1973—2023年慢性心力衰竭中医证候特征演变规律文献研究  

Literature Study on the Evolution of TCM Syndrome Characteristics of Chronic Heart Failure From 1973 to 2023

作　　者：张赤道 王永霞[1,2] 朱明军[1] 邢作英[1] 邱伯雍 王新陆[1] 于瑞[1] ZHANG Chidao;WANG Yongxia;ZHU Mingjun;XING Zuoying;QIU Boyong;WANG Xinlu;YU Rui(Heart Center of the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China;Henan University of Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学第一附属医院心脏中心,郑州450000 [2]河南中医药大学,郑州450000

出　　处：《世界科学技术-中医药现代化》2025年第1期121-131,共11页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：国家自然科学基金委员会面上项目(82074229):以临床解码通路为导向的通脉养心丸干预心梗后心脏重构的作用机制研究,负责人:王永霞;河南省卫生健康委国家中医临床研究基地科研重点专项(KY-B0357-002):通过回顾性和前瞻性临床研究探讨心力衰竭中医证候特征和演变规律,负责人:王永霞。

摘　　要：目的通过文献挖掘1973-2023年慢性心力衰竭中医证候,总结其中医证候特征演变规律。方法检索1973年1月1日-2023年10月1日中国知网等3个数据库中有关慢性心力衰竭中医证候临床研究的相关文献,使用SPSS 21.0和Rstudio软件对最终纳入文献的中医证候类型和证候要素分布特征进行描述性统计分析、关联规则分析和聚类分析。结果最终纳入218篇文献,包括41604例患者,覆盖全国29个省、市、自治区,其中179篇文献明确报道中医复合证型,共包含31123例患者,常见中医证候类型主要包括气虚血瘀证等;累计提取证候要素71996例次,常见病性证候要素主要包括气虚、血瘀、痰浊等;病位证候要素主要包括心、肝、脾等。不同时期中医证候特征呈现一定演变规律,1973-2023年间,气虚血瘀证、痰瘀互阻证占比呈上升趋势;单纯虚证总体占比1994-2003年较1973-1993年升高,但在2004-2023年均降低,且低于1973-1993年;阳虚水泛证占比呈下降趋势;不同地区证候类型整体由单纯虚证转变为虚实夹杂证,如频数占比最高的华北地区由心肺气虚证转变为气虚血瘀证等;关联规则分析及聚类分析结果显示,各时间段证候要素均存在气虚、血瘀、痰浊、水饮组合,但各个时期兼夹不同,存在一定差异。近年来,慢性心力衰竭病位证候要素心、肝、脾占比总体呈上升趋势,本虚病性证候要素占比总体呈下降趋势,标实病性证候要素占比总体呈上升趋势。结论慢性心力衰竭证候特征总属本虚标实之证,“虚气留滞”为其核心病机,病位主要为心、肝、脾,以气虚、痰浊、血瘀、水饮为主要构成的证候要素逐渐占据主导地位,未来慢性心力衰竭中医证候类型可能呈现“虚痰瘀水”兼夹趋势。Objective To excavate the TCM syndrome of chronic heart failure from 1973 to 2023 and summarize the evolution of the characteristics of medical syndrome.Methods The relevant literature on clinical research on TCM syndromes in three databases including CNKI from January 1,1973 to October 1,2023 was searched,and SPSS 21.0 and Rstudio software were used to conduct descriptive statistical analysis,association rule analysis,and cluster analysis on the distribution characteristics of TCM syndrome types and pattern elements in the final literature.Results A total of 218 literatures,including 41604 patients,covering 29 provinces,municipalities and autonomous regions across the country,were included,of which 179 articles explicitly reported the TCM composite syndrome type,including 31123 patients.A total of 71996 pattern elements were extracted,and the common elements included qi deficiency,blood stasis,phlegm turbidity,etc.The main location of the disease include heart,liver,spleen,etc.The characteristics of TCM syndromes in different regions and different periods show certain evolution rules,from 1973 to 2023,the proportion of qi deficiency and blood stasis pattern and phlegm and stasis mutual obstruction pattern showed an upward trend.The proportion of simple false evidence increased from 1994 to 2003 compared with 1973 to 1993,but decreased from 2004 to 2023,and was lower than that from 1973 to 1993.The proportion of yang deficiency water pan syndrome showed a downward trend;The evolution of syndromes in different regions has changed from deficiency to deficiency and real mixed syndrome,for example,North China,which has the highest proportion,has changed from cardiopulmonary qi deficiency to qi deficiency and blood stasis.In recent years,the proportion of heart,liver and spleen in the chronic heart failure syndrome pattern showed an overall upward trend,the proportion of the syndrome elements of the deficiency syndrome showed a downward trend,and the proportion of the syndrome elements of the standard disease syndrome

关 键 词：慢性心力衰竭 中医证候 证候要素 虚气留滞 演变规律 

分 类 号：R-058[医药卫生]