目的:分析冠心病(CHD)痰瘀证(PBS)与血瘀证(BSS)患者冠状动脉斑块特征的相关性。
方法:根据中医辨证分为不同组。从医疗记录中收集基线人口统计学和临床变量。此外,使用血管内超声(IVUS)评估冠状动脉斑块的特征和病理表现。
结果:共213例CHD患者分为两组:184例诊断为PBS,其余29例诊断为BSS。在年龄上没有显著差异,身体质量指数,高血压患者的比例,糖尿病,吸烟,高脂血症,冠状动脉旁路移植术和经皮冠状动脉介入术的病史,药物,来自心脏超声图像的指数,两组血脂和C反应蛋白比较(P>0.05),除了性别,IVUS的重量和比例观察到靶血管(P<0.05或P<0.01)。在BSS中观察到更多的不良事件,例如急性心肌梗死(P=0.003)和不稳定型心绞痛(P=0.048)。此外,解剖,BSS血栓和冠状动脉扩张明显增加(P<0.05或P<0.01)。相比之下,PBS有更多的稳定型心绞痛和慢性完全闭塞患者,SYNTAX(经皮冠状动脉介入治疗与Taxus和冠状动脉搭桥手术之间的协同作用)评分显着升高(P<0.05或P<0.01)。此外,PBS中致密钙显著升高(P<0.01)。
结论:冠状动脉斑块特征与不同的CM综合征相关。使用PBS的患者与较高程度的钙化斑块和严重的冠状动脉狭窄有关,提示临床预后不良,但发生急性冠脉事件的概率较低。相比之下,BSS患者的钙化斑块程度仍然相对较低,斑块更脆弱,导致急性冠脉事件发生的可能性仍然很高。
OBJECTIVE: To analyse the correlation between the characteristics of coronary plaque in coronary heart disease (CHD) patients with phlegm-blood stasis syndrome (PBS) and blood stasis syndrome (BSS).
METHODS: Patients were divided into different groups based on Chinese medicine (CM) syndrome differentiation. The baseline demographics and clinical variables were collected from the medical records. Additionally, the characteristics of plaque and pathological manifestations in coronary artery were evaluated using intravascular ultrasound (IVUS).
RESULTS: A total of 213 CHD patients were enrolled in two groups: 184 were diagnosed with PBS and the remaining 29 were diagnosed with BSS. There were no significant differences in age, body mass index, proportions of patients with high blood pressure, diabetes mellitus, smoking, hyperlipidemia, history of coronary artery bypass graft and percutaneous coronary intervention, medications, index from cardiac ultrasound image, blood lipids and C-reactive protein between the two groups (P>0.05), except gender, weight and proportions of IVUS observed target vessels (P<0.05 or P<0.01). More adverse events such as acute myocardial infarction (P=0.003) and unstable angina (P=0.048) were observed in BSS. Additionally, dissection, thrombus and coronary artery ectasia were significantly increased in BSS (P<0.05 or P<0.01). In contrast, PBS had more patients with stable angina and chronic total occlusion with significantly higher SYNTAX (synergy between percutaneous coronary intervention with Taxus and coronary artery bypass surgery) scores (P<0.05 or P<0.01). Moreover, dense-calcium was significantly elevated in PBS (P<0.01).
CONCLUSIONS: Coronary plaque characteristics were correlated with different CM syndromes. Patients with PBS were associated with a higher degree of calcified plaque and severe coronary artery stenosis, indicating poor clinical prognosis but with a low probability of acute coronary events. In contrast, the degree of calcified plaque in patients with BSS remained relatively low, and plaque was more vulnerable, resulting in the possibility of the occurrence of acute coronary events remaining high.