广西慢性心力衰竭中医临床证候及要素的回顾性研究

Retrospective Study on Traditional Chinese Medicine Clinical Syndromes and Factors of Chronic Cardiac Failure in Guangxi

目的探讨广西慢性心力衰竭（CHF）中医辨证分型规律,为中医药防治心力衰竭提供相关的临床资料。方法采用回顾性研究方式,收集广西地区7家医院1 647例CHF住院病人的一般资料、基础病、中医证型及服用中药情况、心功能分级、超声心动图心功能测定、N末端脑尿钠肽前体（NT-proBNP）等资料,并进行统计分析。结果 CHF病人年龄68.98岁±13.06岁,以70岁-79岁患病率最高,60岁以前男性患病率高于女性,60岁以后女性高于男性;基础病中,以冠心病所占比例最大,占42.44%;CHF病人主要以心功能Ⅲ级为主,占总例数的58.04%;中医证型分布规律：心肺气虚证占25.39%,气虚血瘀证占21.91%,气阴两虚证占19.37%,痰浊阻肺证占17.12%,阳虚水泛证占16.21%,各证型之间差异具有统计学意义（P〈0.05）;基础病为冠心病的CHF与中医证型之间无相关性;基础病为高血压性心脏病的CHF与中医证型之间存在相关性;CHF住院病人心功能分级在各证型间差异有统计学意义（P〈0.05）,其中心功能Ⅱ级以气虚血瘀证为主,心功能Ⅲ级以心肺气虚证为主,心功能Ⅳ级以阳虚水泛证为主;CHF住院病人左室射血分数（LVEF）、左室舒张末内径（LVEDD）、左室收缩末内径（LVESD）在各证型间差异有统计学意义（P〈0.05）,其中LVEF降低以及LVEDD、LVESD增大均以阳虚水泛证为主;N末端脑钠肽前体（NT-proBNP）与CHF中医辨证分型存在相关性（P〈0.05）,以阳虚水泛证NT-proBNP升高明显。结论广西慢性心力衰竭病人以老年人为主,其中女性的患病率随年龄的增长而升高。冠心病是慢性心力衰竭主要的基础疾病,住院病人主要以心功能Ⅲ级为主;中医辨证分型主要以心肺气虚证为主,并且高血压性心脏病与中医证型存在相关性,冠心病与中医证型无相关性;慢性心力衰竭病人以心功能Ⅲ级为主,与中医证型存在相关性,其中心功能Ⅱ级以气虚血瘀证为主,心功能Ⅲ级以心肺气虚证为主,心功能Ⅳ级以阳虚水泛证为主,以阳虚水泛证的心衰程度最重;LVEF、LVEDD、LVESD、NT-proBNP与中医辨证分型存在相关性,可作为中医辨证分型的参考。

Objective To discuss the correlation of rules of traditional Chinese medicine（TCM）patterns of chronic heart failure（CHF）patients in Guangxi,so as to provide clinical data for the TCM treatment in CHF.Methods The information of 1,647 CHF patients from7 hospitals were collected in the research,including their general information,basic diseases,complex diseases,TCM patterns and oral administration of Chinese materia medica,cardiac function classification,determination of echocardiography and cardiac function,as well as pro-brain natriuretic peptide.Results CHF patients were at the age of 68.98±13.06 in average,those at the age from70 to 79 had the highest morbidity.Moreover,the morbidity of male patients was higher than that of female patients before the age of 60 and vice versa.In basic diseases,coronary heart disease was accounted for the largest proportion,accounting for 42.44%.CHF patients mainly with cardiac function Ⅲ was accounted for 58.04%.TCM syndrome type distribution law showed that patients with heart-lung qi deficiency syndrome accounted for 25.39%,qi deficiency and blood stasis syndrome accounted for 21.91%,qi-yin deficiency syndrome accounted for 19.37%,phlegm obstructing lung syndrome accounted for 17.12%,edema due to yang deficiency syndrome accounted for16.21%.There was statistical significance among different syndrome types（P〈0.05）.There was a correlation between hypertension and CHF.There was no correlation between coronary heart disease and CHF.CHF patients mainly suffered from cardiac function Ⅲ,which had a correlation with TCM patterns（P〈0.05）.Furthermore,patients suffered from cardiac function Ⅱ mainly with the pattern of qi deficiency and blood stasissyndrome,cardiac functionⅢ mainly with the pattern of heart-lung qi deficiency syndrome,cardiac functionⅣ mainly with the pattern of edema due to yang deficiency syndrome.The heart failure with the pattern of edema due to yang deficiency syndrome was the most severe.There was a correlation between LVEF,LVEDD,LVESD and TCM patterns（P〈0.05）.The decreasing level of LVEF in the left ventricular and increasing level of LVEDD and LVESD were mainly with the pattern of edema due to tang deficiency syndrome.There was significant correlation between NT-proBNP and TCM patterns（P〈0.05）.The decreasing level of NT-proBNP were mainly with the pattern of edema due to tang deficiency syndrome.Conclusion Guangxi patients with CHF in the elderly,and the morbidity of female patients will increase as their ages grows.The heart disease is the underlying diseases of CHF.CHF patients mainly suffered from cardiac function Ⅲ,which had a correlation with TCM patterns.Furthermore,patients suffered from cardiac function Ⅱ mainly with the pattern of qi deficiency and blood stasis,cardiac function Ⅲ mainly with the pattern of heart-lung qi deficiency,cardiac functionⅣ mainly with the pattern of edema due to yang deficiency.The heart failure the pattern of edema due to yang deficiency was the most severe.There was significant correlation between LVEF,LVEDD,LVESD,NT-proBNP and TCM patterns,can be used as a reference for TCM patterns.