图参数与冠状动脉病变严重程度的关系，以及脉图参数对冠心病的诊断价值。[结果] 脉图参数中反应动脉血管外周阻力的指标（h3、h4、W1/t、h3/h1、h4/h1）随冠状动脉病变严重程度的增加呈增高趋势，代表动脉血管弹性的指标（h1）随冠状动脉病变的严重程度呈降低趋势。h1与Gensini评分呈负相关，h3、h4、W1/t、h3/h1、h4/h1与Gensini评分呈正相关，差异具有统计学意义（P＜0.05或P＜0.01）。以“是否诊断冠心病”为状态变量，作ROC曲线分析，h3、h4、W1/t、h3/h1、h4/h1对冠心病均达到了中等程度的诊断价值。其中诊断价值最高的是h3/h1，ROC曲线下面积高达0.680。[结论] 随着冠脉病变程度的加重，反应动脉血管外周阻力的脉图参数增高，代表动脉血管弹性的脉图参数降低，说明中医脉图参数对冠心病的诊断有一定价值，并对预测高血压病患者发生冠心病的风险有参考意义。

Abstract:

[Objective] To evaluate the correlation between traditional Chinese medicine (TCM) pulse parameters and the severity of coronary heart disease,so we can predict the risk of coronary heart disease in hypertension patients. [Methods] From May 2015 to January 2022,149 hypertensive patients who underwent coronary angiography were selected from the Department of Cardiology,Tianjin People's Hospital. The patients were divided into non-coronary heart disease group (28 cases) and coronary heart disease group (121 cases) according to the results of coronary angiography. The coronary heart disease group included the single-vessel disease group (43 cases), double-vessel disease group (36 cases),and three-vessel disease group (42 cases). Before coronary angiography,the ZM-IIIc intelligent traditional Chinese medicine pulse system was used to collect the patient's pulse map. After that,the relationship between the pulse parameters and the severity of coronary artery disease,and the diagnostic value of the pulse parameters for coronary heart disease were analyzed. [Results] The indexes of program parameters reflecting peripheral resistance of the arterial vasculature (h3,h4,W1/t,h3/h1, h4/h1) tended to increase with the severity of coronary artery lesions. The indexes representing arterial vascular elasticity (h1) tended to decrease with the severity of coronary artery lesions. In addition,h1 was negatively correlated with Gensini score,and h3,h4,W1/t,h3/ h1 ,and h4/h1 were positively correlated with Gensini score,with statistically significant differences (P<0.05 or P<0.01). Subsequently, the ROC curves were analyzed with "whether to diagnose coronary artery disease" as the status variable. h3,h4,W1/t,h3/h1,and h4/h1 all achieved moderate diagnostic value for coronary artery disease. The highest diagnostic value was found for h3/h1,with an area under the ROC curve of 0.680. [Conclusion] As the degree of coronary artery disease increases,pulsogram parameters,which respond to the peripheral resistance of the arterial vessels,increase and pulsogram parameters,which represent the elasticity of the arterial vessels, decrease. This study illustrates the value of TCM pulsogram parameters for the diagnosis of coronary artery disease and is informative in predicting the risk of developing coronary artery disease in hypertensive patients.