中医杂志

目的探讨冠心病合并血脂异常患者的证候要素及病位靶标的分布规律。方法收集680例冠心病合并血脂异常患者的临床中医证候资料,包括症状、体征、舌象和脉象及一般资料,采用二分类法处理中医临床症状、体征、舌象、脉象信息,建立Excel 2019数据库矩阵,运用因子分析方法归纳患者各证候要素及病位靶标的分布情况。结果共纳入与冠心病合并血脂异常证候紧密相关的变量84个,其中中医症状及体征变量60个,舌象、脉象变量24个。症状及体征频次(频率)前3位依次为胸闷461次(67.79%)、失眠302次(44.41%)、眩晕229次(43.97%);舌象中舌质频次(频率)最高的为舌质紫暗408次(60.00%),苔色最高的为白苔326次(47.94%),苔质最高的为腻苔298次(43.82%);脉象中频次(频率)最高的为弦脉345次(50.74%)。得到特征根大于1.0的公因子,进行最大方差旋转后,提取到36个公因子,其方差累积贡献率为63.39%,归纳出13个证候要素,得到7个病位靶标。按患者在各公因子得分,归纳主要的证候要素为痰浊(460例,67.65%)、精亏(117例,17.21%)、内热(82例,12.06%)、阳虚(65例,9.56%),主要的病位靶标为脾(504例,74.12%)、肺(309例,45.44%)、肾(174例,25.59%)。结论冠心病合并血脂异常的病性为本虚标实、虚实夹杂,其证候要素实者为痰浊,虚者为阳虚、精亏、阴虚,主要病位靶标为脾、肺、肾。

Objective To explore the distribution of patten elements and disease location in patients with coronary heart disease and dyslipidemia. Methods The clinical data on symptoms, signs, tongue and pulse manifestation of 680 patients with coronary heart disease and dyslipidemia were collected and dealt with as dichotomous variables. Thereafter, a database matrix was constructed through Excel 2019 software. Factor analysis was performed to investigate the distribution of patten elements and disease location of the patients. Results Eighty-four variables in close relationship with coronary heart disease and dyslipidemia were included, including 60 symptoms and signs, and 24 tongue and pulse manifestation variables. Chest tightness(461 times, 67.79%), insomnia(302 times, 44.41%), and dizziness(229 times, 43.97%) were the most frequent symptoms and signs; purple dusky tongue was most commonly seen for the tongue body(408 times, 60.00%); white(326 times, 47.94%) and greasy(298 times, 43.82%) were the most frequent color and texture of the tongue coating. Wiry pulse(345 times, 50.74%) had the highest frequency of all pulse manifestations. The common factors with eigenvalue greater than 1.0 rule were retained, and varimax rotation method was used. Totally, 36 common factors were extracted, accounting for 63.39% of the variance contribution rate; 13 patten elements and seven disease locations were inducted. According to the patients score of each common factor, the main patten elements were phlegm-turbidity(460 cases, 67.65%), essence deficiency(117 cases, 17.21%), internal heat(82 cases, 12.06%), and yang deficiency(65 cases, 9.56%); the main disease locations were spleen(504 cases, 74.12%), lung(309 cases, 45.44%), and kidney(174 cases, 25.29%). Conclusion The pathogenesis of coronary heart disease with dyslipidemia is root deficiency and branch excess, with deficiency-excess complex. The excess patten elements is phlegm, while the deficiency patten elements include yang deficiency, essence deficiency, and yin deficiency. The main disease locations are spleen, lung and kidney.