抗纤益心方逆转扩张型心肌病心室重构的影响因素  

Influence Factors of Kangxian Yixin Formula Reversing Ventricular Remodeling in Patients with Dilated Cardiomyopathy

作　　者：刘舜禹 王素云 李梦頔 李巧稚 王振涛[1] LIU Shunyu;WANG Suyun;LI Mengdi;LI Qiaozhi;WANG Zhentao(Henan Province Hospital of Traditional Chinese Medicine,Zhengzhou Henan China 450002;Henan University of Chinese Medicine,Zhengzhou Henan China 450046;The First Affiliated Hospital to Henan University of Chinese Medicine,Zhengzhou Henan China 450000)

机构地区：[1]河南中医药大学第二附属医院/河南省中医院,河南郑州450002 [2]河南中医药大学,河南郑州450046 [3]河南中医药大学第一附属医院,河南郑州450000

出　　处：《中医学报》2024年第7期1543-1550,共8页Acta Chinese Medicine

基　　金：河南省科技攻关项目(232102310422);河南省中医药科学研究专项课题项目(2022ZY2025);河南省特色骨干学科中医学第二批学科建设项目(STG-ZYX01-202104)。

摘　　要：目的:分析影响抗纤益心方逆转扩张型心肌病(dilated cardiomyopathy,DCM)心室重构的关键因素。方法:选取已完成的《抗纤益心方治疗扩张型心肌病的队列研究》课题中所纳入的抗纤益心方治疗队列中的患者,其中达到DCM左心室逆重构(left ventricular reverse remodeling,LVRR)标准的患者(LVRR组)30例,按照巢式病例对照研究的方法以及1:4的比例,在同队列中筛选出未发生心室逆重构(no left ventricular reverse remodeling,NLVRR)组(NLVRR组)120例。收集两组患者的入组前一般情况、病程情况、中医证候积分、心脏超声结果、用药情况等信息。采用多因素Logistic回归方法分析抗纤益心方逆转DCM心室重构的影响因素,ROC曲线评价所筛选出的影响因素对LVRR达标的预测价值。结果:多因素Logistic回归分析结果显示,基线收缩压(OR=0.932,95%CI:0.868~1.000,P=0.049)、病程(OR=1.124,95%CI:1.032~1.223,P=0.007)、左室舒张末期内径(left ventricular end diastolic dimension,LVEDD)(OR=3.219,95%CI:1.499~6.913,P=0.003)、β受体阻滞剂目标剂量(OR=0.009,95%CI:0~0.236,P=0.005)是抗纤益心方逆转DCM心室重构的独立影响因素。ROC曲线分析结果显示,LVEDD(AUC=0.958,P<0.001)、病程(AUC=0.828,P<0.001)、β受体阻滞剂目标剂量(AUC=0.667,P=0.005)对抗纤益心方逆转DCM心室重构具有预测价值,其灵敏度分别为82.5%、69.2%、53.3%,特异度分别为100%、83.3%、80%,病程临界值为10.5个月,LVEDD临界值为68.5 mm,收缩压临界值为116 mm Hg(1 mm Hg=0.133 kPa)。对多因素Logistic回归分析中有意义的4个独立预测因子进行联合预测准确率高于单个因素(AUC=0.988,95%CI:0.973~1.000,P<0.001),灵敏度为99.2%,特异度为90%。结论:基线收缩压、病程、LVEDD以及β受体阻滞剂目标剂量是抗纤益心方逆转DCM心室重构的独立影响因素。Objective:To analyze the key factors affecting the reversal of ventricular remodeling in patients with dilated cardiomyopathy(DCM)by Kangxian Yixin Formula.Methods:30 patients who met the criteria of left ventricular reverse remodeling(LVRR)with DCM(LVRR group)were selected from the Kangxian Yixin Formula treatment cohort included in the completed project of"Cohort study on treatment of dilated cardiomyopathy with Kangxian Yixin Formula".According to the nested case-control study method,120 patients without left ventricular reverse remodeling(NLVRR)were selected from the same cohort(NLVRR group)at a ratio of 1:4.The patients′general information before enrollment,course of disease,TCM syndrome score,cardiac ultrasound results,medication and other information of the two groups were collected.Multivariate logistic regression analysis was used to analyze the influencing factors of Kangxian Yixin Formula reversing ventricular remodeling in DCM.ROC curve was used to evaluate the predictive value of the selected influencing factors for reaching the standard of LVRR.Results:Multivariate logistic regression analysis showed that baseline systolic blood pressure(OR=0.932,95%CI:0.868-1,P=0.049),course of disease(OR=1.124,95%CI:1.032-1.223,P=0.007),left ventricular end diastolic dimension(LVEDD)(OR=3.219,95%CI:1.499-6.913,P=0.003)and target dose ofβ-blocker(OR=0.009,95%CI:0-0.236,P=0.005)were independent influencing factors of Kangxian Yixin Formula reversing ventricular remodeling in DCM patients.The results of ROC curve analysis showed that LVEDD(AUC=0.958,P<0.001),course of disease(AUC=0.828,P<0.001)and target dose ofβ-blocker(AUC=0.667,P=0.005)had predictive value for the reversal of ventricular remodeling in DCM with Kangxian Yixin Formula.The sensitivity was 82.5%,69.2%and 53.3%,and the specificity was 100%,83.3%and 80%respectively.The critical value of course of disease,LVEDD and systolic blood pressure was 10.5 months,68.5 mm and 116 mm Hg(1 mm Hg=0.133 kPa)respectively.The combined prediction accuracy of four sig

关 键 词：扩张型心肌病 抗纤益心方 心室重构 

分 类 号：R259.41[医药卫生—中西医结合]