430例不同证型急性心肌梗死患者发病节气的圆形分布统计分析

目的 探讨急性心肌梗死(AMI)的发病节气与其中医证型之间的关系.方法 选择2003年2月4日(立春)至2008年2月3日(立春)在佛山市中医院住院的430例AMI患者病历资料,将发病节气化为角度坐标进行圆形分布统计,分析AMI不同证型的发病节气特点.结果 430例AMI患者中气滞血瘀型134例,痰浊闭塞型188例,阴血虚型29例,阳气虚型79例;其中以实证(气滞血瘀型+痰浊闭塞型)为主,占74.9%.圆形分布统计法分析结果显示,AMI患者总体发病节气高峰为立春时节[集中向量(r)=0.127 4,P＜0.01],标准差(s)=116.300 6°,发病节气高峰期处于冬、春两季.气滞血瘀型发病节气高峰为冬至末至小寒前(r=0.200 5,P＜0.01),高峰期集中于冬季;痰浊闭塞型发病节气高峰为春分时节(r=0.147 0,P＜0.05),高峰期集中于春季,但两节气发病高峰都比较平缓;而阴血虚型、阳气虚型未发现特定的发病节气高峰期(均P＞0.05).结论 AMI发病节气存在集中趋势,提示治疗AMI应以豁痰泄浊、活血化瘀、通脉止痛为基本大法,冬季以活血化瘀、温阳通脉法为主,春季以通阳泄浊、豁痰开结为基本治法.

Investigation on the relationship between the solar term of onset and syndrome types in 430 patients with acute myocardial infarction by circular statistical analysis

Objective To study the relationship between the solar term of onset of acute myocardial infarction (AMI) and its syndrome types in traditional Chinese medicine (TCM).Methods The clinical data about 430 patients with AMI hospitalized in Foshan Hospital of TCM from February 4th 2003 (Beginning of Spring) to February 3rd 2008 (Beginning of Spring) were collected, and the solar term of onset as angle coordinate was regarded, then the peak phase of the onset solar term in each syndrome type of AMI was calculated by circular statistical analysis.Results Among 430 patients with AMI, 134 patients were considered to have qi stagnancy and blood stasis syndrome (气滞血瘀型), 188 patients showed the syndrome of turbid sputum obstruction (痰浊闭塞型), 29 of them showed deficiency of yin-blood (阴血虚型), and 79 showed deficiency of yang qi (阳气虚型 ).The clinical manifestation of AMI was mainly sthenia syndrome (实证, qi stagnancy and blood stasis +turbid sputum obstruction,74.9%).According to the circular statistical analysis,the peak of the solar terms of AMI onset occurred at the Beginning of Spring in all cases (r=0.127 4, P＜0.01), and standard deviation (s)=116.300 6°, showed it mainly occurred in winter and spring.As the peak of the onset of qi stagnancy and blood stasis occurred at Winter Solstice and Lesser Cold (r=0.200 5, P＜0.01), its peak occurred in winter； the turbid sputum obstruction syndrome occurred at Spring Equinox (r=0.147 0, P＜0.05), mainly in spring, yet the symptoms of above two peaks were generally mild.Besides, there was no significant difference in onset of the solar term in regard to onset of deficiency of yin-blood and deficiency of yang qi (both P＞0.05).Conclusion There is a close relationship between periodicity of the solar terms and onset of AMI.The main treatment for AMI is to expel turbid sputum, activate blood to resolve stasis and promote blood circulation to relieve pain； also the method of activating blood to resolve stasis is frequently contemplated in winter, and the method of expelling turbid sputum is the main strategy in spring.