慢性心力衰竭利尿剂抵抗与中医证候积分的相关性分析  

Correlation Analysis between Diuretic Resistance and Traditional Chinese Medicine Syndrome Score in Patients with Chronic Heart Failure

作　　者：杨娅鸿 李萍[1,2] 郑亮 谢娟[1] 黄栗锋[3] 朱雨婷 贺桢 YANG Yahong;LI Ping;ZHENG Liang;XIE Juan;HUANG Lifeng;ZHU Yuting;HE Zhen(School of Public Health and Wellness,Guizhou Medical University,Guiyang 561113,Guizhou,China;Shanghai Pudong New Area Guangming Hospital of Traditional Chinese Medicine,Shanghai 201200,China;School of Medicine,Tongji University,Shanghai 200090,China)

机构地区：[1]贵州医科大学公共卫生与健康学院,贵州贵阳561113 [2]上海市浦东新区光明中医医院,上海201200 [3]同济大学医学院,上海200090

出　　处：《中华中医药学刊》2025年第2期182-186,I0036,共6页Chinese Archives of Traditional Chinese Medicine

基　　金：国家中医药管理局名老中医传承工作室建设项目(2014-398);上海市浦东新区科技与经济委员会医疗卫生项目(PKJ2022-Y65);上海市浦东新区卫生健康委员会联合攻关项目(PW2020D-3)。

摘　　要：目的探讨慢性心力衰竭(慢性心衰)利尿剂抵抗发生与中医证候积分的相关性,为预防慢性心衰利尿剂抵抗的出现及诊疗提供参考依据。方法回顾性收集2020—2022年样本医院住院患者资料,将患者分为发生利尿剂抵抗组(154例)和未发生利尿剂抵抗组(265例),应用χ^(2)检验、t检验比较两组一般资料,采用Logistic回归和Lasso回归分析中医证候积分与利尿剂抵抗发生的相关性。结果2020—2022年样本医院慢性心力衰竭住院患者共756例,符合入组病例419例,其中发生利尿剂抵抗154例,未发生利尿剂抵抗265例,两组均使用中西医标准治疗。两组患者在年龄、性别、心功能分级和合并疾病的差异均无统计学意义(P>0.05),两组具有可比性。发生利尿剂抵抗组的入院总积分(17.43±4.19)显著高于未发生利尿剂抵抗组的积分(15.80±5.10),Logistic回归模型比较显示患者入院时喘促积分(OR:1.359,95%CI:1.109~1.666)、胸闷心悸积分(OR:1.33395%CI:1.092~1.628)、尿少肢肿积分(OR:1.245,95%CI:1.105~1.404)是利尿剂抵抗发生的危险因素。Lasso回归显示喘促积分和尿少肢肿积分与利尿剂抵抗关联性较强。结论慢性心衰利尿剂抵抗与中医证候积分具有相关性,入院时应及时关注患者症状和准确评估中医证候积分。Objective The correlation between the occurrence of diuretic resistance in chronic heart failure and traditional Chinese medicine(TCM)syndrome score was explored and the prevention of diuretic resistance in chronic heart failure and the reference basis for diagnosis and treatment were provided.Methods The data of hospitalized patients from 2020 to 2022 was collected and stratified into two cohorts:those with diuretic resistance(154 cases)and those without diuretic resistance(265 cases).Chi-square test and T-test were employed to compare the general data between the two groups.Logistic regression and Lasso regression were utilized to investigate the correlation between TCM syndrome score and diuretic resistance.Result From 2020 to 2022,a total of 756 inpatients diagnosed with chronic heart failure were enrolled from sample hospitals.Among them,419 patients met the inclusion criteria,including 154 cases with diuretic resistance and 265 cases without diuretic resistance.Both groups received standard treatment consisting of traditional Chinese and Western medicine.There were no significant differences between the two groups in age,sex,cardiac function grade or combined diseases(P>0.05)and the two groups were comparable.The total admission score of the diuretic resistance group[(17.43±4.19)point]was significantly higher than that of the non-diuretic resistance group[(15.80±5.10)point].Logistic regression model comparison showed that the scores of dyspnea(OR:1.359,95%CI:1.109~1.666),chest tightness and palpitation(OR:1.333,95%CI:1.092~1.628)and hypuria and limb swelling(OR:1.245,95%CI:1.105~1.404)at admission was a risk factor for diuretic resistance when the patient was admitted.Lasso regression showed that the scores of dyspnea and hypuria and limb swelling were strongly correlated with diuretic resistance.Conclusion There is a correlation between diuretic resistance and TCM syndrome score in chronic heart failure.Patients'symptoms should be paid attention to and TCM syndrome score should be accurately evaluated wh

关 键 词：慢性心力衰竭 利尿剂抵抗 中医证候积分 LOGISTIC回归 Lasso回归 

分 类 号：R256.2[医药卫生—中医内科学]