慢性心力衰竭不同中医证型患者生存质量评价及其影响因素的前瞻性多中心研究  

A Prospective Multicenter Study on Quality of Life of Patients with Chronic Heart Failure with Different TCM Syndromes and The Related Factors

作　　者：黄尉威 姚美丹 邓佳妮 关卓骥 冼绍祥[2] 陈洁[2] HUANG Weiwei;YAO Meidan;DENG Jiani;GUAN Zhuoji;XIAN Shaoxiang;CHEN Jie(Guangzhou University of Chinese Medicine,Guangzhou,510405;The First Affiliated Hospital of Guangzhou University of Chinese Medicine)

机构地区：[1]广州中医药大学,广东省广州市510405 [2]广州中医药大学第一附属医院

出　　处：《中医杂志》2023年第8期805-811,共7页Journal of Traditional Chinese Medicine

基　　金：国家中医药管理局第二批国家中医临床研究基地建设项目(国中医药科技函[2018]131号);广州市市校(院)联合资助项目基础与应用基础研究项目(202201020342);广州市科学技术局2022年重点研发计划(2060404);国家中医药管理局2021年岐黄学者支持项目(国中医药人教函[2022]6号)。

摘　　要：目的探讨慢性心力衰竭(简称慢性心衰)不同中医证型患者心功能指标和生存质量的差异,以及对生存质量影响的相关因素。方法采用配额抽样方法,按照年龄、性别、心功能分级分层纳入来自广州中医药大学第一附属医院等12所医院的慢性心衰患者538例,其中气虚血瘀证235例、阳气亏虚血瘀证组135例、气阴两虚血瘀证168例。收集各证型患者一般人口社会学特征、心功能分级、心力衰竭分层[包括射血分数下降心衰(HFrEF)、射血分数保留心衰(HFpEF)、射血分数临界值心衰(HFmrEF)]情况,检测心功能相关指标[包括左室舒张末内径(LVDD)、左室射血分数(LVEF),血浆脑钠肽(BNP)、N端-B型钠尿肽原(NT-proBNP)];采用简明健康量表36(SF-36量表)评分[分为生理机能(PF)、生理职能(RP)、躯体疼痛(BP)、一般健康状况(GH)、精力(VT)、社会功能(SF)、情感职能(RE)、精神健康(MH)8个方面]进行生存质量评价。分析心功能分级、心功能相关指标与SF-36量表评分的相关性。结果3种证型患者心功能分级和心力衰竭分层分布比例差异均有统计学意义(P<0.05)。心功能分级中,Ⅲ级患者气虚血瘀证占比最高(59.1%),心功能Ⅱ、Ⅳ级患者均以阳气亏虚血瘀证占比最高(分别为21.5%、37.0%);心力衰竭分层中,HFrEF、HFpEF患者均以气阴两虚血瘀证占比最高(分别为39.9%、49.4%),HFmrEF患者以气虚血瘀证占比最高(24.3%)。3种证型患者LVEF、LVDD、BNP水平比较差异无统计学意义(P>0.05),NT-proBNP水平比较差异具有统计学意义(P<0.05)。各证型患者SF-36量表评分中气虚血瘀证PF评分显著高于另外两种证型(P<0.05);气阴两虚血瘀证GH评分显著低于另外两种证型(P<0.05);气虚血瘀证VT评分显著高于气阴两虚血瘀证(P<0.05)。相关性分析结果显示,心功能分级与SF-36量表8个方面评分及总分均存在负相关(P<0.05),其中PF、VT评分相关系数大于0.3。结论气虚�Objective To explore the differences in the cardiac function and quality of life(QOL)in patients with chronic heart failure(CHF)of different traditional Chinese medicine(TCM)syndrome,as well as the factors associated with QOL.Methods Using quota sampling,538 CHF patients from 12 hospitals,such as the First Affiliated Hospital of Guangzhou University of Chinese Medicine,were stratified into three groups according to age,gender and cardiac function level,which were qi deficiency and blood stasis syndrome group(235 cases),yang qi depletion and blood stasis syndrome group(135 cases)and qi and yin deficiency and blood stasis syndrome group(168 cases).The general demographic and sociological characteristics,cardiac function grades,heart failure stratification condition including heart failure with reduced ejection fraction(HFrEF),heart failure with preserved ejection fraction(HFpEF)and heart failure with mid-range ejection fraction(HFmrEF),and cardiac function indicators including left ventricular end-diastolic diameter(LVDD),left ventricular ejection fraction(LVEF),brain natriuretic peptide(BNP)and N-terminal pro brain natriuretic peptide(NT-proBNP)were collected from each group.The Chinese version of the Brief Health Scale-36(SF-36)was used to investigate QOL in eight aspects including physical functioning(PF),role-functioning physical(RP),body pain(BP),general health(GH),vitality(VT),social functioning(SF),role-functioning emotional(RE),and mental Health(MH).The correlation between cardiac function indicators and SF-36 scores was analyzed.Results There were statistical differences in the dcardiac function grades and heart failure stratification of three TCM syndromes(P<0.05).From the perspective of cardiac function grades,qi deficiency and blood stasis syndrome had the largest proportion in grade III patients(59.1%),while yang qi depletion and blood stasis syndrome was most frequently seen in both grade II and IV patients(21.5%and 37.0%).For heart failure stratification,qi and yin deficiency and blood stasis syndrom

关 键 词：慢性心力衰竭 生存质量 气虚血瘀证 多中心研究 

分 类 号：R259[医药卫生—中西医结合]