冠心病稳定型心绞痛痰瘀互结证及其兼证患者临床与表型组学特征分析OA

Objective To explore the clinical and phenomics characteristics of patients with phlegm-stasis bind-ing syndrome and its accompanied patterns in stable angina pectoris(SAP)of coronary heart disease(CHD).Methods A multicenter cross-sectional study design was adopted.A total of 300 patients with SAP of CHD were enrolled and classified into 120 cases of phlegm-stasis binding syndrome,125 cases of qi deficiency-accompanied syndrome,38 cases of qi stagnation-accompanied syndrome,and 17 cases of toxin accumulation-accompanied syndrome according to traditional Chinese medicine(TCM)patterns.Data of patients with different TCM patterns were collected,includ-ing general condition,TCM symptoms,blood lipids,coagulation function,immune indicators,and serum metabolo-mics.Metabolic pathway enrichment analysis was used to compare differences in phenomics characteristics among groups.Metabolites with variable importance in projection(VIP)≥1 and fold change(FC)≥2 were considered as representative differential metabolites.Results Patients in each TCM pattern type were most commonly in the 60-75 years age group,with a relatively high proportion of males.Regarding TCM symptoms,patients with phlegm-stasis binding syndrome most commonly presented with wiry-choppy or wiry-slippery pulse,chest pain,and chest tightness;in patients with qi deficiency-accompanied syndrome,fatigue,chest pain,and weak pulse were most common;in patients with qi stagnation-accompanied sydnrome,wiry-choppy or wiry-slippery pulse,chest pain,and symptoms that increase or decrease with emotional changes,belching,or flatulence were most common;in patients with toxin accumulation-accompanied syndrome,bitter taste in the mouth,chest tightness,irritability,restlessness or manic delirium,and dry and hard stools or foul-smelling diarrhea were most common.Comparisons among the different TCM patterns showed statistically significant differences in coagulation parameters(P＜0.05),whereas no statistically significant difference was found in blood lipid levels and immune indicators(P＞0.05).Metabolomics analysis sug-gested that disorders of glycerophosphate metabolism and valine,leucine,and isoleucine metabolism are characteris-tic features of phlegm-stasis binding syndrome and its accompanied patterns.The representative differential metabo-lites between phlegm-stasis binding syndrome and qi deficiency-accompanied syndrome were 7,8-dihydrobiopterin(FC=3.58)and oxypurinol(FC=124.50).Those between phlegm-stasis binding syndrome and qi stagnation-accompanied syndrome were cytidine 5'-diphosphocholine(FC=2.62)and D-mannosamine(FC=2.99).Those between phlegm-stasis binding syndrome and toxin accumulation-accompanied syndrome were anserine(FC=7.83)and canrenone(FC=8.94).Conclusion There are certain differences in the clinical characteristics and phe-nomics characteristics among patients with SAP due to CHD exhibiting phlegm-stasis binding syndrome and its accom-panied patterns.The phenomics characteristics mainly involve biological alterations such as lipid metabolism disorders,amino acid metabolism abnormalities,and multiple immune indicators activation,which may provide a reference for precise differentiation and treatment of SAP of CHD in TCM clinical practice.