慢性心力衰竭中医证型与其合并症的相关性研究

A Correlation Research on Chinese Medical Syndromes of Chronic Heart Failure and Various Complications

目的利用Logistic回归方法研究临床慢性心力衰竭(chronic heart failure,CHF)患者中医证型及其合并症的相关关系,从而揭示CHF及其合并症的中医证型分布规律。方法通过临床横断面调查研究630例CHF患者的人口学资料、现病史、中医四诊相关信息及其合并症分布情况,对CHF患者进行中医辨证,采用逻辑回归的方法对结果进行分析。结果本研究纳入的CHF患者中常见合并症依次为高血压病、心律失常、糖尿病、脑血管意外、高血脂等;主要中医证型依次为气虚证、血瘀证、水停证、阴虚证、痰浊证、阳虚证等。经Logistic回归分析后显示,CHF常见合并症与中医证型分布有一定的相关性。CHF合并高血压患者中,回归模型显示气虚证、阳虚证与合并高血压病呈显著负相关(P<0.05);在CHF合并糖尿病患者中,回归模型显示水停证、痰浊证与合并糖尿病呈显著正相关(P<0.05);在CHF合并心律不齐患者中,各证型分布差异无统计学意义;在CHF合并高血脂患者中,回归模型显示气虚证、水停证与合并高血脂症呈显著负相关(P<0.05),而血瘀证、阴虚证和痰浊证与合并高脂血症呈显著正相关(P<0.01);在CHF合并脑血管意外患者中,回归模型显示气虚证、阳虚证与合并脑血管意外呈显著负相关(P<0.01,P<0.05)。结论 CHF主要中医证型分布与其合并症有一定的关联规律,对应用中医药治疗CHF及其合并症具有一定指导意义。

Objective To study the correlation between various complications of chronic heart failure （CHF） patients and Chinese medical syndromes, thus indicating distribution laws of Chinese med- ical syndromes in various complications of CHF patients. Methods Chinese medical syndrome typing was performed in 630 CHF patients by cross-sectional study of the demographic data, history of present diseases, related information on Chinese medical four diagnostic methods, and the distribution of compli- cations.Logistic regression analysis was used to determine the correlation of various complications of CHF patients and Chinese medical syndromes. Results In this study, recruited were common complica- tions such as hypertension, diabetes, arrhythmia, hyperlipemia, and cerebral vascular accident, and so on. Main syndromes were sequenced as qi deficiency syndrome, blood stasis syndrome, water retention syndrome, yin deficiency syndrome, phlegm turbid syndrome, yang deficiency syndrome. Results of Lo- gistic regression analysis indicated that correlation existed between common complications and Chinese medical syndromes. In CHF complicated hypertension patients, Logistic regression analysis showed qideficiency syndrome and yang deficiency syndrome were negatively correlated with hypertension （P 〈 0.05）. In CHF complicated diabetes patients, Logistic regression analysis showed phlegm turbid syn- drome and water retention syndrome were positively correlated with diabetes （P 〈0, 05）. In CHF compli- cated arrhythmia patients, there was no statistical difference in the distribution of each syndrome （P 〉 0.05）. In CHF complicated hyperlipemia patients, Logistic regression analysis showed qi deficiency syn- drome and water retention syndrome were negatively correlated with hyperlipemia （P 〈0.05）, while blood stasis syndrome, yin deficiency syndrome, and phlegm turbid syndrome were positively correlated with hyperlipemia （P 〈0.01 ）. In CHF complicated cerebral vascular accident patients, Logistic regression analysis showed qi deficiency syndrome and yang deficiency syndrome were negatively correlated with cerebral vascular accident （P 〈 0.01, P 〈 0.05）. Conclusions There existed certain correlations be- tween complications of CHF and the distribution of main Chinese medical syndromes. It could be used as guidance for treating CHF and its various complications by Chinese medicine and pharmacy.