基于横断面研究探究肺动脉高压患者中医证候与临床指标的相关性  

Analysis of TCM Syndrome Distribution Characteristics of Pulmonary Hypertension Based on Cross-Sectional Clinical Investigation

作　　者：董政委 赵换 张健 何庆勇[4] 樊官伟[5,6] DONG Zhengwei;ZHAO Huan;ZHANG Jian;HE Qingyong;FAN Guanwei(The First Affiliated Hospital of Henan University of Chinese Medicine,Heart Center/National Regional(Traditional Chinese Medicine)Cardiovascular Diagnosis and Treatment Center,Zhengzhou 450000,China;Tianjin University of Traditional Chinese Medicine,College of Chinese Medicine,Tianjin 301617,China;Shanghai Key Laboratory of New Drug Design,School of Pharmacy,East China University of Science&Technology,Shanghai 200237,China;Guang’an Men Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China;The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin Key Laboratory of Traditional Chinese Medicine Prescription and Syndrome Transformation,Tianjin 300193,China)

机构地区：[1]河南中医药大学第一附属医院心脏中心/国家区域(中医)心血管诊疗中心,郑州450000 [2]天津中医药大学中药学院,天津301617 [3]华东理工大学药学院上海市新药设计重点实验室,上海200237 [4]中国中医科学院广安门医院,北京100053 [5]天津中医药大学,天津301617 [6]天津中医药大学第一附属医院天津市中医方证转化研究重点实验室,天津300193

出　　处：《世界科学技术-中医药现代化》2024年第8期2009-2015,共7页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：河南省自然科学基金青年科学基金项目(242300421526):丹参酮IIA靶向结合DYRK1A介导PKA/TFAM通路抗肺动脉高压血管重塑的机制研究,负责人:董政委。

摘　　要：目的通过收集肺动脉高压(Pulmonary hypertension,PH)患者的中医临床证候学资料,明确PH优势证候及与临床指标的相关性,为中医药临床辨证施治提供依据。方法采用横断面的研究方法,收集2020年1月-2021年7月中国中医科学院广安门医院心血管病房符合PH诊断患者,共收集298例患者资料,排除数据不全、重复住院等因素,纳入236例患者,对患者临床资料进行整理、分析和统计,得出PH的证候、证型分布规律,并探究证候与血流动力学、心功能、凝血功能之间的相关性。结果本研究PH临床常见8个证候高到低排列依次为血瘀证>气虚证>水停证>痰浊证>血虚证>阳虚证>阴虚证>气滞证;8个证型高到低排列依次为气虚血瘀证>脾肺两虚证>瘀水互结证>痰水互结证>痰瘀互结证>阳虚水停证>痰浊阻肺证>气阴两虚证;气虚证与肺动脉收缩压(Systolic pulmonary artery pressure,SPAP)负相关,水停证与SPAP正相关;气虚证与心功能分级负相关,水停证和痰浊证与心功能分级正相关。结论血瘀是PH的核心病机,PH患者临床表现及证候逐渐由气虚经血瘀转化为以实证为主的痰饮、水停,因虚致实,“瘀”贯穿疾病全程并对PH的进展产生了重要的影响。Objective To clarify the predominant symptoms of PH and their correlation with clinical indicators by collecting Chinese medicine clinical syndromic data of patients with pulmonary hypertension(PH).To provide a basis for the clinical diagnosis and treatment of Chinese medicine.Methods Adopting a cross-sectional study method,from January 2020 to July 2021,the cardiovascular ward of Guang′an men Hospital of the China Academy of Traditional Chinese Medicine was in line with the patients with the diagnosis of PH.A total of 298 patients′data were collected,and 236 patients were included in this study by excluding factors such as incomplete data and repeated hospitalization.The clinical data of the patients were organized,analyzed and counted.The distribution pattern of symptoms and syndrome types of PH was derived,and the correlation between syndrome elements and hemodynamics,cardiac function,and coagulation function was explored.Results The eight syndrome elements of PH in this study were,in descending order,blood stasis>Qi deficiency>water stagnation>phlegm turbidity>blood deficiency>yang deficiency>yin deficiency>qi stagnation;The eight syndrome types were in the order of high to low:Qi deficiency and blood stasis,spleen and lung deficiency,blood stasis and water stagnation,phlegm and water stagnation,phlegm and blood stasis stagnation,phlegm and water stagnation,yang deficiency and water stagnation,phlegm and turbid obstruction of lungs,and deficiency of both qi and yin;Qi deficiency was negatively correlated with Systolic pulmonary artery pressure(SPAP),and water stagnation was positively correlated with SPAP;Qi deficiency was negatively correlated with cardiac function grading,and water stagnation and phlegm turbidity evidence were positively correlated with cardiac function grading.Conclusion Blood stasis is the core pathogenesis of PH,and the clinical manifestations and symptoms of PH patients gradually transformed from qi deficiency through blood stasis to phlegm turbidity and water stagnation."Stasis"is

关 键 词：横断面研究 肺动脉高压 中医证候学 证候分布特点 

分 类 号：R544.16[医药卫生—心血管疾病]