摘要
目的 探讨早发冠心病(Premature coronary artery disease,PCAD)痰瘀互结证与全身免疫炎症反应指数(Systemic immune-inflammation response index,SIIRI)及冠脉病变程度的关系。方法 选取2022年8月—2024年2月因“胸痛”于北京中医药大学第三附属医院心内科住院,且冠状动脉造影(Coronary angiography,CAG)拟诊为冠心病的患者201例。根据男性年龄<55岁,女性年龄<65岁的标准,分为早发冠心病组(PCAD组)168例和非早发冠心病组(非PCAD组)33例。PCAD组按中医证候诊断标准分为痰瘀互结组(84例)和非痰瘀互结组(84例)。根据Gensini评分将PCAD组分为轻度冠脉狭窄组(Gensini评分<30分)和重度冠脉狭窄组(Gensini评分≥30分)。采用Spearman进行相关性分析,Logistic回归分析冠脉重度狭窄影响因素,ROC曲线评估SIIRI预测效能。结果 PCAD组SIIRI水平高于非PCAD组,差异有统计学意义(P<0.05),痰瘀互结组SIIRI水平、重度冠脉病变比例及Gensini评分明显>非痰瘀互结组,差异有统计学意义(P<0.05);PCAD两组中医证候积分、Gensini评分与SIIRI均呈正相关,且痰瘀互结组相关性更强。SIIRI为PCAD重度冠脉狭窄及PCAD痰瘀互结证重度冠脉狭窄的独立危险因素。SIIRI最佳截断值186.34时预测灵敏度64.1%、特异度78.9%;191.96时预测痰瘀互结证冠脉重度狭窄灵敏度89.1%、特异度58.6%,均优于传统炎症指标。结论 SIIRI与PCAD痰瘀互结证显著相关,可作为辨证分型的客观指标。SIIRI是PCAD痰瘀互结证患者冠脉严重狭窄的独立危险因素,且预测价值优于传统复合炎症指标。
Objective To investigate the relationship of premature coronary artery disease(PCAD)with phlegm and blood stasis syndrome between systemic immune-inflammatory response index(SIIRI)and the degree of coronary artery lesions.Methods A total of 201 patients were selected in this study.They(men<55 years old and women<65 years old)were hospitalized in the Department of Cardiology,Beijing University of Chinese Medicine Third Affiliated Hospital for“chest pain”from August 2022 to February 2024 and diagnosed with coronary artery disease by coronary angiography(CAG).Based on the CAG results,the patients were divided into a premature coronary artery disease(PCAD group,168 cases)and a non-premature coronary artery disease(non-PCAD group,33 cases).Based on the TCM syndrome diagnostic criteria,the PCAD group was further divided into a phlegm and blood stasis syndrome group(84 cases)and a non-phlegm and blood stasis syndrome group(84 cases).Additionally,according to the Gensini score,the PCAD group was divided into a mild coronary artery stenosis group(Gensini score<30 points)and a severe coronary artery stenosis group(Gensini score≥30 points).Spearman was applied for correlation analysis,Logistic regression was used to analyze the factors affecting severe coronary artery stenosis,and ROC curves were employed to assess the predictive efficacy of SIIRI.Results Compared to the non-PCAD group,the PCAD group exhibited a higher SIIRI level(P<0.05).Compared to the non-phlegm and blood stasis syndrome group,the phlegm and blood stasis syndrome group exhibited higher SIIRI level,severe coronary lesion proportion,and Gensini score(P<0.05).In both PCAD groups,SIIRI was positively correlated with syndrome score and Gensini score,with a stronger correlation in the phlegm and stasis syndrome group.SIIRI was an independent risk factor for severe coronary artery stenosis in PCAD and in PCAD with phlegm and blood stasis syndrome.When the optimal cut off value of SIIRI was 186.34,the predictive sensitivity was 64.1%,and the specificity was 78.9%;when the value was 191.96,the predictive sensitivity of severe coronary artery stenosis in PCAD with phlegm and blood stasis syndrome was 89.1%,and the specificity was 58.6%,which was superior to that of traditional inflammatory indices.Conclusion SIIRI is significantly correlated with PCAD with phlegm and blood stasis syndrome and can be used as an objective index for syndrome differentiation and classification. SIIRI is an independent risk factor for severe coronary artery stenosis in PCAD patients with phlegm and blood stasis syndrome,and its predictive value is superior to that of traditional composite inflammatory indicators.
作者
刘琪
陈步星
LIU Qi;CHEN Buxing(Beijing University of Chinese Medicine,Beijing 100029;The Third Affiliated Hospital of Beijing University of Chinese Medicine,Beijing 100029)
出处
《世界中西医结合杂志》
2026年第1期66-73,共8页
World Journal of Integrated Traditional and Western Medicine
基金
国家自然科学基金项目(81770349)。
关键词
全身免疫炎症反应指数
早发冠心病
痰瘀互结证
冠状动脉狭窄严重程度
GENSINI评分
systemic immune-inflammatory response index
premature coronary artery disease
phlegm and blood stasis syndrome
severity of coronary artery stenosis
gensini score
