射血分数保留心力衰竭中医证素分布规律研究  

Study on the distribution of Chinese medicine syndrome elements in heart failure with preserved ejection fraction

作　　者：彭菊琴 侯丕华[2] 彭娴 陈芳玲 张艺楠 李春岩[5] PENG Ju-qin;HOU Pi-hua;PENG Xian;CHEN Fang-ling;ZHANG Yi-nan;LI Chun-yan(Beijing Key Laboratory of Pharmacology of Traditional Chinese Medicine,Institute of Basic Medical Sciences of Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China;China-Japan Friendship Hospital,Beijing 100029,China;Xiaogan Central Hospital,Xiaogan 432000,China;Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]中国中医科学院西苑医院基础医学研究所,北京中药药理重点实验室,北京100091 [2]中日友好医院,北京100029 [3]孝感市中心医院,孝感432000 [4]北京中医药大学,北京100029 [5]中日友好医院中西医结合心内科,北京100029

出　　处：《中华中医药杂志》2020年第7期3660-3664,共5页China Journal of Traditional Chinese Medicine and Pharmacy

摘　　要：目的:通过调查射血分数保留心力衰竭(HFpEF)患者中医证素的分布规律,探索其规范化的中医辨证体系。方法:采集170例HFpEF患者中医症状81项、舌脉31项,构建HFpEF中医证候数据库,运用半定量方法进行中医证素辨证,提取9个病位证素和12个病性证素,对所有中医症状、舌脉进行频数统计分析,分析主要中医症状、证素分布及组合规律。结果:①HFpEF常见的症状依次是胸闷(164/170,96.5%)、神疲乏力(134/170,78.8%)、气短(124/170,72.9%)、夜间不能平卧(98/170,57.6%)、气喘(90/170,52.9%)、下肢水肿(87/170,51.2%)、动则喘甚(86/170,50.6%)等;②HFpEF病位证素以心(165/170,97.1%)为主,其次为脾(54/170,31.8%)、肺(49/170,28.8%)、肾(48/170,28.2%),病性证素以气虚(165/170,97.1%),水停(87/170,51.2%)、血瘀(70/170,41.2%)和痰浊(49/170,28.8%)为主;③HFpEF病位证素组合以涉及一脏、两脏为主(128/170,75.3%),病性证素虚实证组合中以本虚标实证居多(128/170,75.3%),证素组合以两证素相兼居多(71/170,41.8%),其中又以气虚兼水停(31/170,18.2%)出现频率最高,其次为气虚兼血瘀(25/170,14.7%)、气虚兼痰浊(13/170,7.6%)、血瘀兼水停(2/170,1.2%)。结论:HFpEF病位在心,与脾关系密切,总病机特点为本虚标实,气虚为本,水停、血瘀、痰浊为标,中医证型以气虚水停证为主。Objective:To investigate the distribution of Chinese medicine syndrome elements of heart failure with preserved ejection fraction(HFpEF),and to explore the standardized syndrome differentiation system.Methods:The information of 170 HFpEF patients were collected,including 81 items of symptoms and 31 items of tongue and pulse picture.Semiquantitative methods were used to syndrome differentiation.A database of Chinese medicine syndrome elements was established,and 9 disease location syndrome elements and 12 disease nature syndrome elements were extracted.Frequency analysis was performed on all symptoms,tongue and pulse picture.Then distribution of main symptoms and syndrome elements were analyzed.Results:①Common symptoms of HFpEF were chest tightness(164/170,96.5%),fatigue(134/170,78.8%),shortness of breath(124/170,72.9%),no supine at night(98/170,57.6%),asthma(90/170,52.9%),lower limb edema(87/170,51.2%),and asthma worsens after activity(86/170,50.6%);②The disease location syndrome elements of HFpEF were mainly in heart(165/170,97.1%),followed by spleen(54/170,31.8%),lungs(49/170,28.8%),kidneys(48/170,28.2%).The single disease nature syndrome elements were ordered in qi deficiency(165/170,97.1%),retained fluid(87/170,51.2%),blood stasis(70/170,41.2%)and turbid phlegm(49/170,28.8%);③In the distribution of disease location syndrome elements combination of HFpEF patients mainly involved in one organ and two organs(128/170,75.3%).For the disease location syndrome elements combination,the essential deficiency and superficiality excess was highest(128/170,75.3%);In the combination of nature syndrome,the frequency of two nature syndromes were the most(71/170,41.8%),among them,the frequency of qi deficiency and retained fluid was most(31/170,18.2%),next in turn qi deficiency and blood stasis(25/170,14.7%),qi deficiency and turbid phlegm(13/170,7.6%),blood stasis and retained fluid(2/170,1.2%).Conclusion:The disease location of HFpEF is located at heart,and closely associate with spleen.The pathogenesis of HFpEF is th

关 键 词：射血分数保留心力衰竭 中医 证素 临床流行病学 

分 类 号：R259[医药卫生—中西医结合]