中医药辨治稳定性冠心病的病、证、症-疗效-用药规律的真实世界研究  

A Real-world Study on the Diseases/Syndromes/Symptoms-Curative Effects-Medication Rules of Traditional Chinese Medicine in the Treatment of Stable Coronary Heart Disease

作　　者：毕颖斐[1] 王贤良[1] 王聪[1] 于潇涵 熊可[3] 王时望 贺晓旭 赵晶珊 赵志强[1] 郑青山[7] 毛静远[1] 张伯礼[3] BI Yingfei;WANG Xianliang;WANG Cong;YU Xiaohan;XIONG Ke;WANG Shiwang;HE Xiaoxu;ZHAO Jingshan;ZHAO Zhiqiang;ZHENG Qingshan;MAO Jingyuan;ZHANG Boli(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin,300380;Sichuan Second Hospital of Traditional Chinese Medicine;Tianjin University of Traditional Chinese Medicine;Hangzhou Hospital of Traditional Chinese Medicine;Hangzhou Red Cross Hospital;Tiancunlu Community Health Service Center,Haidian District,Beijing;Shanghai University of Traditional Chinese Medicine)

机构地区：[1]天津中医药大学第一附属医院/国家中医针灸临床医学研究中心,天津300380 [2]四川省第二中医医院 [3]天津中医药大学 [4]杭州市中医院 [5]杭州市红十字会医院 [6]北京市海淀区田村路社区卫生服务中心 [7]上海中医药大学

出　　处：《中医杂志》2023年第7期702-709,共8页Journal of Traditional Chinese Medicine

基　　金：国家中医药行业科研专项(201407001-6A);国家中医药管理局中医药创新团队及人才支持计划项目(ZYYCXTD-C-202203);天津市卫生健康委员会中医药重点领域科技项目(2022009)。

摘　　要：目的基于真实世界探讨中医药辨治稳定性冠心病患者的病-疗效-用药、证-疗效-用药、症-疗效-用药规律。方法建立中医诊疗信息数据库,在维持原西医治疗不变的基础上,对来自全国不同地域的中医专家辨治稳定性冠心病患者的过程进行1~2周的跟踪和记录。统计治疗前纳入患者的证候要素及证候类型分布,于治疗前后进行中医证候积分评价,并以治疗后中医证候积分改善率≥50%为中医证候积分有效病例。治疗前后采用欧洲五维健康量表[包括五维健康描述系统(EQ-5D)评分、视觉模拟(EQ-VAS)评分]评价患者健康状况,并以治疗后EQ-VAS评分改善率>10%为有效病例。选取冠心病的典型症状胸痛并记录发作情况进行中药联合应用的效应分析。结果纳入2046例患者,其中2003例患者有明确的证候要素诊断,1998例患者有明确的证候类型诊断,1953例患者有完整中医证候积分数据,1954例患者符合EQ-5D评分分析标准,1906例患者符合EQ-VAS评分分析标准,1826例患者有胸痛发作次数记录。治疗前中医证候要素分布前三位为血瘀(1793例、89.5%)、气虚(1651例、82.4%)、痰浊(1428例、71.3%),中医证候类型分布前三位为气虚血瘀(450例、22.5%)、痰瘀互结(285例、14.3%)、气虚痰瘀(233例、11.7%)。治疗后符合中医证候积分有效标准的患者共672例,在气虚血瘀、痰瘀互结、气虚痰瘀证中有效病例的占比分别为37.5%、30.2%、33.0%。符合EQ-VAS评分有效标准的患者共707例,使用频率前三位中药为丹参(484例,68.5%)、茯苓(420例,59.4%)、川芎(375例,53.0%)。胸痛症状消失的患者共306例,使用频率前三位中药为丹参(207例,67.6%)、茯苓(196例,64.1%)、半夏(162例,52.9%)。有胸痛发作次数记录的患者使用频率较高(>10%)的中药共计34种,合用指数(CI值)前六位中药为丹参(0.306)、茯苓(0.264)、川芎(0.226)、半夏(0.221)、陈皮(0.207)、赤芍(0.205)。34种�Objective To explore disease/syndrome/symptoms-curative effects-medication rules of traditional Chinese medicine(TCM)in the treatment of patients with stable coronary heart disease(SCHD)in a real-world study.Methods An information database for TCM diagnosis and treatment was established,and records for pattern differentiation and treatment of SCHD in addition to maintaining the western medicine by TCM experts from different regions of China were tracked for 1 to 2 weeks.The syndrome elements and syndrome types of the included patients were counted before treatment.The TCM syndrome scores were evaluated before and after treatment,and the patients with an improvement rate equaling or exceeding 50%after treatment were regarded as the effective cases.The European five-dimensional health scale including EuroQol-5D(EQ-5D)score and visual analogue(EQ-VAS)score were used to evaluate the patient's health status,and those with improvement rate of EQ-VAS score after treatment exceeding 10%were taken as the effective cases.Chest pain as a typical symptom of CHD was recorded to analyze the effect of the combined application of Chinese herbal medicine.Results Of the included 2046 patients,there were 2003 cases with definite syndrome elements and 1998 cases with definite syndrome types regarding the diagnosis.Totally,1953 cases had complete data in terms of the TCM syndrome score,while 1954 cases and 1906 cases had eligible data for EQ-5D and EQ-VAS analyses,respectively.Occurrence of chest pain was recorded in 1826 cases.Before treatment,the top three syndrome elements were blood stasis(1793 cases,89.5%),qi deficiency(1651 cases,82.4%),and phlegm turbidity(1428 cases,71.3%),and the top three syndrome types were qi deficiency and blood stasis(450 cases,22.5%),binding of phlegm and stasis(285 cases,14.3%),and qi deficiency and phlegm stasis(233 cases,11.7%).Totally,672 cases met the effective criteria of TCM syndrome score after treatment,and the effective cases accounted for 37.5%,30.2%,and 33.0%of all the cases with qi deficie

关 键 词：稳定性冠心病 欧洲五维健康量表 健康状况评价 用药规律 效应分析 真实世界研究 

分 类 号：R259[医药卫生—中西医结合]