Distribution characteristics of TCM composite patterns of 312 patients with coronary heart disease with depression based on cross-sectional survey and latent structure model

LEI Shuyang; XIANG Xinghua; WANG Liying; BAI Weiguo; YANG Wei; HAN Xuejie

doi:10.3969/j.issn.1006-2157.2023.05.020

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Distribution characteristics of TCM composite patterns of 312 patients with coronary heart disease with depression based on cross-sectional survey and latent structure model

Clinical Studies | 更新时间：2023-06-05

- Distribution characteristics of TCM composite patterns of 312 patients with coronary heart disease with depression based on cross-sectional survey and latent structure model
- Journal of Beijing University of Traditional Chinese Medicine Vol. 46, Issue 5, Pages: 722-730(2023)
- 作者机构：
  
  1.浙江中医药大学基础医学院　杭州　310053
  2.中国中医科学院中医临床基础医学研究所
- 作者简介：
  
  Prof. HAN Xuejie, Ph.D., Chief Physician, Doctoral Supervisor. Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, No. 16 Dongzhimennei Nanxiaojie Road, Dongcheng District, Beijing 100700. E-mail: xuejieh@126.com
- 基金信息：
  
  National Key Research and Development Program(2018YFC1704306;2018YFC1704300)
- DOI：10.3969/j.issn.1006-2157.2023.05.020
  CLC： R256.22
- Received：08 December 2022，
  
  Published Online：17 March 2023，
  
  Published：30 May 2023
- 稿件说明：
移动端阅览
LEI Shuyang, XIANG Xinghua, WANG Liying, et al. Distribution characteristics of TCM composite patterns of 312 patients with coronary heart disease with depression based on cross-sectional survey and latent structure model[J]. Journal of beijing university of traditional chinese medicine, 2023, 46(5): 722-730.
DOI：

LEI Shuyang, XIANG Xinghua, WANG Liying, et al. Distribution characteristics of TCM composite patterns of 312 patients with coronary heart disease with depression based on cross-sectional survey and latent structure model[J]. Journal of beijing university of traditional chinese medicine, 2023, 46(5): 722-730. DOI： 10.3969/j.issn.1006-2157.2023.05.020.

摘要

目的

探究冠心病伴发抑郁状态(CHDD)复合证候分布特点。

方法

基于前期文献挖掘的3 446例CHDD患者中医证候特征内容设计调查问卷，运用横断面调查方法，于2020年11月1日—2021年10月31日在北京3家医院共招募312例CHDD患者，通过Bridged Islands算法对高频症状及舌脉象(出现频次>10%)进行隐结构分析。

结果

高频症状47个、舌脉象11个，包括心慌、气短、乏力、胸痛、心情低落等，构建隐结构(隐树)模型共得到18个隐变量，集中反映了气虚、气郁、阴虚、阳虚、血瘀、气滞、痰湿7个病性要素，心、肝、胆、脾、肾5个病位要素。对18个隐变量进行综合聚类分析，共推断出3种复合证候类型，分别为心胆气虚－肝郁血瘀证(占72%)、脾肾阳虚－痰气郁结证(占62%)及心肾不交－湿热内蕴证(占59%)。

结论

临床中CHDD患者证候类型并非单一虚证或实证，而是呈现以虚、瘀、郁为核心病机的3种虚实夹杂复合证候，其中心胆气虚－肝郁血瘀证是CHDD关键证候。此研究结果为临床辨证施治提供了参考依据。

Abstract

Objective

We aimed to explore the distribution characteristics of composite patterns of coronary heart disease with depression (CHDD).

Methods

A questionnaire was designed based on the characteristics of traditional Chinese medicine (TCM) patterns of 3 446 CHDD patients

and a cross-sectional survey method was used to recruit CHDD patients in three hospitals in Beijing. A total of 312 CHDD patients were investigated between November 1

2020 and October 31

2021. Latent structure analysis was conducted to examine the high-frequency symptoms and tongue-pulse manifestations (frequency > 10%) by the Bridged Islands algorithm.

Results

In total

47 high-frequency symptoms and 11 high-frequency tongue-pulse manifestations in 312 CHDD patients were selected

including palpitation

shortness of breath

fatigue

chest pain

and depressed mood. A total of 18 latent variables were obtained by constructing a latent structure (latent tree) model

reflecting the seven disease elements of qi deficiency

qi stagnation

yin deficiency

yang deficiency

blood stasis

qi stagnation

and phlegm-dampness and the five disease locations of heart

liver

gallbladder

spleen

and kidney. A comprehensive cluster analysis of 18 latent variables was conducted

and three TCM composite pattern types were inferred

namely (i) a pattern of qi deficiency of both heart and gallbladder with stagnation of liver qi and blood stasis (72% of the total population)

(ii) a pattern of spleen and kidney yang deficiency with phlegm-qi stagnation (62% of the total population)

and (iii) a pattern of disharmony of heart and kidney with internal retention of damp-heat (59% of the total population).

Conclusion

The clinical pattern types of CHDD patients are not a single TCM deficiency pattern or excess pattern

but present three complex patterns with deficiency

blood stasis

and depression as the core pathogenesis. The pattern of qi deficiency of both heart and gallbladder with stagnation of liver qi and blood stasis is the key pattern of CHDD. The present study provides a reference for further improvement of the clinical TCM treatment of CHDD.

关键词

Keywords

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