病性类证候要素对慢性心力衰竭患者预后的影响

Impacts of the Syndrome Elements on the Prognosis in the Patients of Chronic Heart Failure

目的探讨中医证候要素是否影响慢性心力衰竭(CHF)患者的中远期预后。方法入选274例CHF患者,提取中医证候要素,并采集患者年龄、NYHA分级、左室射血分数(LVEF)等临床资料,随访5年内患者的生存状况,因心衰死亡为终点事件,通过Cox比例风险回归分析中医证候要素对终点事件的影响,行Kaplan-Meier法生存分析。结果 274例CHF患者出现的病性类证候要素有12种,分别是气虚、血瘀、水停、痰阻、阴虚、阳虚、气滞、血虚、痰湿、痰热、热蕴和寒凝。5年生存率为70.7%,95%CI:65.21%~76.19%。多因素Cox比例风险分析显示,在调整了患者年龄、NYHA分级和LVEF等混杂因素的干扰后,气虚(HR=2.972,95%CI:15.15~5.829),血瘀(HR=2.036,95%CI:1.218~3.404),水停(HR=2.042,95%CI:1.278~3.260)和阳虚(HR=3.134,95%CI:1.962~5.005)4个证候要素对患者的5年生存率有显著影响(P<0.01)。Kaplan-Meier法生存分析显示:有气虚、血瘀、水停、阳虚患者的5年生存率(66.1%、64.3%、52.8%和35.5%)明显低于无气虚、血瘀、水停、阳虚患者的生存率(84.7%、80.2%、79.2%和79.2%),差异有统计学意义(χ2=7.647、7.488、18.982、44.282,P=0.006、0.006、0.000、0.000)。结论 CHF患者的中远期预后差,出现气虚、血瘀、水停、阳虚等中医证候要素者预示着死亡风险的增加。

Objective To discuss the impacts of the syndrome elements in TCM on the middle-term and long-term prognosis in the patients of chronic heart failure（ CHF）. Methods In the recruited 274 patients of CHF,the TCM syndrome elements were extracted. The clinical data such as age,NYHA grade and LVEF were collected. The survival situation was followed up in 5 years. The death due to heart failure was the endpoint event. Through Cox proportional hazards regression,the impacts of TCM syndrome elements were analyzed on the endpoint event. Kaplan-Meier method was adopted for the survival analysis. Results Of 274 CHF cases,12 syndromes were involved,named qi deficiency,blood stagnation,retention of body fluid,blockage with phlegm,yin deficiency,yang deficiency,qi stagnation,blood deficiency,phlegm damp,phlegm heat,heat accumulation and cold stagnation. The 5-year survival rate was 70. 7%,95% CI： 65. 21% - 76. 19%.The multi-factor Cox proportional risk analysis showed that the 5-year survival rate was impacted significantly in the patients with 4 syndromes,i. e. qi deficiency（ HR = 2. 972,95% CI： 15. 15 - 5. 829）,blood stagnation（ HR = 2. 036,95% CI： 1. 218 - 3. 404）,retention of body fluid（ HR = 2. 042,95% CI： 1. 278 - 3. 260）and yang deficiency（ HR = 3. 134,95% CI： 1. 962 - 5. 005） after regulating the disturbance with age,NYHA grade and LVEF（P〈0. 01）.The Kaplan-Meier survey analysis showed that the 5-year survival rates（66.1%,64.3%,52.8%and 35.5%）in the patients of qi deficiency,blood deficiency,retention of body fluid and yang deficiency were lower apparently than those without them（84.7%,80.2%,79.2%and79.2%）separately,indicating the significant differences（χ^2=7.647,7.488,18.982,44.282,P=0.006,0.006,0.000,0.000）.Conclusion The middle-term and long-term prognosis of CHF is poor.The cases with qi deficiency,blood deficiency,retention of body fluid and yang deficiency predict the increase of death risk.