中西医对射血分数保留心力衰竭(HFpEF)研究简况

Overview of Chinese Medicine and Western Medicine on Heart Dailure with Preserved Ejection Fraction(HFpEF)

左心室射血分数保留的心力衰竭（Heart failure with preserved ejection fraction,HFpEF）是指临床具有心力衰竭（Heart Failure,HF）症状或体征,且左心室射血分数（LVEF）≥50%的一种综合征,是射血分数保留的心血管疾病患者的共同终末归路,西医诊断标准可简单归纳为＂1＋1＋1＂诊断模式,常见于老年患者,女性多见,且大多有高血压病、糖尿病、冠心病、房颤等基础病,因此这类疾患常成为搭往HFpEF的桥梁。根据HFpEF临床表现,可将其归属于＂心悸＂＂、怔忡＂＂、水肿＂＂、胸痹＂等范畴,任继学最早用＂心衰＂来命名,张伯礼、薛博瑜首次将＂心衰病＂作为一种独立的病证加入心系疾病中;以心气虚为始动因素,多见于气阴两虚,并常兼见瘀血、水饮和痰浊等,心功能多处于Ⅰ~Ⅲ级,多见于潜证、轻度和中度心衰病。西医无特异性手段,对症治疗为主;中医按心气虚、气阴两虚等治疗,生脉散、炙甘草汤等。中西医的治疗目标已不仅仅满足于改善症状,提高生活质量,而是从心脏的结构、功能、细胞生物学等更深层次进行治疗。心室重构是潜证心衰病的内在因素,与瘀血密切相关,且阴虚灼伤阴液可致瘀、阴虚无气而无力推动血液在脉管中正常运行,治疗要以益气养阴为主,佐以活血化瘀、化痰祛湿,从改善衰竭心脏病理变化的角度来寻求一个更具有修复性的长远策略。

Heart failure with preserved ejection fraction （ HFpEF ） is a clinical heart failure symptom with a syndrome of left ventricular ejection fraction （ LVEF ） ≥ 50%, which is a common terminal destination of patients with cardiovascular disease. The diagnostic criteria of Western medicine can be simply summarized as ＂1＋1＋1＂ diagnosis mode. Because this disease is widely found in elderly patients, especially more common in women, and most of the patients have basic disease such as hypertension, diabetes, coronary heart disease, atrial fibrillation etc, this kind of disease could become a bridge to HFpEF. According to the clinical manifestations of HFpEF, it can be attributed to ＂cardiopalmus＂, ＂palpitation＂, ＂edema＂, ＂thoracic obstruction＂ etc. HFpEF was first named as ＂heart failure＂ by Ren Jixue, and then Zhang Boll and Xue Boyu take ＂heart failure＂ as an independent disease in heart-system disease for the first time. The primary factor is insufficiency of the Xin Qi, and deficiency of both Xin Qi and Xin Yin become more common, with blood stasis, retained fluid and phlegm etc. Those heart function in grade Ⅰ -Ⅲ, and more common in the latent syndrome, 1 stage and 2 stage of heart failure. Western medicine has no specific measures, but mainly uses symptomatic treatment. According to the deficiency of Xin Qi and/or Xin Yin of TCM treatment, Shengmai San, Zhigancao Decoction, etc have been widely used. Treatment goals of TCM and Western medicine are not only to better symptoms or improve the quality of life, but also treat from the structure, function, cell biology or other further methods. Ventricular remodeling is the inherent factor of latent syndrome of heart failure, which is closely related with the blood stasis, and the Yin asthenia could cause blood stasis, leading that Xin Qi cannot promote the normal operation of blood in the vessel without enough Xin Qi and Xin Yin. The mainly treatment of HFpEF is Yi Qi Yang Yin, accompanied by HuoXueHuaYu, HuaTanQuShi. In the purpose of seeking for a long-term and more corrective strategy, the perspective of improving cardiac pathological change was proposed.