2型心肾综合征血瘀证的临床特征及其远期预后价值

Clinical characteristics and long-term prognosis of type 2 cardiorenal syndrome patients with blood-stasis pattern

目的探讨2型心肾综合征(CRS)中血瘀证的临床特征及其对远期预后的影响。方法将符合纳入标准的390例慢性心力衰竭病例分为CRS组与非CRS组,比较两组间证候要素的差异,进行相关数据采集,并随访至1 810 d,获取终点事件(是否存活)。根据肾功能与远期预后的关系描绘受试者工作特征曲线(ROC曲线),以此分组,探索不同肾功能分组慢性心衰患者的中医证候分布规律。在此基础上,进一步探讨血瘀证与肾功能水平间的内在联系及其与相关西医指标的关联。结果血瘀证与慢性心衰患者的肾功能水平呈正相关(P=0.025),与气虚证、阳虚证呈负相关,考虑与CRS的病情演变有关。结论血瘀证在2型CRS的发生发展中发挥重要作用,可能预示着由心及肾病情的恶化。

Objective To explore the clinical characteristics and the long-term prognosis of type 2 cardiorenal syndrome（ CRS） patients with blood-stasis pattern. Methods 390 cases eligible were divided into CRS group and non-CRS group. After comparing TCM pattern elements between the two groups,we collected the related clinical data. Then all patients were followed-up for 1 810 days to get their final events（ survive or dead）. Using ROC curves plotted based on the relationship between renal function and long-term prognosis,patients were re-assigned into renal function level groups to try to find out the distribution of TCM pattern and the relationship of blood-stasis pattern with renal function or with modern medical indices. Results Blood-stasis pattern was positive correlated with renal function of chronic heart failure（ CHF） patients（ P = 0. 027）,but was negative correlated with qi deficiency pattern or yang deficiency pattern,maybe due to the progression of CRS. Conclusion The important effect of blood-stasis pattern on the occurrence and development was proved,and the blood-stasis pattern may indicate the deterioration,dysfunction of heart leading to dysfunction of kidney.