急性冠状动脉综合征中医辨证分型与冠状动脉SYNTAX积分及短期预后的关系

目的探讨急性冠状动脉综合征（ACS）患者中医辨证分型与冠状动脉病变的关系及对短期预后的影响。方法252例ACS患者根据中医辨证分型分为4组：D血瘀阻证组（178例）、气阴两虚证组（50例）、心肾阴虚证组（14例）和痰阻心脉证组（10例）。经冠状动脉造影明确冠状动脉病变，分析不同证型对住院期间和短期预后的影响。结果252例患者中，三支和二支病变者182例（72．2％），B型和C型病变214例（85．0％），左主干病变44例（17．5％），慢性完全闭塞病变68例（27．0％）。痰阻心脉证组（10例）、心血瘀阻证组（178例）、心肾阴虚证组（14例）、气阴两虚证组（50例）患者SYNTAX评分分别为（33．2±2．0）、（29．7±2．3）、（27．6±1．9）、（28．5±2．5）分，痰阻心脉证组SYNTAX评分明显高于心肾阴虚证组及气阴两虚证组，差异有统计学意义（P〈0．05）。痰阻一tk,脉证组三支病变（7／10）、左主干病变（5／10）、慢性完全闭塞性病变（4／10）、c型病变（9／10）比例均明显高于其他3组，差异有统计学意义（P〈0．05）。住院期间4组均无主要心血管不良事件（MACE）发生。随访半年时痰阻心脉证组MACE发生率（3／10）高于心血瘀阻证组[3．9％（7／178）]、气阴两虚证组[4．0％（2／50）]和心肾阴虚证组（0）。结论ACS主要中医证型为心血瘀阻证。尽管痰阻心脉证患者较少，但冠状动脉SYNTAX积分高，病变高危复杂，短期预后较差，临床上应该高度重视这一证型的患者，及早行冠状动脉检查以明确病变并规范治疗。

Study on traditional Chinese medicine syndrome and SYNTAX score and short term prognosis in patients with acute coronary syndrome

Objective To explore the relationship between traditional Chinese medicine （TCM） syndrome and coronary lesion and the effect on prognosis in patients with acute coronary syndrome（ACS）. Methods A total of 225 patients were divided into four clinical types of traditional Chinese medicine syndrome： heart blood stasis syndrome group（ 178 cases）, dual deficiency of qi and yin syndrome group（50 cases）, yin deficiency of heart and kidney syndrome group（ 14 cases） and phlegm blocking heart vessel syndrome group（ 10 cases）. The effect of TCM syndrome on in-hospital and half a year clinical follow-up outcomes, including all-cause mortality, major adverse cardiac event（MACE）, stroke and other major bleeding were collected and analyzed. Results Of the 225 patients, 182 cases （72.2%） were three and two vessel lesion; 214 cases（85.0% ） were type B and C lesion; 44 cases （17.5%） were left main coronary artery disease. According to SYNTAX score, phlegm blocking heart vessel syndrome group [ （33.2 ＋ 2.0） scores] was higher than dual deficiency of qi and yin syndrome group, yin deficiency of heart and kidney syndrome group [ （ 27.6 ± 1.9 ）, （ 28.5 ± 2.5 ） scores, respectively, P 〈 0. 05 ]. Phlegm blocking heart vessel syndrome group had a higher rate of left main lesion （5/10）, chronic obstructive lesion （4/10）, type C lesion （9/10] than the other three groups （P 〈0.05）. All the patients had no in-hospital MACE; However, at 6 months, phlegm blocking heart vessel syndrome group had a higher MACE rate than the other groups （3/10 vs 7/178, 2/50, 0）. Conclusions The main type of ACS is heart blood stasis syndrome. Although the phlegm blocking heart vessel syndrome is less, the patients had higher SYNTAX score and severe lesion. We should pay attention to this type patients and take the coronary examination in time to evaluate lesion in order to improve the short term prognosis.