不同代谢-体重分型下冠心病心绞痛患者的中医证候及体质特点分析OA

Objective To explore the types of traditional Chinese medicine(TCM)syndromes and the constitution types of patients with coronary heart disease presenting angina pectoris symptoms under different types of metabolic-weight types(normal or overweight/obesity),and to conduct a correlation analysis.Methods A cross-sectional study was conducted in patients with coronary heart disease and symptoms of angina pectoris who were recruited from the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine and Tianjin Nankai Hospital between September 2024 and January 2025.Participants were stratified into four types based on the presence or absence of metabolic syndrome and body mass index:metabolically healthy-normal weight(MH-NW),metabolically unhealthy-normal weight(MU-NW),metabolically healthy-overweight/obesity(MH-OW/OB),and metabolically unhealthy-overweight/obesity(MU-OW/OB).TCM syndrome and constitution profiles were obtained,and the Apriori algorithm in R was used to conduct association analyses among syndrome elements,as well as among TCM constitution types,metabolic status-weight types,and TCM syndrome types,respectively.Results A total of 430 patients with coronary heart disease and angina pectoris were enrolled.The distribution among the MH-NW,MU-NW,MH-OW/OB,and MU-OW/OB types was 19.5%,18.1%,14.4%,and 47.9%,respectively.The metabolically unhealthy patients(MU-NW and MU-OW/OB)had a greater prevalence of hypertension,type 2 diabetes,and hyperlipidemia than the metabolically healthy patients(MH-NW and MH-OW/OB),(P<0.05).Among the MU-OW/OB type,the proportion of three-vessel disease was higher(P<0.05).Overall,the distribution of TCM syndrome elements in these patients reflected a pathogenesis characterized by a combination of root deficiency and excess manifestations.Syndrome characteristics varied among the different metabolic-weight types:The MH-NW type showed a higher prevalence of qi deficiency,yang deficiency,and qi stagnation.Strong associations were observed among qi deficiency,phlegm turbidity,and blood stasis.The most common syndrome was qi deficiency and blood stasis(20.2%).The MU-NW type had a higher proportion of yin deficiency,with notable associations between yin deficiency and qi deficiency,and between yin deficiency and blood stasis.The most frequent syndrome was deficiency of both qi and yin with blood stasis(16.7%).In the MH-OW/OB type,the associations between yin deficiency and qi deficiency,and among qi deficiency,phlegm turbidity,and blood stasis were more prominent.The syndrome of qi deficiency,phlegm and blood stasis(16.1%)was common.The MU-OW/OB type exhibited higher proportions and strong interconnections of blood stasis,phlegm turbidity,and heat accumulation,with the primary syndrome being phlegm-heat and blood stasis(25.7%).Regarding TCM constitution,the metabolically healthy patients(MH-NW and MH-OW/OB types)showed relatively higher proportions of balanced constitution(20.2%/24.2%)and qi-deficiency constitution(19.0%/21.0%).The MU-NW type had a higher proportion of yin-deficiency constitution(19.2%).In the MU-OW/OB type,the proportions of dampness-heat constitution(24.3%),phlegm-dampness constitution(21.8%),blood-stasis constitution(19.9%),and qi-deficiency constitution(19.4%)were relatively higher.Correlation analysis indicated the strongest association was between the dampness-heat constitution and the MU-OW/OB type,and between the MU-OW/OB type and syndrome of phlegm-heat and blood stasis.Conclusion Chinese medicine syndromes and constitution distributions in patients with angina pectoris of coronary heart disease differed across metabolic-body weight types.Patients with the MU-OW/OB type were characterized predominantly by excess syndromes involving the intermingling of phlegm,heat and blood stasis,and showed a certain association with damp-heat constitution.The syndrome and constitution characteristics of different types reflected varying contributions of pathological factors,including qi deficiency,yin deficiency,phlegm-turbidity,blood stasis and heat,during disease development and progression.These findings may provide a reference for individualized syndrome differentiation of coronary heart disease angina pectoris based on different metabolic-body weight types.