中医证型与冠状动脉内光学相干断层成像评价分层斑块稳定性的相关性研究

Study on correlation between traditional Chinese medicine syndrome types and the stability of layered plaques evaluated by intracoronary optical coherence tomography

关键词:  光学相干断层成像  冠心病  分层斑块  中医证型  气虚血瘀证

Key words:  optical coherence tomography  coronary heart disease  layered plaque  traditional Chinese medicine syndrome types  qi deficiency and blood stasis syndrome

摘要:

[目的] 通过冠状动脉内光学相干断层成像评价分层斑块稳定性与中医证型的相关性。[方法] 采用病例对照研究对2022年8月—2023 年8 月于北京中医药大学第三附属医院心内科确诊为冠心病的患者124例进行调查，行冠状动脉光学相干断层成像检查并获取相关图像资料；根据相关指南进行中医证型诊断。首先，以中医证型为自变量，以冠状动脉是否为分层斑块为因变量进行χ²检验筛选出有意义的中医证型。其次，以中医证型为自变量，以冠状动脉分层斑块是否为多层-分层斑块为因变量进行χ²检验筛选出与多层-分层斑块有相关性的中医证型。最后，以与多层-分层斑块相关的中医证型为标准分组，比较两组患者间具有不稳定特征的分层斑块数量差异。采用SPSS 26.0进行统计分析。[结果] 124例患者中占比较多的为心肾阴虚证（41例，37%）、气虚血瘀证（37例，33%）。根据是否检出冠状动脉分层斑块将患者分为分层组（83例）与未分层组（41例）并与不同证型进行χ²检验，表示气虚血瘀证与冠状动脉分层斑块间具有显著相关性（P<0.05，OR=2.75）。将分层组进一步分为单层-分层斑块组（40例）和多层-分层斑块组（43例）并行χ²检验，表示气虚血瘀证与冠状动脉多层-分层斑块间具有显著相关性（P<0.05，OR=3.29）。对比分层组中气虚血瘀证患者与非气虚血瘀证患者的冠状动脉分层斑块稳定性，气虚血瘀证患者中平均每人检出薄纤维帽粥样斑块-分层斑块（1.24±0.87） 个，薄纤维帽-分层斑块（2.07±1.05） 个，具有不稳定特征的分层斑块数量多于非气虚血瘀证患者（P<0.01）。[结论] 气虚血瘀证与冠状动脉分层斑块稳定性具有一定相关性，临床上运用中医药从益气活血化瘀论治冠心病是否可以更好地改善冠状动脉分层斑块稳定性值得进一步探索。

Abstract:

[Objective] To evaluate the correlation between the stability of layered plaques and traditional Chinese medicine(TCM) syndrome types by coronary optical coherence tomography. [Methods] A case-control study was conducted to investigate 124 patients diagnosed with coronary heart disease in the Department of Cardiology of the Third Affiliated Hospital of Beijing University of Chinese Medicine from August 2022 to August 2023. Coronary optical coherence tomography was performed and relevant image data were obtained. TCM syndrome diagnosis was performed according to the relevant guidelines. Firstly,the Chi-square test was conducted to select the significant TCM syndrome types with the TCM syndrome types as independent variables and whether the coronary plaque was layered as the dependent variable. Secondly,with TCM syndrome types as independent variables and whether the coronary layered plaque was multi-layered as the dependent variable,Chi-square test was performed to screen out the TCM syndrome types associated with multi-layered plaques. Finally,the number of layered plaques with unstable characteristics was compared between the two groups according to the TCM syndrome types related to multi-layered plaques as grouping standard. SPSS 26.0 software was used for statistical analysis. [Results] Among the 124 patients,the proportion of heart and kidney yin deficiency syndrome(41 cases,37%),and qi deficiency and blood stasis syndrome(37 cases,33%) were relatively high. The patients were divided into the layered plaque group(n=83) and the non-layered plaque group(n=41) according to the presence or absence of the layered coronary plaque,and the Chi-square test was performed with different syndrome types. The test results showed that there was a significant correlation between coronary layered plaques and qi deficiency and blood stasis syndrome(P<0.05,OR=2.75). The layered plaque group was further divided into the single-layered plaque group(n=40) and the multi-layered plaque group(n=43) and the Chi-square test was performed. The results of Chi-square test showed that there was a significant correlation between qi deficiency and blood stasis syndrome and coronary artery multi-layered plaque(P<0.05,OR=3.29). By comparing the stability of coronary layered plaques between patients with qi deficiency and blood stasis syndrome and patients with non-qi deficiency and blood stasis syndrome in the layered plaque group,the average number of thin fibrous cap atherosclerotic layered plaques and thin fibrous cap layered plaques were(1.24±0.87) and(2.07±1.05) respectively in patients with qi deficiency and blood stasis syndrome. The number of layered plaques with unstable characteristics was more than that in patients with non-qi deficiency and blood stasis syndrome(P<0.01). [Conclusion] Qi deficiency and blood stasis syndrome has a certain correlation with the stability of coronary layered plaques. Whether the clinical application of traditional Chinese medicine in the treatment of coronary heart disease from supplementing qi,activating blood and removing blood stasis can better improve the stability of coronary layered plaque is worthy of further exploration.