疏肝定悸汤加减对阵发性房颤肝郁气滞型患者终点事件发生影响的回顾性队列研究  

The Effect of Modified Shugan Dingji Decoction (疏肝定悸汤) on the Occurrence of Endpoint Events in Patients with Paroxysmal Atrial Fibrillation of Liver Constraint and Qi Stagnation: A Retrospective Cohort Study

作　　者：陆海楠 乔思雨 张帅[2] 张懿 沈琳[2] LU Hainan;QIAO Siyu;ZHANG Shuai;ZHANG Yi;SHEN Lin(905 Hospital of People's Liberation Army Navy,Shanghai,200050;Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine)

机构地区：[1]中国人民解放军海军第九〇五医院,上海市200050 [2]上海中医药大学附属龙华医院

出　　处：《中医杂志》2024年第1期66-71,共6页Journal of Traditional Chinese Medicine

基　　金：上海市卫生和计划生育委员会上海市2017年度中医优势病种培育项目(zybz-2017003);上海市科学技术委员会科研计划项目(18401971500);龙华医院科技创新项目(CX202213)。

摘　　要：目的 回顾性分析疏肝定悸汤加减对肝郁气滞型阵发性房颤患者房颤复发的影响,探索终点事件发生的影响因素。方法 采用回顾性队列研究,通过上海中医药大学附属龙华医院电子病历数据库,筛选纳入2018年1月1日至2021年12月31日阵发性房颤肝郁气滞型患者。根据是否服用疏肝定悸汤加减将纳入患者分为暴露组和非暴露组各100例。收集患者一般资料(包括年龄、性别、体重指数、病程、合并疾病等)、用药情况、心脏结构和功能指标(左房内径、左室舒张末期内径、每搏输出量、射血分数)及终点事件(通过24 h动态心电图或者心电图判断阵发性房颤是否复发)的发生情况。使用Kaplan-Meier (K-M)曲线和Log-Rank检验对两组患者进入终点事件情况进行生存分析。利用单因素和多因素Cox回归分析各因素对进入终点事件的影响,并比较治疗前后患者的肝肾功能指标进行安全性评估。结果 非暴露组共49例(49.0%)发生终点事件,暴露组共26例(26.0%)发生终点事件(χ^(2)=11.211,P=0.001)。单因素Cox回归分析显示,年龄、病程、高血压病、糖尿病、慢性心功能不全、左房内径、每搏输出量、是否服用疏肝定悸汤加减可能是阵发性房颤肝郁气滞型患者终点事件发生的影响因素(P<0.05或P<0.01)。多因素Cox回归结果显示,暴露组发生终点事件的风险显著低于非暴露组(P<0.01);病程>12个月的患者发生终点事件的风险明显高于病程≤12个月的患者(P<0.01);与合并高血压病的患者相比,未合并高血压病患者发生终点事件的风险更低(P<0.05);左房内径>40 mm的患者发生终点事件的风险显著高于左房内径≤40 mm的患者(P<0.01)。两组患者治疗前后肝肾功能指标组间比较差异均无统计学意义(P>0.05)。结论 服用疏肝定悸汤加减是阵发性房颤肝郁气滞型患者进入终点事件的保护因素,有助于减少房颤的复发和进展,病程�Objective To retrospectively analyze the effect of modified Shugan Dingji Decoction(疏肝定悸汤)on the occurrence of endpoint events in patients with paroxysmal atrial fibrillation of liver constraint and qi stagnation.Methods A retrospective cohort study was conducted using the electronic medical record database of Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine to screen and include patients with paroxysmal atrial fibrillation of liver constraint and qi stagnation from January 1st,2018,to December 31th,2021.The included patients were divided into an exposure group and a non-exposure group,each consisting of 100 cases,based on whether they received modified Shugan Dingji Decoction.General information of the patients including age,gender,body mass index,duration of illness and comorbidities,medication history,cardiac structure and function indicators such as left atrial diameter,left ventricular end-diastolic diameter,stroke volume and ejection fraction,and the occurrence of endpoint events assessed through 24-hour dynamic electrocardiography or electrocardiogram to determine the recurrence of paroxysmal atrial fibrillation were collected.Kaplan-Meier(K-M)curves and Log-Rank tests were used to conduct survival analysis on the occurrence of endpoint events in the two groups of patients.Univariate and multivariate Cox regression analyses were used to analyze the impact of various factors on entry into endpoint events.Additionally,a safety assessment was performed by comparing liver and kidney function indicators before and after treatment.Results In the non-exposure group,a total of 49 cases(49.0%)experienced endpoint events,while in the exposure group,there were 26 cases(26.0%).The Log-rank test indicated significant difference between the two groups(χ^(2)=11.211,P=0.001).Univariate Cox regression analysis showed that age,duration of illness,hypertension,diabetes,chronic heart failure,left atrial diameter,stroke volume,and the use of modified Shugan Dingji Decoction may be t

关 键 词：阵发性房颤 肝郁气滞 疏肝定悸汤 影响因素 回顾性队列研究 

分 类 号：R259[医药卫生—中西医结合]