心力衰竭住院患者中医证候特征与左室功能的关系研究

Research of the Syndrome Features of TCM in Congestive Heart Failure Inpatients and a Relationship with Left Ventricular Function

目的:了解心力衰竭住院患者中医证候分布规律及其与左室功能的关系。方法:调查2006年1月1日-2006年12月31日北京地区的3所三级甲等中医院心力衰竭(CHF)住院患者。建立临床调查表(CRF)及ACCESS数据库;组织课题研究人员进行填表培训,经一致性检验通过,查阅病历填写CRF,应用SPSS统计软件进行数据分析。结果:共收集有效病例155例,证素分布规律研究显示,CHF患者中证素出现频率较高的前4位依次为气虚证、血瘀证、痰阻证、阴虚证,其中气虚证出现在82.5%的CHF患者中。临床实际证型分布规律研究显示,155例CHF患者中共出现63种证型,其中只出现一次的有47种证型,而出现频次超过10次的仅有4种证型,重复率均较低。分类证型分布规律特征研究显示:心衰患者以虚实夹杂居多。从水饮证、气虚证、血虚证、血瘀证、阴虚证、痰阻证、阳虚证到气滞证,LVEF值呈现依次升高的趋势;从水饮证、气滞证、气虚证、阳虚证、痰阻证、血瘀证、阴虚证到血虚证,LVDd呈现依次减小的趋势,水饮证和气虚证在LVEF和LVDd都列于左室功能较差的位置。按分类证型研究,有气虚证与无气虚证相比,LVDd更大、LVEF更小,有水饮证与无水饮证相比,LVDd更大、LVEF更小。研究显示临床实际证型复杂多样,分布趋于分散,缺乏规律性。结论:CHF常见证素依次为气虚证、血瘀证、痰阻证、阴虚证;分类证型以虚实夹杂居多;临床实际证型缺乏规律性。中医证候与左室功能存在一定的相关性,气虚证与水饮证是反映左室功能下降的重要证素。中医证候诊断亟待规范化。

Objective：To investigate the rule of Congestive Heart Failure（CHF）inpatient syndrome distribution of Traditional Chinese Medicine（TCM）and its relationship with left ventricular function.Methods：To make a retrospective study on the patient who were in 3 TCM hospitals in Beijing from January 1st 2006 throghout December 31 2006,using the uniform questionary and ACCESS database.Until consistency test had passed after the training of research staff filling forms,they were not access to medical records fill in CRF.SPSS statistical software is for data analysis.Results：Valid cases were collected for 155 cases,the Securities prime distribution studies have shown that,CHF patients with a higher frequency permits the former prime 4 followed by qi deficiency,blood stasis,Phlegm Obstruction,Yin deficiency,Qi deficiency of which appears in the 82.5 % of CHF patients.The actual distribution of clinical syndromes study shows that 155 cases of CHF occurred in patients with 63 kinds of TCM Syndrome types,which only occur once there are 47 kinds of syndrome types,but there more than 10 times the frequency of only four kinds of syndrome type,the repetition rate is low.Category distribution of characteristics of syndromes study show that deficiency complicated with excess can be seen on many occasions.In the aspect of relativity in left ventricular function,classify the total cases into 8 Syndrome Factor groups,Fluid Retention〉Qi Deficiency〉Blood Deficiency〉Blood Stasis〉Yin Deficiency〉Phlegm Obstruction〉Yang Deficiency〉 Qi stagnation in LVEF.But Fluid Retention〉Qi stagnation 〉Qi Deficiency〉Yang Deficiency〉Phlegm Obstruction 〉Blood Stasis〉Yin deficiency 〉Blood Deficiency in LVDd.Qi Deficiency and Fluid Retention are in the position of lower left ventricular function in LVEF and LVDd.Devide the total cases into two group,Qi Deficiency syndrome and Non-Qi-Deficiency syndrome.LVEF level is lower and LVDd is higher in the one Qi Deficiency syndrome group than in Non-Qi-Deficiency syndrome group.LVEF level is lower and LVDd is higher in the one Fluid Retention syndrome group than in Non-Fluid-Retention syndrome group.Clinical studies have shown that the actual syndrome-types are complex and diverse,lack of regularity,the distribution tends to spread.Conclusion：The first four Syndrome factors among CHF patients are Qi Deficiency,Blood Stasis,Phlegm Obstruction,Yin Deficiency.And deficiency complicated with excess can be seen on many occasions.The Clinical practice Syndromes are lack of regularity.TCM Syndromes are correlated with left ventricular function in a certain extent.3.Qi Deficiency and Fluid Retention are important Syndrome Factors as a reflection of cardiac insufficienc.The standardization of the clinical TCM syndrome diagnosis should be strengthen urgently.