慢性心衰患者证型及舌象分布特点与心功能分级的相关性研究

Correlation between distribution features of syndrome types and tongue manifestations and cardiac functional grading in patients with chronic heart failure

目的研究慢性心力衰竭患者不同心功能分级的中医证型类型及其舌象分布特点。方法通过多中心临床流行病学调查,收集612例慢性心力衰竭患者的临床资料,对不同心功能分级患者的中医证型类型及舌象数据进行描述性统计分析并探讨其分布规律。结果慢性心力衰竭心功能Ⅱ级患者证型以气虚血瘀证(27.6%)出现频率最多,舌象以淡红舌(21.2%)、红舌(21.2%)、薄白苔(78.2%)、舌下络脉淡紫色(27.6%)为主;慢性心力衰竭心功能Ⅲ级患者证型以气虚血瘀证(17.5%)居多,舌象以暗红舌(27.8%)、薄白苔(78.2%)、舌下络脉青紫(26.3%)为多见;慢性心力衰竭心功能Ⅳ级患者证型以阳虚水泛夹痰瘀互阻证(17.6%)为多,舌象以暗红舌(25.7%)、白苔稍厚(35.3%)、舌下络脉青紫(40.4%)最为常见。结论随着心功能分级的增加,心力衰竭患者的证型呈现由以气虚血瘀证为主逐渐向以阳虚水泛夹痰瘀互阻证为主转化的趋势,舌色由淡红逐渐向暗红转变,苔质由薄苔逐渐向稍厚苔转变,舌下络脉颜色由淡紫向青紫转变,提示随着慢性心力衰竭患者心功能恶化,患者血瘀程度逐渐加重,舌象逐渐趋于异常或体现出气虚血瘀、虚实夹杂的本质。

Objective To study the distributions features of TCM syndrome types and tongue manifestations in patients with chronic heart failure （CHF） with different cardiac functional grades. Methods The clinical materials were collected from 612 CHF patients through the survey of multiple center clinical epidemiology. The types of TCM syndrome and data of tongue manifestations were given descriptive and statistical analysis, and the distribution laws were studied in the patients with different cardiac functional grades. Results In CHF patients with cardiac functional grade Ⅱ , the most common syndrome type was syndrome of qi deficiency and blood stasis （27.6%）, and tongue manifestations showed as pink tongue （21.2%）, red tongue （21.2%）, thin and white tongue fur （78.2%） and lavender sublingual collateral vessels （27.6%）. In CHF patients with cardiac functional grade Ⅲ, the most common syndrome type was syndrome of qi deficiency and blood stasis （ 17.5% ）, and tongue manifestations showed as dark red tongue （27.8%）, thin and white tongue fur （78.2%） and blue sublingual collateral vessels （26.3%）. In CHF patients with cardiac functional grade Ⅳ, the most common syndrome type was syndrome of yang deficiency with water flood combining syndrome of phlegm accumulating with stasis, and tongue manifestations showed as dark red tongue （25.7%）, slightly thick and white tongue fur （35. 3% ） and blue sublingual collateral vessels （40. 4% ）. Conclusion The syndrome types have a tendency transforming gradually from syndrome of qi deficiency and blood stasis to syndrome of yang deficiency with water flood combining syndrome of phlegm accumulating with stasis as the increase of cardiac functional grades. The color of tongue transforms from pink to dark red, tongue fur, from thin to slightly thick, and color of sublingual collateral vessels, from lavender to blue. The study results indicate that the degree of blood stasis is aggravating as the deterioration of cardiac function in CHF patients. The tongue manifestations trend to become abnormal or reflect the nature of qi deficiency and blood stasis, and deficiency complicated with excessiveness.