慢性心力衰竭患者不同中医证型临床特征及证型影响因素研究  

Study on the Clinical Characteristics and Affecting Factors of Patients with Different Chinese Medicine Syndromes of Chronic Heart Failure

作　　者：孙梓宜 姚魁武[2,3] 孙晓宁 林建国 王子涵 张笑霄 王擎擎 段锦龙 李春岩[4] 黄力[4] SUN Zi-yi;YAO Kui-wu;SUN Xiao-ning;LINJian-guo;WANG Zi-han;ZHANG Xiao-xiao;WANG Qing-qing;DUAN Jin-long;LI Chun-yan(and HUANG Li41 Graduate School,Beijing University of Chinese Medicine,Beijing,100029;Department of Cardiovascular Disease,Guang'anmen Hospital of China Academy of Chinese Medical Sciences,Beijing,100032;Academic Administration Office,China Academy of Chinese Medical Sciences,Beijing,100700;Department of Integrative Cardiology,China-Japan Friendship Hospital,Beijing,100029)

机构地区：[1]北京中医药大学研究生院,北京100029 [2]中国中医科学院广安门医院心血管科,北京100032 [3]中国中医科学院学术管理处,北京100700 [4]中日友好医院中西医结合心脏科,北京100029

出　　处：《中国中西医结合杂志》2024年第7期785-791,共7页Chinese Journal of Integrated Traditional and Western Medicine

摘　　要：目的探讨慢性心力衰竭(CHF)不同中医证型患者临床特征的差异及阳气亏虚血瘀证的影响因素。方法纳入来自中日友好医院中西医结合心脏科的CHF患者179例,其中气虚血瘀证58例、气阴两虚血瘀证31例、阳气亏虚血瘀证90例。收集各证型患者一般人口社会学特征、纽约心脏协会(NYHA)心功能分级、心力衰竭分类[射血分数保留型心力衰竭(HFpEF)、射血分数中间值心力衰竭(HFmrEF)、射血分数降低型心力衰竭(HFrEF)],检测心功能相关指标[N端脑钠肽前体(NT-proBNP)、心脏超声],实验室检查指标(血常规、肝肾功、电解质),并采用明尼苏达心力衰竭患者生活调查问卷(MLHFQ)对患者“身体”“情绪”“其他”3个领域进行生活质量评价。比较以上因素在不同证型患者间的差异,构建中医证型的无序多分类Logistics回归模型,分析以上因素与阳气亏虚血瘀证间的关联。结果阳气亏虚血瘀证组的NYHAⅣ级患者比例、MLHFQ其他领域得分高于气虚血瘀证组(P<0.05);NYHAⅡ级、HFmrEF患者比例低于气虚血瘀证和气阴两虚血瘀证组(P<0.05),MLHFQ身体、情绪领域得分及总分高于气虚血瘀证和气阴两虚血瘀证组(P<0.05);血清Ca^(2+)、红细胞计数(RBC)和血红蛋白(Hb)浓度低于气阴两虚血瘀证患者(P<0.05)。与气虚血瘀证比较,RBC、Hb、女性、几乎不运动、NYHAⅡ级和Ⅲ级是阳气虚衰血瘀证的独立影响因素。结论气虚血瘀和气阴两虚血瘀证是CHF相对稳定的病程阶段;阳气亏虚血瘀证属于病程的严重阶段。RBC、Hb、女性、运动频率和NYHA分级可作为阳气亏虚血瘀证的辨证辅助依据。(中国临床试验注册中心,No.ChiCTR1900024482)。Objective To explore the clinical differences among patients with chronic heart failure(CHF)with different Chinese medicine(CM)syndromes,and to identify the influencing factors of yang qi depletion and blood stasis syndrome.Methods Totally 179 patients with CHF was conducted in the Department of Integrative Cardiology,China-Japan Friendship Hospital,including 58 cases of qi deficiency and blood stasis syndrome(QBS),31 cases of qi and,yin deficiency and blood stasis syndrome(QYBS),and 90 cases of yang qi depletion and blood stasis syndrome(YBS).Demographic and sociological characteristics,New York Heart Association(NYHA)functional classification,and heart failure classifications[including heart failure with preserved ejection fraction(HFpEF),heart failure with mid-range ejection fraction(HFmrEF),heart failure with reduced ejection fraction(HFrEF)]were collected.Cardiac function-related indicators[including N-terminal pro-B-type natriuretic peptide(NT-proBNP),cardiac uhrasonography],laboratory test indicators(including routine blood tests,liver and kidney function,electrolytes)were detected.Quality of life in three domains(physical,emotional,and others)were assessed using the Minnesota Living with Heart Failure Questionnaire(MLHFQ).Differences among the CM syndromes were compared,and an unordered multinomial Logistic regression model was constructed to analyze the association between the influencing factors and QBS.Results Compared with the QBS,the YBS showed a higher NYHA classⅣpatients proportion,and MLHFQ scores in other domains(P<0.05).The YBS showed fewer NYHA classⅡand HFmrEF patients proportion,and higher MLHFQ physical and emotional domain scores,as well as total scores,than the QBS and QYBS(P<0.05).Serum Ca^(2+),red blood cell(RBC)count,and hemoglobin(Hb)concentration were lower than those in the QYBS(P<0.05).Compared with QBS,RBC,Hb,female gender,rare exercise,and NYHA classⅡandⅢwere independent influencing factors for YBS.Conclusions QBS and QYBS are relatively stable stages of CHF progression.YB

关 键 词：慢性心力衰竭 中医证型 阳气亏虚血瘀证 Logistics回归分析 

分 类 号：R259[医药卫生—中西医结合]