慢性心力衰竭气虚血瘀证潜在亚组人群特征探索研究  

Exploratory study on characteristics of potential subgroups in patients with chronic heart failure of qi deficiency and blood stasis syndrome

作　　者：杨帅[1] 凌艺月 贾志山 李小茜[1] 何建成[1] 姚磊[2] 曹雪滨 YANG Shuai;LING Yiyue;JIA Zhishan;LI Xiaoqian;HE Jiancheng;YAO Lei;CAO Xuebin(Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;The Hospital of 82nd Group Army PLA,Baoding,Hebei 071000,China)

机构地区：[1]上海中医药大学,上海201203 [2]上海中医药大学附属岳阳中西医结合医院,上海200437 [3]陆军第八十二集团军医院,河北保定071000

出　　处：《上海中医药杂志》2024年第11期21-27,共7页Shanghai Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81803996);教育部“气血理论”医药基础研究创新中心项目(2023YZZ02);上海市卫健委临床科研项目(202240212);上海市科委科技计划项目(21DZ2271000)。

摘　　要：目的探索慢性心力衰竭(CHF)气虚血瘀证潜在亚组人群,为心力衰竭的中医精准辨治提供客观依据。方法收集126例CHF气虚血瘀证患者的19种症状/体征指标和21种生化指标,利用R和Python软件进行K-mediods聚类算法分析,以轮廓系数确定最佳的聚类数目。组间比较,连续变量采用Kruskal-Wallis检验,分类变量采用Pearson's chi-squared检验或者Fisher's exact检验。结果CHF气虚血瘀证患者被聚类为3组,组间比较发现,气喘、不寐、颈脉怒张、纳差、畏寒5个症状/体征以及NYHA分级、氨基末端脑钠肽前体(NT-proBNP)、红细胞比容、尿素氮4个临床指标差异具有统计学意义(P<0.05)。第1组人群整体各症状/体征发生频率和临床指标严重程度相对较低;第2组人群以颈脉怒张发生频率较其他组高为特征,且促甲状腺激素、总胆固醇及低密度脂蛋白有偏高趋势,血小板有偏低的趋势;第3组人群以畏寒、纳差、不寐的发生率较其他组显著升高为特征,伴随尿素氮增高、红细胞比容降低。结论CHF气虚血瘀证潜在3种亚型,分别是气虚血瘀证本证型、气虚血瘀兼痰浊型、气虚血瘀兼阳虚型。Objective To explore potential subgroups among patients with chronic heart failure(CHF)of qi deficiency and blood stasis syndrome,providing an objective basis for precise traditional Chinese medicine(TCM)diagnosis and treatment of heart failure.Methods Nineteen symptoms/signs and 21 biochemical indicators were collected from 126 patients with CHF of qi deficiency and blood stasis syndrome.The K-medoids clustering algorithm was applied using R and Python software,and the optimal number of clusters was determined via the silhouette coefficient.For intergroup comparisons,continuous variables were analyzed using the Kruskal-Wallis test,and categorical variables were analyzed using Pearson's chi-squared test or Fisher's exact test.Results Patients with CHF of qi deficiency and blood stasis syndrome were clustered into three groups.Intergroup comparisons revealed that five symptoms/signs(shortness of breath,insomnia,jugular vein distention,poor appetite,and aversion to cold)and four clinical indicators(NYHA classification,NT-proBNP,hematocrit,and blood urea nitrogen)showed statistical significance(P<0.05).Group 1 had relatively lower frequencies of symptoms/signs and less severe clinical indicators.Group 2 was characterized by a higher frequency of jugular vein distention compared to other groups,with tendencies toward elevated thyroid-stimulating hormone,total cholesterol,low-density lipoprotein,and decreased platelet counts.Group 3 exhibited significantly higher incidences of aversion to cold,poor appetite,and insomnia,accompanied by increased blood urea nitrogen and decreased hematocrit.Conclusion Three potential subtypes of qi deficiency and blood stasis syndrome in CHF patients have been identified:pure qi deficiency and blood stasis syndrome type,qi deficiency and blood stasis combined with phlegm-dampness type,and qi deficiency and blood stasis combined with yang deficiency type.

关 键 词：慢性心力衰竭 气虚血瘀证 痰浊 阳虚 聚类算法 数据挖掘 辨证论治 

分 类 号：R259[医药卫生—中西医结合]