169例慢性肺源性心脏病患者急性加重期的证候要素调查及其与病情预后、转归的相关性研究  

Investigation of Syndrome Elements and Its Relationship with Prognosis and Outcome in 169 Cases Patients with Pulmonary Heart Disease at Acute Exacerbation

作　　者：袁艺 吴佳莉 杨斯皓 肖丹[1] 詹云 YUAN Yi;WU Jia-li;YANG Si-hao;XIAO Dan;ZHAN Yun(Yibin Hospital,West China Hospital,Sichuan University/Yibin Second Peopled Hospitalf Yibin Sichuan 644000,China)

机构地区：[1]四川大学华西医院宜宾医院/宜宾市第二人民医院,四川宜宾644000

出　　处：《中医药导报》2021年第4期53-57,共5页Guiding Journal of Traditional Chinese Medicine and Pharmacy

基　　金：宜宾市卫生和计划生育委员会科研项目(2018YW019)。

摘　　要：目的:调查慢性肺源性心脏病(CPHD)患者急性加重期的证素分布情况及组合规律,并与病情预后、转归因子进行相关性分析。方法:收集169例CPHD急性加重期患者的四诊信息,提取证素,进行定性、定量、组合规律分析。记录N末端B型脑钠肽原(NT-proBNP)、降钙素原(PCT)、左室射血分数(LVEF)、肺动脉平均压(MPAP)和住院时间等CPHD预后、转归因子,并与证素进行相关性分析。结果:CPHD急性加重期以实性证素为主,占65.87%(442/671),虚性证素占34.13%(229/671),实性证素中以血瘀多见,出现频率为97.63%(165/169),虚性证素以气虚多见,出现频率为65.68%(111/169);病位主要在肺,出现频率为85.21%(144/169),其次在心和肾,出现频率分别为54.43%(92/169)和39.64%(67/169);组合证素以三证素组合为主,占72.78%(123/169),且以实性、虚实夹杂为主,两者共占95.85%(162/169);证候要素程度以2级和3级为主,分别占49.71%(84/169)和40.23%(68/169);痰蒙神窍和阳虚水泛患者LVEF最低(P<0.05),NT-proBNP、MPAP最高(P<0.05),住院时间最长(P<0.05);痰热壅肺患者PCT最高(P<0.05),NT-proBNP、PCT、MPAP和住院时间均随着证素程度加重而增加(P<0.05),LVEF随着证素程度加重而降低(P<0.05);气虚、阳虚与NT-proBNP、LVEF相关性强,痰热与PCT、MPAP和住院时间相关性强,痰浊、血瘀与MPAP相关性强,肺与NT-proBNP、PCT、LVEF、MPAP相关性强,心与NT-proBNP、LVEF、MPAP相关性强,肾与NT-proBNP、MPAP相关性强;证素2级与PCT相关性强,证素3级与NT-proBNP、PCT、LVEF、MPAP及住院时间相关性强。结论:CPHD急性加重期以实性证素为主,血瘀、痰热、痰浊多见,病位主要在肺、心、肾,证素组合以实性、虚实夹杂最多见,证素程度以2级和3级为主,基本与其病机相符;证素及其程度与CPHD预后、转归密切相关,临床辨证诊疗中要注意对证素的定性与定量判断。Objective: To study distribution and combination law of syndrome elements of chronic pulmonary heart disease(CPHD) at acute exacerbation and to analyze the relevance between prognosis as well as outcome factors. Methods: Information of four diagnostic methods was recorded in 169 CPHD patients at acute exacerbation, and the syndrome elements were collected. Then qualitative, quantitative and combination laws were analyzed. And prognostic and prognostic factors such as N-terminal pro-B-type natriuretic peptide(NT-proBNP),procalcitonin(PCT), left ventricular ejection fraction(LVEF), mean pulmonary artery pressure(MPAP) and length of stay were taken notes and relevance between prognostic, prognostic factors and syndrome elements was ana-lyzed. Results: Excess syndrome was the main syndrome in CPHD patients at acute exacerbation, accounting for65.87%(442/671), and deficiency syndrome accounts for 34.13%(229/671). Stasis of blood is more common in excess syndrome elements, with the rate of 97.63%(165/169). Qi deficiency is more common in deficiency syndrome elements, with the rate of 65.68%(111/169). The main disease position was lung, with the rate of 85.21%(144/169), followed by heart and kidney, respectively with the rate of 54.43%(92/169) and 39.64%(67/169). The main combined syndrome elements is the proportion of combination three diagnostic, with the rate of 72.78%(123/169), in which the proportion of excess syndromes and excess syndromes mixed with deficiency syndromes were 95.85%(162/169). The main degree syndrome elements were the second degree and third degree accounting for respectively 49.71%(84/169) and 40.23%(68/169). Patients with phlegm obscuring the vital orifices and Yang deficiency water flooding showed the lowest levels of LVEF(P<0.05), while the highest levels of NT-proBNP and MPAP(P<0.05) and the longest length of stay(P<0.05). Patients with Phlegm heat obstructing lung showed the highest PCT(P<0.05). Besides, levels of NT-proBNP, PCT, MPAP and length of stay increased along with increasing of syn

关 键 词：慢性肺源性心脏病 急性加重期 证素 病情预后 转归 相关性分析 

分 类 号：R256.24[医药卫生—中医内科学]