【目的】 探讨Wellens综合征（WS）冠状动脉（简称冠脉）左前降支狭窄程度及预后与中医不同证型之间的关系。【方法】 采 用回顾性分析方法，收集2021年9月至2023年9月于广州中医药大学第一附属医院心内科住院治疗，符合Wellens综合征诊 断且完善冠脉造影检查的70例患者作为研究对象，整理资料，建立数据库，将所有患者分为气虚血瘀证、气阴两虚证、热 毒血瘀证、痰浊血瘀证4种证型，分析所有患者的基本资料、中医证型分布特点、左前降支狭窄程度（Gensini评分）、风险预 后的评分（TIMI危险评分），探讨Wellens综合征左前降支狭窄程度及预后与中医证型的关系。【结果】（1）中医证型分布方面， 在70例Wellens综合征患者中，热毒血瘀证占比最多，为37.14%（26/70），气虚血瘀证占比最少，为12.86%（9/70），中医证 型分布占比从高到低依次为热毒血瘀证 > 痰浊血瘀证 > 气阴两虚证 > 气虚血瘀证。（2）性别、年龄方面，不同中医证型间的 性别、年龄分布比较，差异均无统计学意义（P > 0.05）。（3）中医证型分布与Gensini评分、TIMI危险评分方面，不同中医证型 组间的 Gensini评分比较，差异有统计学意义（P < 0.01），热毒血瘀证和痰浊血瘀证的 Gensini评分较高，其中以痰浊血瘀证 的Gensini评分最高，事后两两比较发现，热毒血瘀证组和痰浊血瘀证组的Gensini评分均明显高于气虚血瘀证组（P < 0.05）。 不同中医证型组间的TIMI危险评分比较，差异有统计学意义（P < 0.05），事后两两比较发现，热毒血瘀证组的TIMI危险评分 高于气虚血瘀证组（P < 0.05），其余各组间两两比较，差异均无统计学意义（P > 0.05）。（4）心电图分型与 Gensini评分、TIMI 危险评分方面，WS-Ⅱ型患者的Gensini评分、TIMI危险评分均高于WS-Ⅰ型患者（P < 0.05）。（5）对TIMI危险评分及Gensini 评分进行相关性分析，发现TIMI危险评分与Gensini评分之间存在相关关系（RS＝0.258，P < 0.05）。【结论】 在Wellens综合征 患者中，热毒血瘀证和痰浊血瘀证的Gensini评分较高，提示左前降支狭窄程度更严重，且Gensini评分与TIMI危险评分存在 一定的相关关系。

Objective To investigate the correlation of the degree of left anterior descending artery stenosis of coronary artery with the prognosis and traditional Chinese medicine（TCM）syndrome types of Wellens􀆳 syndrome （WS）patients. Methods A retrospective analysis was conducted on 70 patients who were hospitalized in the Cardiology Department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from September 2021 to September 2023， and the patients all met the diagnostic criteria of WS and had completed coronary artery angiography. The clinical data of the patietns was collated and then a database was constructed. The patients were differentiated into four TCM syndrome types，namely qi deficiency and blood stasis syndrome，qi and yin deficiency syndrome，heat toxin resulting in blood stasis syndrome，and turbid phlegm resulting in blood stasis syndrome. The analysis was performed for the general information，distribution of TCM syndrome types，Gensini score for the degree of left anterior descending artery stenosis，and thrombolysis in myocardial infarction（TIMI） risk score for the prognosis，and then the correlation of the degree of left anterior descending artery stenosis with the prognosis and TCM syndrome types of WS patients was explored. Results（1）The analysis of the distribution of TCM syndrome types showed that among the 70 WS patients， heat toxin resulting in blood stasis syndrome accounted for the largest proportion of 37.14%（26/70），while qi deficiency and blood stasis syndrome accounted for the smallest proportion of 12.86%（9 / 70）. The TCM syndromes types ranking in descending order were as follows：heat toxin resulting in blood stasis syndrome > turbid phlegm resulting in blood stasis syndrome > qi and yin deficiency syndrome > qi deficiency and blood stasis syndrome.（2）There was no statistically significant difference in the distribution of gender and age among WS patients with various TCM syndrome types（P > 0.05）. （3）The differences in Gensini score among WS patients with various TCM syndrome types groups were statistically significant（P < 0.01），and the Gensini scores were higher in the heat toxin resulting in blood stasis syndrome and turbid phlegm resulting in blood stasis syndrome，particularly in turbid phlegm resulting in blood stasis syndrome. Post-hoc pairwise comparisons showed that the Gensini scores in heat toxin resulting in blood stasis syndrome group and turbid phlegm resulting in blood stasis syndrome group were both significantly higher than those in qi deficiency and blood stasis syndrome group（P < 0.05）. No statistically significant differences were presented in TIMI risk score among WS patients with various TCM syndrome types（P < 0.05）. Post-hoc pairwise comparisons show that the TIMI risk score of heat toxin resulting in blood stasis syndrome group was higher than that of the qi deficiency and blood stasis syndrome group（P < 0.05），while there was no statistically significant difference among the rest groups（P > 0.05）.（4）The Gensini score and TIMI risk score of patients with electrocardiogram （ECG）classification WS- Ⅱ were higher than those of patients with ECG classification WS- Ⅰ（P < 0.05）. （5）Correlation analysis of the TIMI risk score and Gensini score revealed that there existed a correlation between them（RS = 0.258，P < 0.05）. Conclusion In patients with WS，the Gensini score is higher in those with heat toxin resulting in blood stasis syndrome and turbid phlegm resulting in blood stasis syndrome，indicating that the left anterior descending artery stenosis is severer. And there is a correlation between Gensini score and TIMI risk score.

R259.414

广东省中医药局科研项目（编号：20193005）