815例不稳定型心绞痛中医证候因子分析.docVIP

815例不稳定型心绞痛中医证候因子分析 　【摘要】 　　目的：探讨不稳定型心绞痛（unstable angina, UA）中医证候规律，并初步建立证候诊断标准。方法：多中心前瞻性收集815例经冠状动脉造影证实的UA患者，采用因子分析对其四诊信息进行中医证候非线性降维研究。结果：在提取的5个公因子中，F1为心肾阴虚，F2为心脾两虚，F3为痰瘀互阻，F4为气虚血瘀，F5为阳虚寒凝。其中以F4气虚血瘀所占比例最大，并且初步建立了各个证候的诊断条件。结论：气虚血瘀是UA的核心病机。因子分析能够帮助进行中医证候的分类研究和初步建立证候诊断标准。 【关键词】 心绞痛 不稳定型 证候 因子分析 参考标准 　　Factor analysis of traditional Chinese medicine syndromes in 815 patients with unstable angina 　　Jie WANG, Qingyong HE, Haixia LI, Yutao FANG 　　Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China 　　Objective: To explore the laws of traditional Chinese medicine (TCM) syndromes in unstable angina, and to establish the preliminary diagnostic criteria for TCM syndromes. 　　Methods: Multicenter prospective research on TCM syndromes in 815 cases of unstable angina was done with the nonlinear dimension reduction by factor analysis. 　　Results: There were five extracted factors in factor analysis: F1, F2, F3, F4 and F5. F1 was yin deficiency of heart and kidney, F2 was deficiency of both heart and spleen, F3 was intermingled phlegm and blood stasis, F4 was qi deficiency and blood stasis, and F5 was yang deficiency and coagulated cold. Qi deficiency and blood stasis (F4) syndrome accounted for the maximum proportion. The diagnostic criteria for TCM syndromes were preliminarily and respectively established. 　　Conclusion: Qi deficiency and blood stasis is the key factor of pathogenesis. The factor analysis can help us classify traditional Chinese medicine syndromes and establish the preliminary diagnostic criteria. 　　Keywords: angina, unstable; syndrome complex; factor analysis; reference standards 　　不稳定型心绞痛（unstable angina, UA）是常见的急性冠状动脉综合征之一，易发展为急性心肌梗死或猝死。目前中医界一般将稳定型心绞痛（stable angina, SA）和UA一起研究，然而两者在发病机制、临床特点、治疗措施和预后转归上均存在明显不同，应该分开研究［1］。早在1996年陈可冀院士［2］就呼吁：不要仅停留在SA的中医药防治研究，要加强UA的中医药防治研究。但目前关于UA中医证候规律的研究仍很少，且缺乏统一认识。因此，对UA证候规律的研究具有重要现实意义。中医证候是一个高度非线性的复杂巨系统，应进行证候要素应证组合“降维升降阶”的研究［3］。笔者采用因子分析法对多中心收集的815例经冠状动脉造影证实的UA中医证候进行