冠心病患者中医证型系统聚类分析及各证型相关影响因素分析OA

Objective To investigate how clusters of traditional Chinese medicine(TCM)syndromes relate to the severity of coronary artery stenosis in patients with coronary heart disease(CHD).Methods We enrolled 170 CHD patients treated at Outpatient Department,the 901 Hospital,Joint Logistic Support Force,People's Liberation Army between March 2022 and March 2024.TCM syndromes were derived via hierarchical cluster analysis based on the four diagnostic modalities(inspection,listening/smelling,inquiry,palpation).We examined the correspondence between TCM syndrome clusters and CHD subtypes,and compared clinical indicators across syndrome groups,focusing on stenosis-related factors.Multivariable Logistic regression analyzed determinants of TCM syndrome types.Results Six TCM syndrome clusters were identified:Phlegm-turbidity obstruction,blood stasis,qi-yin deficiency,heart-kidney yin deficiency,qi stagnation with blood stasis,and qi deficiency with blood stasis.Phlegm-turbidity obstruction was more frequently associated with unstable angina,whereas qi-yin deficiency was more common in stable angina.Patients differed significantly across syndrome groups in total cholesterol(TC),low-density lipoprotein-cholesterol(LDL-C),high-density lipoprotein-cholesterol(HDL-C),fasting plasma glucose(FPG),Gensini score,Syntax score,stenosis severity,and number of diseased vessels(all P<0.05).In regression analyses,higher TC,Gensini score,Syntax score,and a greater number of diseased branches were independent correlates of phlegm-turbidity obstruction.LDL-C,Gensini score,Syntax score,and stenosis severity collectively characterized blood stasis-related patterns(blood stasis and qi deficiency with blood stasis).FPG and the number of diseased vessels were significantly associated with heart-kidney yin deficiency.Low HDL-C combined with elevated FPG marked qi-yin deficiency.Elevated TC was associated with a higher likelihood of qi stagnation with blood stasis(all P<0.05).Conclusion In patients with CHD,six TCM syndrome patterns were identified:phlegm-turbidity obstruction,cardiac blood-stasis obstruction,qi deficiency with blood stasis,heart-kidney yin deficiency,combined qi-and-yin deficiency,and qi stagnation with blood stasis.Those classified with phlegm-turbidity obstruction were more prone to unstable angina,whereas patients with combined qi-and-yin deficiency tended to present with stable angina.TCM syndrome type was closely associated with conventional clinical and angiographic measures,including TC,LDL-C,HDL-C,FPG,Gensini score,Syntax score,degree of coronary stenosis,and number of affected coronary vessels.