作者：白雪松1，2 ，黄晶晶2 ，黄彬3，4 ，李业莹1，2 ，沈傲1，2 ，梁田2

单位：

1.230000安徽省合肥市，安徽中医药大学　2.221003江苏省徐州市中医院心血管科　3.350122福 建省福州市，福建中医药大学中西医结合研究院　4.350122福建省福州市，福建省中西医结合老年性疾病 重点实验室

Units：

1.Anhui University of Traditional Chinese Medicine, Hefei 230000, China 2.Cardiovascular Department, Xuzhou City Hospital of TCM, Xuzhou 221003, China 3.Institute of Integrated Traditional Chinese and Western Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China 4.Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fuzhou 350122, China

关键词：

心绞痛，不稳定型；经皮冠状动脉介入治疗；聚类分析；证候

Keywords：

Angina, unstable; Percutaneous coronary intervention; Cluster analysis; Symptom complex

CLC：

R 541.4

DOI：

10.12114/j.issn.1008-5971.2024.00.011

Funds：

徐州市科技重点研发计划（社会发展）项目（KC20142）

摘要：

目的　采用聚类变量分析方法分析不稳定型心绞痛患者PCI后中医证候特征。方法　选取2022年8—9 月在徐州市中医院心血管科住院治疗的行PCI的不稳定型心绞痛患者62例，自制资料提取表，内容包括患者的一般资 料和中医证候因子。对中医证候因子进行Z-score标准化处理及聚类变量分析；最后，由4名主治医师以上职称的中医 根据相关指南从聚类变量分析结果中筛选合适的聚类簇目，总结病性证素、病位证素及中医证候。结果　根据聚类变 量分析结果，中医症状和舌脉体征可聚为24类，共归纳出15类证素，其中病性证素9个，分别为气虚、气滞、阴虚、 阳虚、血虚、实热、痰浊、水湿、血瘀；病位证素6个，分别为心、肝胆、脾、肾、肺、胃。剔除不符合实际情况的 聚类变量，发现中医证候聚为5类时，各中医证候之间的相关系数绝对值均＜1，提示聚类结果较好。5类中医证候分 别为心气阴两虚证、气虚血瘀证、脾肾阳虚证、气滞血瘀证、瘀热互结证。结论　不稳定型心绞痛患者PCI后属本虚 标实，实证以气滞、实热、血瘀、痰浊、水湿为主，虚证以气虚、阴虚、阳虚、血虚为主，病位涉及心、肝胆、脾、 肾、肺、胃等脏腑，中医证候可分为心气阴两虚证、气虚血瘀证、脾肾阳虚证、气滞血瘀证、瘀热互结证。

Abstract：

Objective To analyze the characteristics of TCM syndromes in patients with unstable angina pectoris after PCI by cluster variable analysis method. Methods A total of 62 patients with unstable angina pectoris who underwent PCI in the Cardiovascular Department, Xuzhou City Hospital of TCM from August to September in 2022 were selected, the self-made data extraction table included the patient's general information and TCM syndromes factors. Z-score standardization and clustering variable analysis were carried out for TCM syndrome factors. Finally, according to the relevant guidelines, four TCM doctors with attending phsicians or above selected the appropriate cluster items from the results of cluster variable analysis, and summarize the syndrome elements of disease nature, syndrome elements of disease location and TCM syndromes. Results According to the results of cluster variable analysis, TCM symptoms and tongue pulse signs could be clustered into 24 categories, and a total of 15 categories of syndrome factors were summarized, including 9 disease syndrome factors (namely Qi deficiency, Qi stagnation, Yin deficiency, Yang deficiency, blood deficiency, excess heat, phlegm retention, water-dampness, and blood stasis) and 6 disease location syndrome factors (namely heart, liver and gallbladder, spleen, kidney, lung, and stomach) . After eliminating the clustering variables that did not conform to the actual situation, it was found that when the TCM syndromes were clustered into 5 categories, the absolute values of the correlation coefficients between the TCM syndromes were all < 1, indicating that the clustering results were good. The 5 categories of TCM syndromes were syndrome of heart deficiency of Qi and Yin, syndrome of Qi deficiency with blood stasis, syndrome of Yang deficiency of spleen and kidney, syndrome of Qi stagnation with blood stasis, and syndrome of blood stasis with heat. Conclusion Patients with unstable angina pectoris after PCI are characterized by deficiency in origin and excess in superficiality. The main syndromes are mainly Qi stagnation, excess heat, blood stasis, phlegm retention, and water dampness. The deficiency syndromes are mainly Qi deficiency, Yin deficiency, Yang deficiency, and blood deficiency. The disease location involves the heart, liver and gallbladder, spleen, kidney, lung, stomach and other internal organs. TCM syndromes can be divided into syndrome of heart deficiency of Qi and Yin, syndrome of Qi deficiency with blood stasis, syndrome of Yang deficiency of spleen and kidney, syndrome of Qi stagnation with blood stasis, and syndrome of blood stasis with heat.

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