近20年射血分数保留的心力衰竭患者发病规律的临床变迁  

Research on the incidence patterns of heart failure with preserved ejection fraction:Clinical changes over the past 20 years

作　　者：刘思雨 石玉姣 刘永成 梁小雨 杨晨光 乔文博 董国菊[1,3] LIU Siyu;SHI Yujiao;LIU Yongcheng;LIANG Xiaoyu;YANG Chenguang;QIAO Wenbo;DONG Guoju(Xiyuan Hospital of China Academy of Chinese Medical Sciences,Beijing 100091,China)

机构地区：[1]中国中医科学院西苑医院心血管一科,北京100091 [2]中国中医科学院研究生院 [3]国家中医心血管病临床医学研究中心

出　　处：《环球中医药》2024年第8期1460-1468,共9页Global Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(82074423);中国中医科学院科技创新重大攻关项目(CI2021A00903);中国中医科学院西苑医院能力提升项目(XYZX0201-02);中国中医科学院科技创新工程医理交叉课题(CI2023C010YL)。

摘　　要：目的回顾性分析近20年来射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者发病情况、临床特征及中医证候演变情况。方法选择跨度20年内的2003年、2013年和2023年,每年均选择心血管疾病高发期10~12月,运用卡方检验、单因素方差分析比较中国中医科学院西苑医院心血管科在这3个年度10~12月份出院的HFpEF患者的一般资料、合并疾病分布、用药情况、超声指标、中医证候分布情况。结果(1)HFpEF患者的绝对数量以及在整个心衰人群中的占比随时间呈上升趋势。(2)HFpEF患者的年龄随时间推移呈明显增长趋势;患者左房内径、左室后壁厚度随时间推移也呈升高趋势;历经20年变迁,HFpEF人群共病负担加重,主要基础疾病一直为高血压、冠心病、心房颤动和糖尿病,高脂血症和高尿酸血症此类代谢性疾病的患者数量及占比增加;随着新药的研发和指南的推广,HFpEF患者长期口服药中血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂、β受体阻滞剂数量呈增长趋势,强心药物呈下降趋势。(3)中医证候分布规律显示,气虚证、血瘀证和水饮证为HFpEF患者的主要证候。结论随着时间推移,HFpEF患者发病率上升、发病程度加重,与人口老龄化、合并基础疾病多,尤其代谢性疾病增多有关。HFpEF的中医关键病机以气虚、血瘀、水饮为主,随时间推移中医核心病机并未发生改变。Objective This study retrospectively analyzed the incidence,clinical characteristics,and evolution of traditional Chinese medicine(TCM)syndrome patterns in patients with heart failure with preserved ejection fraction(HFpEF)over the past 20 years.Methods Patients discharged from the cardiovascular department of Xiyuan Hospital,China Academy of Chinese Medical Sciences,during the peak period of cardiovascular diseases(October to December)in 2003,2013,and 2023 were selected.The method of chi-square tests,univariate ANOVA,and Brown-Forsythe ANOVA were used to compare the basic characteristics,comorbidities,medication usage,echocardiographic parameters,and distribution of TCM syndromes among HFpEF patients in these three years.Results(1)The absolute number of HFpEF patients and their proportion within the heart failure population have shown an increasing trend over time.(2)There has been a significant increase in the age of HFpEF patients over time;the left atrial diameter(LAD)and left ventricular posterior wall thickness(LVPW)have also shown significant increase.Over the past 20 years,the comorbidity burden among patients with HFpEF had increased.The primary underlying diseases had consistently been hypertension,coronary artery disease,atrial fibrillation,and diabetes.Additionally,the number and proportion of patients with metabolic diseases such as hyperlipidemia and hyperuricemia had also risen.With the development of new drugs and the promotion of guidelines,there has been a growing trend in the long-term oral use of ACE inhibitors/ARBs/ARNIs and beta-blockers,while the use of cardiotonic drugs has declined.(3)The pattern distribution of TCM syndromes indicated that qi deficiency,blood stasis,and fluid retention were the main syndromes in HFpEF patients.Conclusion Over time,the incidence and severity of HFpEF have increased,associated with an aging population,a higher prevalence of comorbidities,and,in particular,an increase trend in metabolic diseases.The key TCM pathomechanisms in HFpEF,characterized by qi defic

关 键 词：射血分数保留的心力衰竭 发病规律 临床特征 合并疾病 用药情况 中医证候 人口老龄化 代谢性疾病 

分 类 号：R259[医药卫生—中西医结合]