中医体质对心肌梗死患者再入院影响的前瞻性队列研究  

Prospective cohort study on the impact of traditional Chinese medicine constitution on readmission of patients with myocardial infarction

作　　者：郭红鑫 于瑞[1] 王新陆[1] 李兴渊[1] 彭广操[1] 任红杰[1] 王永霞[1] 朱明军[1] GUO Hongxin;YU Rui;WANG Xinlu;LI Xingyuan;PENG Guangcao;REN Hongjie;WANG Yongxia;ZHU Mingjun(Heart Center,The First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China;First Clinical Medical College,Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学第一附属医院心脏中心,郑州450000 [2]河南中医药大学第一临床医学院,郑州450000

出　　处：《中华中医药杂志》2024年第5期2230-2235,共6页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家重点研发计划重点专项课题(No.2019YFC1710003,No.2019YFC1710000);国家自然科学基金重点项目(No.82030120);国家中医药高层次人才项目—岐黄学者;河南中医药大学研究生科研创新重点项目(No.2023KYCX002)。

摘　　要：目的:探讨中医体质对心肌梗死(MI)患者再入院的影响。方法:采用前瞻性研究方法入组MI患者,根据随访1年内是否发生再入院分为再入院组和未再入院组,统计基线两组中医体质和临床资料,将差异具有统计学意义的偏颇体质和临床资料纳入Logistic回归方程,分析患者再入院的危险因素,采用受试者工作特征曲线(ROC)评价回归模型和危险因素的预测价值。结果:共入组277例患者,随访1年内有242例患者报告了是否再入院,其中再入院组有49例。在中医体质方面,242例患者以气虚质、血瘀质和阳虚质为主。两组在气虚质、血瘀质、痰湿质、平和质、是否为复合体质、CCS分级、血运重建治疗、硝酸酯类治疗、眠差、纳差方面差异有统计学意义(P<0.05)。气虚质、血瘀质、痰湿质、非平和质、复合体质、未进行血运重建、使用硝酸酯类药物、CCS分级≥Ⅱ级、眠差者和纳差者的再入院风险显著增高。Logistic回归分析结果显示,经多因素校正,气虚质再入院风险是非气虚质的2.53倍(95%CI[1.05,6.12],P<0.05),气虚质是影响该地区MI患者再入院的独立危险因素。根据回归模型预测值和气虚质判定结果绘制ROC曲线,回归模型AUC=0.77,气虚质AUC=0.67,差异有统计学意义(P<0.05)。结论:气虚质是影响该地区MI患者再入院的独立危险因素,早期应特别关注这类患者,及时采取有效预防策略,以降低再入院率。Objective:To explore the influence of traditional Chinese medicine(TCM)constitution on readmission of patients with myocardial infarction(MI).Methods:MI patients were enrolled using a prospective study method,and were divided into readmission and non-readmission groups according to whether readmission occurred within 1 year of follow-up,and the TCM constitution and clinical information of the two groups were counted at baseline.TCM constitution and clinical data with statistically significant differences were included in logistic regression equations to analyze the risk factors for patient readmission,and the predictive value of the regression model and risk factors was evaluated using the receiver operating characteristic curve(ROC).Results:A total of 277 patients were enrolled,and 242 patients reported whether or not they were readmitted to the hospital within 1 year of follow-up,including 49 in the readmission group.In terms of TCM constitution,242 patients were predominantly qi deficiency constitution,blood stasis constitution,and yang deficiency constitution.The 2 groups had significant differences in qi deficiency constitution,blood stasis constitution,phlegm dampness constitution,gentleness constitution,CCS grading,reconstruction therapy,nitrate therapy,poor sleep,and poor appetite(P<0.05).The risk of readmission was significantly higher for those who were qi deficiency constitution,blood stasis constitution,phlegm-dampness constitution,not gentleness constitution,did not undergo reconstruction therapy,treated with nitrates,had a CCS classification≥Ⅱ,had poor sleep,and poor appetite.The results of the Logistic regression analyses showed that,after correction for multifactorial factors,the risk of readmission for qi deficiency constitution was 2.53 times higher than that of non-qi deficiency constitution(95%CI[1.05,6.12],P<0.05).The ROC curves were plotted according to the predicted values of the regression model and qi deficiency constitution,and the AUC of the regression model=0.77 and the AUC of qi d

关 键 词：中医体质 心肌梗死 再入院 影响因素 LOGISTIC回归 

分 类 号：R259[医药卫生—中西医结合]