心脾同治法治疗射血分数改善型心力衰竭的回顾性研究  

Retrospective study of heart and spleen combined therapy in treatment of heart failure with improved ejection fraction

作　　者：孔京晶 刘攀 戴小华[3] KONG Jingjing;LIU Pan;DAI Xiaohua(The First Clinical School of Medicine,Anhui University of Chinese Medicine,Hefei 230031,China;School ofChinese Medicine,Anhui University of Chinese Medicine,Hefei 230031,China;The First Affiliated Hospital ofAnhui University ofChinese Medicine,Hefei 230031,China)

机构地区：[1]安徽中医药大学第一临床医学院,合肥230031 [2]安徽中医药大学中医学院,合肥230031 [3]安徽中医药大学第一附属医院,合肥230031

出　　处：《中华中医药杂志》2024年第10期5596-5601,共6页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家重点研发计划(No.2017YFC1700306);安徽省中医药传承创新科研项目(No.2022CCZD02)。

摘　　要：目的:观察心脾同治法治疗射血分数改善型心力衰竭(HFimpEF)的临床疗效,并回顾HFimpEF中医证型特点,分析1年内再住院危险因素。方法:收集HFimpEF患者的病例资料,依据患者住院期间口服心脾同治中药情况(≥10 d)分为中药组235例,对照组213例,统计并分析两组中医证候、NYHA心功能分级、B型钠尿肽(BNP)、心脏彩超相关指标、体重及1年内再住院率的差异,Logistic回归分析探索影响1年内再住院的危险因素。结果:最终纳入448例病例,1年内发生再住院事件142例,中医证型前3名:痰浊闭阻证(29.9%)、气阴两虚证(16.5%)、气虚血瘀证(16.1%)。影响HFimpEF再住院的因素是中药治疗(OR=0.447)、高尿酸血症(OR=1.800)、血脂异常(OR=1.918)、2型糖尿病(OR=1.881)、脑卒中(OR=2.395);心脾同治中药治疗效果:与对照组比较,中药组NYHA心功能分级明显改善,BNP、1年内再住院率显著降低(P<0.01),左室射血分数(LVEF)显著提高(P<0.05)。结论:HFimpEF证型主要是痰浊闭阻证;心脾同治中药治疗可降低HFimpEF患者再住院风险、明显改善患者心功能、显著降低BNP、提高LVEF;有高尿酸血症、血脂异常、2型糖尿病、脑卒中病史会增加HFimpEF患者再住院风险。Objective:To evaluate the clinical efficacy of heart and spleen combined therapy in treatment of heart failure with improved ejection fraction(HFimpEF),to review the characteristics of traditional Chinese medicine(TCM)syndromes in HFimpEF,and to analyze the risk factors for rehospitalization within one year.Methods:Case data of HFimpEF patients were collected,and based on oral administration of the heart and spleen treatment TCM formula for≥10 days during hospitalization,patients were divided into a TCM group(235 cases)and a control group(213 cases).The differences in TCM syndromes,NYHA cardiac function classification,brain natriuretic peptide(BNP),echocardiography parameters,weight,and the rate of rehospitalization within one year were statistically analyzed.Logistic regression was used to explore the risk factors for rehospitalization within one year.Results:A total of 448 cases were included,with 142 rehospitalization events within one year.The top three TCM syndromes were phlegm turbidity obstruction syndrome(29.9%),qi and yin deficiency syndrome(16.5%),and qi deficiency and blood stasis syndrome(16.1%).Factors affecting rehospitalization in HFimpEF included TCM treatment(OR=0.447),hyperuricemia(OR=1.800),dyslipidemia(OR=1.918),type 2 diabetes(OR=1.881),and stroke(OR=2.395).The effects of the heart and spleen treatment TCM formula:Compared to the control group,the TCM group showed significant improvements in NYHA cardiac function classification,a significant reduction in BNP and the rate of rehospitalization within one year(P<0.01),and an increase in left ventricular ejection fraction(LVEF)(P<0.05).Conclusion:The main TCM syndrome in HFimpEF is phlegm turbidity obstruction syndrome.Heart-spleen combined treatment with TCM can reduce the risk of re hospitalization in HFimpEF patients,significantly improve the cardiac function,significantly reduce BNP,and increase LVEF.A history of hyperuricemia,dyslipidemia,type 2 diabetes,and stroke increases the risk of re-hospitalization in HFimpEF patients.

关 键 词：射血分数改善型心力衰竭 左室射血分数 心脾同治法 回归分析 倾向性匹配 

分 类 号：R259[医药卫生—中西医结合]