冠脉狭窄程度及血瘀证积分与红外热成像特征的相关性研究

【作者】 陈明；

【导师】 杜金行；

【作者基本信息】 北京中医药大学 ， 中医内科学（专业学位）， 2021， 硕士

【摘要】 心血管病死亡占我国城乡居民总死亡原因的首位,我国目前冠心病患者数目约1100万,早期筛查冠心病及通过无创检测手段了解冠脉狭窄程度具有重要意义。红外热成像检查能够灵敏反映心肌缺血程度,可作为冠心病的辅助检查之一,体表相应区域温度或可作为红外热成像评价冠心病冠脉狭窄程度及血瘀证严重程度的监测指标。研究目的:1.通过比较不同冠脉狭窄程度患者红外热成像指标的差异性,研究冠脉狭窄程度与红外热成像指标是否具有相关性。2.比较冠心病血瘀证轻度血瘀组与冠心病血瘀证重度血瘀组患者红外热成像观察指标的差异性,研究血瘀证积分与红外热成像指标是否具有相关性。研究方法:1.纳入150例拟行冠脉造影检查的患者,在冠脉造影术前行红外热成像检查,测量相应10个指标,术后根据冠脉造影结果按冠脉狭窄程度分为轻度狭窄组、中度狭窄组、重度狭窄组,计算Gensini积分及病变支数。比较不同冠脉狭窄程度患者的10项红外热成像指标是否有差异。2.比较冠心病血瘀证不同血瘀程度患者,10项红外热成像指标是否具有差异。研究结果:1.冠脉轻度狭窄组、冠脉中度狭窄组、冠脉重度狭窄组三组受检者性别、年龄差异存在统计学意义,三组间冠脉病变支数、Gensini积分差异存在统计学意义,狭窄程度越重,冠脉病变支数越多,Gensini积分越高。2.不同冠脉狭窄程度与10项红外热成像指标的单因素分析,不同冠脉狭窄程度,各红外热成像指标组间差异无统计学意义。3.不同冠脉狭窄程度与10项红外热成像指标的多因素分析,结果显示重度狭窄组患者与轻度狭窄组患者相比,右侧少海穴温度降低0.8142度,P值=0.0157,该差异在调整性别、年龄、LDL、Gensini积分等混杂因素后,仍具有统计学意义,(P<0.05);中度狭窄组患者与轻度狭窄组患者相比,左侧曲泽穴温度降低0.2241度,P值=0.0350,该差异在调整性别、年龄、LDL、Gensini积分等混杂因素后,仍具有统计学意义,(P<0.05)4.冠心病患者轻度血瘀组和重度血瘀组性别、吸烟史差异存在统计学意义,两组间冠脉病变支数、Gensini积分差异存在统计学意义,重度血瘀组三支病变比例为82.9%,轻度血瘀组三支病变比例为39.0%,重度血瘀组Gensini积分均值和标准差为48.1±31.4分,轻度血瘀组Gensini积分均值和标准差为15.1±7.8分,三支病变、Gensini积分比例重度血瘀组大于轻度血瘀组。5.冠心病血瘀证患者不同血瘀程度与10项红外热成像指标的单因素分析,左侧少海穴重度血瘀组与轻度血瘀组相比,其温度升高0.7520度,P值=0.0032,差异具有统计学意义。6.冠心病血瘀证患者不同血瘀程度与10项红外热成像指标的多因素分析,结果显示不同血瘀程度,各红外热成像指标组间差异无统计学意义。7.比较左右侧相同部位相对温度差值△T,得出左侧神门穴、少海穴、内关穴、曲泽穴相对温度差值△T绝对值均小于右侧,左侧神门穴相对温度差值△T均值绝对值为1.8℃,右侧神门穴相对温度差值△T均值绝对值为2.1℃;左侧少海穴相对温度差值△T均值绝对值为2.7℃,右侧少海穴相对温度差值△T均值绝对值为3.4℃;左侧内关穴相对温度差值△T均值绝对值为0.0℃,左侧内关穴相对温度差值△T均值绝对值为0.4℃;左侧曲泽穴相对温度差值△T均值绝对值为0.1℃,左侧曲泽穴相对温度差值△T均值绝对值为0.6℃。研究结论:1.不同冠脉狭窄程度、冠心病血瘀证不同血瘀程度,其冠脉病变支数、Gensini积分存在差异。2.重度冠脉狭窄组患者与轻度冠脉狭窄组患者相比,右侧少海穴温度下降;中度冠脉狭窄组患者与轻度冠脉狭窄组患者相比,左侧曲泽穴温度下降。冠心病血瘀证重度血瘀组与轻度血瘀组相比,左侧少海穴温度升高。3.左侧手少阴心经、手厥阴心包经皮部及穴位相对温度差值的绝对值小于右侧相应部位的相对温度差值的绝对值。更多还原

