基于因子分析及聚类分析探讨高血压合并射血分数保留型心衰中医证素证型的研究  

Study on TCM syndrome types of hypertension complicated with ejection fraction retention heart failure based on factor analysis and cluster analysis

作　　者：魏锦轩 杨素珍 樊蕊 王钰 刘莉[4] 隋艳波[4] WEI Jinxuan;YANG Suzhen;FAN Rui;WANG Yu;LIU Li;SUI Yanbo(Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第一临床医学院,510405 [2]黑龙江中医大学第一临床医学院 [3]康复大学青岛医院(青岛市市立医院)肾内科 [4]黑龙江中医药大学附属第一医院心血管一科

出　　处：《环球中医药》2023年第6期1097-1104,共8页Global Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81904107);黑龙江省博士后科研启动金(LBH-Q18118);黑龙江中医药大学研究生创新基金(2022yjscx024)。

摘　　要：目的探索高血压合并射血分数保留型心衰的中医证素、证型分布规律。方法采集311例高血压合并射血分数保留型心衰患者的四诊信息,运用因子分析与聚类分析相结合的方法对调查结果进行分析,另将高血压合并射血分数保留型心衰患者通过年龄及美国纽约心脏病协会心功能等级进行分组,观察各证型在不同年龄及心功能等级的分布情况。结果本研究共收集60项症状及体征,筛选出36个中医四诊信息进行统计分析,得到15个公因子,其中病性证素涉及血瘀、气虚、水停、血虚、痰湿、阴虚、阳虚、内热,病位证素涉及心、脾、胃、肝、肺、络、肾、大肠;聚类分析得出6类中医证型,依次为肝肾阴虚(34.73%,108/311)、气虚血瘀(31.19%,97/311)、痰瘀互结(20.58%,64/311)、痰浊闭阻(4.50%,14/311)、阳虚水泛(5.14%,16/311)、心气不足(3.86%,12/311),通过组间比较发现各证型间年龄分布无明显差异,痰瘀互结型患者在心功能IV级中占比较肝肾阴虚型多。结论高血压合并射血分数保留型心衰病性本虚标实,虚实夹杂,主要病位分布在五脏及胃、大肠及络,证型以肝肾阴虚、气虚血瘀及痰瘀互结为主,不同年龄的生理状态不是影响本病证型分布的原因,痰瘀互结型患者的心功能较肝肾阴虚型差。Objective To explore the distribution of TCM syndrome types of hypertension complicated with heart failure with preserved ejection fraction(HFpEF-HTN).Methods The information of four TCM diagnoses of 311 patients with HFpEF-HTN were collected,and the results were analyzed by factor analysis and cluster analysis.The patients were divided into groups according to age and NYHA cardiac function grade.The distribution of syndrome types in different ages and NYHA groups was observed.Results In this study,a total of 60 symptoms and signs were collected,36 TCM diagnostic information were selected for statistical analysis,and 15 common factors were obtained,including blood stasis,Qi deficiency,water stagnation,blood deficiency,phlegm-dampness,Yin deficiency,Yang deficiency and internal heat.The syndrome elements of disease position involve heart,spleen,stomach,liver,lung,collaterals,kidney and large intestine.Six TCM syndrome types were obtained by cluster analysis,which were liver and kidney Yin deficiency(34.73%),Qi deficiency and blood stasis(31.19%),phlegm and blood stasis(20.58%),phlegm obstruction(4.50%),Yang deficiency and water flooding(5.14%)and heart Qi deficiency(3.86%).There was no significant difference in age distribution among different syndrome types.Patients with combination of phlegm and blood stasis accounted for more in the IV class of cardiac function than those with Yin deficiency of liver and kidney.Conclusion HFpEF-HTN disease is characterized by deficiency and excess,and the disease is mainly distributed in the five internal organs,stomach,large intestine and collaterals.The syndrome types are mainly Yin deficiency of liver and kidney,deficiency of Qi and blood stasis and combination of phlegm and blood stasis.The physiological status of different ages does not affect the distribution of the syndrome type.The heart function of patients with phlegm and blood stasis type is worse than that of liver and kidney Yin deficiency type.

关 键 词：高血压合并射血分数保留型心衰 中医证型 NYHA心功能分级 因子分析 聚类分析 

分 类 号：R544[医药卫生—心血管疾病]