【作者】 陈曦；

【导师】 耿乃志；

【作者基本信息】 黑龙江中医药大学 ， 中西医结合临床（专业学位）， 2024， 硕士

【摘要】 目的:本研究通过对冠心病稳定型心绞痛(气滞血瘀型)患者的心脏超声中心室收缩舒张功能等相关指标进行相关性分析,以期为冠心病稳定型心绞痛(气滞血瘀型)的中医辨证提供微观辨证依据和客观指标。方法:本研究共收集106例冠心病稳定型心绞痛患者,其中气滞血瘀组32例、非气滞血瘀组74例,以及健康组80例作为对照。首先采用Philips Sonos5500、Siemens X150、东芝300、GE E10超声诊疗设备对患者进行心脏超声检查,检测并记录左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)、左室后壁厚度(LVPWd)、室间隔厚度(IVST)、左室射血分数(LVEF)、左室短轴缩短速率(LVFS)、心排血量(CO)、E/A峰值比等相关指标。然后对可能导致气滞血瘀型冠心病稳定型心绞痛的因素进行统计,包括:性别、年龄、疾病病程、心功能分级(NYHA)、吸烟史、饮酒史、高血压病史、糖尿病病史、甘油三酯(TG)、血清总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)。最后对健康组与疾病组影响因素以及心脏结构和功能比较,通过logistic回归分析确定冠心病稳定型心绞痛气滞血瘀型的影响因素。结果:1.冠心病稳定型心绞痛患者的左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)、左室后壁厚度(LVPWd)、室间隔厚度(IVST)(P<0.05)均大于健康组;左室射血分数(LVEF)、左室短轴缩短速率(LVFS)、心排血量(CO)、E/A峰值比(P<0.05)均小于健康组。2.冠心病稳定型心绞痛患者血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)(P<0.05)均大于健康组;而高密度脂蛋白胆固醇(HDL-C)(P<0.05)小于健康组。3.气滞血瘀组患者的左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)(P<0.05)均高于非气滞血瘀组,而左室射血分数(LVEF)、左室短轴缩短速率(LVFS)(P<0.05)均低于非气滞血瘀组。4.气滞血瘀组患者的血清总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)(P<0.05)均高于非气滞血瘀组。结论:1.疾病组与健康对照组的超声指标有显著差异。2.气滞血瘀型冠心病稳定型心绞痛患者的危险因素为TC、HDL-C、LVDd、LVDS增加和LVEF、LVFs降低,可为气滞血瘀型冠心病稳定型心绞痛的诊断和治疗提供一定的帮助。更多还原

【Abstract】 Objective:In this study,the correlation analysis of cardiac ultrasound central ventricular systolic-diastolic function-related indexes in patients with coronary heart disease stable angina pectoris(qi stagnation and blood stasis type)was performed with the aim of providing a microscopic evidence basis and objective indexes for Chinese medicine diagnosis of coronary heart disease stable angina pectoris(qi stagnation and blood stasis type).Method:A total of 106 patients with stable angina pectoris of coronary heart disease were collected in this study,including 32 cases in the group of qi stagnation and blood stasis,74 cases in the group of non-qi stagnation and blood stasis,as well as 80 cases in the healthy group as controls.The patients were first examined by cardiac ultrasound using Philips Sonos5500,Siemens X150,Toshiba 300,and GE E10 ultrasound diagnostic and therapeutic equipment,and the left ventricular end-diastolic internal diameter(LVDd),left ventricular end-systolic internal meridians(LVDs),left ventricular posterior wall thickness(LVPWd),interventricular septal thickness(IVST),left ventricular ejection fraction(LVEF),left ventricular short-axis shortening rate(LVFS),cardiac output(CO),peak E/A ratio and other related indexes.Then the factors that may lead to stable angina pectoris in qi stagnation and blood stasis type coronary heart disease were counted,including:gender,age,duration of disease,cardiac function classification(NYHA),history of smoking,history of alcohol consumption,history of hypertension,history of diabetes mellitus,triglyceride TG,serum total cholesterol TC,high-density lipoprotein cholesterol HDL-C,and low-density lipoprotein cholesterol LDLC.Finally,a comparison was made between the healthy group and the diseased group.group influencing factors as well as cardiac structure and function were compared,and the influencing factors of stable angina pectoris qi stagnation and blood stasis type of coronary heart disease were determined by logistic regression analysis.Results:1.The left ventricular end-diastolic internal diameter(LVDd),left ventricular end-systolic internal meridians(LVDs),left ventricular posterior wall thickness(LVPWd),interventricular septal thickness(IVST)of the patients with stable angina pectoris in coronary artery disease were greater than those of the healthy group(P<0.05);and the left ventricular ejection fraction(LVEF),left ventricular short-axis shortening rate(LVFS),cardiac output(CO),and peak E/A ratio(P<0.05)were smaller than those in the healthy group.2.Serum total cholesterol(TC),triglyceride(TG),and low-density lipoprotein cholesterol(LDL-C)in patients with stable angina of coronary artery disease(P<0.05)were greater than those in the healthy group;and highdensity lipoprotein cholesterol(HDL-C)(P<0.05)was smaller than those in the healthy group.3.The left ventricular end-diastolic internal diameter(LVDd)and left ventricular end-systolic internal diameters(LVDs)of the patients in the group with qi stagnation and blood stasis were higher than those in the group without qi stagnation and blood stasis(P<0.05),whereas the left ventricular ejection fraction(LVEF)and left ventricular short-axis shortening rate(LVFS)were lower than those in the group without qi stagnation and blood stasis(P<0.05).4.The serum total cholesterol(TC)and high-density lipoprotein cholesterol(HDL-C)of patients in the qi stagnation and blood stasis group(P<0.05)were higher than those in the non-qi stagnation and blood stasis group.Conclusion:1.There was a significant difference in the ultrasound indices between the disease group and the healthy control group.2.The risk factors of patients with stable angina pectoris of qi stagnation and blood stasis type coronary heart disease are increase of TC,HDL-C,LVDd,and LVDS,and the decrease of LVEF and LVFs.They may provide some help in the diagnosis and treatment of stable angina pectoris in coronary artery disease with qi stagnation and blood stasis.更多还原