【Abstract】 Coronary heart disease poses a serious threat to human health and imposes a huge burden on human health and economy.If coronary heart disease can be prevented and screened early,and the degree of coronary artery stenosis can be predicted in some way,in order to be able to advance Determine whether coronary angiography is needed.Infrared thermal imaging technology is a heat-sensitive skin temperature measuring instrument,which can determine the degree of myocardial ischemia by measuring the temperature of the skin surface.Relevant research believes that infrared thermal imaging technology can assess the degree of coronary stenosis to a certain extent,so this research is carried out around this subject.Research purposes:1.By comparing the differences in the observation indicators of the infrared heat map of patients with different coronary stenosis degrees,explore the possibility of infrared thermal imaging technology to evaluate the degree of coronary stenosis.2.Calculate the blood stasis syndrome score of patients in the moderate stenosis group and severe stenosis group(ie the blood stasis syndrome score of patients with coronary heart disease),and compare the coronary heart disease blood stasis syndrome mild blood stasis group with the coronary heart disease blood stasis syndrome severe blood stasis group The difference of the observation indexes of the infrared heat map of the patients to explore the correlation between the blood stasis syndrome score and the performance of the infrared heat map.research method:1.The 153 patients with chest pain who needed coronary angiography were included in this study.The corresponding 10 indicators were measured by infrared heat map before operation.After the operation,they were divided into mild stenosis according to the coronary angiography results and the degree of coronary artery stenosis.Group,moderate stenosis group,severe stenosis group,calculate the Gensini score and the number of lesions.Compare the 10 infrared heat map indexes of patients with different coronary artery stenosis degrees for differences.2.Calculate the blood stasis syndrome score of patients in the moderate stenosis group and severe stenosis group(ie,the blood stasis syndrome score of patients with coronary heart disease),and compare the coronary heart disease blood stasis syndrome patients with mild blood stasis group and coronary heart disease blood stasis syndrome patients with severe blood stasis group Whether there are differences in the 10 infrared indicators of.Research result:1.Indexes of different stenosis groups with different distributions:Gender,age,history of cerebrovascular disease(P=0.07,marginal statistical significance),history of heart disease(P=0.06,marginal statistical significance),coronary artery lesions,Gensini score,fasting blood glucose(0.06 marginal statistical significance)Scientific significance),creatinine,total cholesterol,triglycerides,LDL-C,HDL-C,Ten core indicators:Shaohai acupoint on the left(P=0.08),marginal statistical significance2.Different blood stasis degree groups have different distribution indicators:gender,smoking history,number of coronary artery lesions,total cholesterol,LDL-C(P=0.05,marginal statistical significance),HDL-C,heart failure(P=0.07,marginal statistical significance),Gensini score,total cholesterol,LDL-C,HDL-C,NT-proBNP,Ten core indicators:left Shaohai point,left hand Jueyin pericardium percutaneous(P=0.07,marginal statistical significance)3.Single factor analysis of the correlation between the degree of stenosis and the temperature difference of each body surface:Shaohai point on the left(severe stenosis group compared with mild stenosis group,the temperature increased by 0.42 degrees,(P value is 0.08,this difference has marginal statistical significance)4.Single factor analysis of the correlation between the degree of blood stasis and the temperature difference of each body surface:Shaohai Point on the left(P<0.05)Percutaneous part of the pericardium of Jueyin on the left hand(compared with the severe blood stasis group and the mild blood stasis group,the temperature increased by 0.11 degrees,the p value was 0.07,this difference has marginal statistical significance)5.Multi-factor analysis of the correlation between the degree of stenosis and the temperature difference of each body surface:Shaohai point on the left(Compared with patients in the mild stenosis group,the temperature difference at this point is reduced by 0.44 degrees,and the P value is 0.07.This difference is adjusted for confounding factors such as gender,age,LDL,and Gensini points.Has marginal statistical significance),Shaohai point on the right(Compared with patients in the severe stenosis group,the temperature at this point is lowered by 0.81.This difference is still statistically significant after adjusting for other confounding factors,P value is 0.01)Quze point on the left(compare the moderate stenosis group with the mild stenosis group,P=0.03),Quze point on the right(severe stenosis group compared with mild stenosis group,P value=0.09),Percutaneous part of the left hand Jueyin pericardium(moderate stenosis group,P=0.06)6.Multi-factor analysis of the correlation between the degree of blood stasis and the temperature difference of each body surface:Shenmen acupoint on the left(Compared with patients in the severe blood stasis group,the temperature difference of this acupoint decreased by 0.68 degrees.After adjusting for confounding factors such as gender,age,LDL,and Gensini score,the P value is 0.09,which is marginal Statistical significance)Shenmen point on the right(severe blood stasis group,P value 0.07)Gensini score(for each point increase in the score,the temperature difference at the Shenmen point on the left side of the patient increases by 0.01 degrees.After adjusting for severe blood stasis group.After gender,age,LDL and other confounding factors,the P value is 0.03,which is still statistically significant)Gensini points(Shenmen acupoint on the right,P value 0.04)LDL>3.1(Shaohai Point on the left,P value 0.09)Note:P value close to 0.05 is marginal and statistically significant.It may be caused by too small sample size or errors.Thousands or even tens of thousands of large sample experiments are needed to prove it,and it has the potential to dig deeper.Analysis conclusion:1.Different stenosis groups have differences in the distribution of Shaohai on the left,and have a certain correlation with Shaohai on the left,Shaohai on the right,Quze on both sides,and the transdermal part of the left hand Jueyin pericardium Sex.2.Different blood stasis groups have different distributions in the left Shaohai acupoint,left hand Jueyin pericardial transdermal part,and are different from the left Shaohai acupoint,left hand Jueyin pericardial transdermal part,and Shenmen acupoints on both sides Have a certain relevance.更多还原