冠心病慢性心力衰竭合并高血压患者证候要素和证候分布特点

Distribution characteristics of TCM patterns and pattern factors in patients with coronary heart disease-induced chronic heart failure complicated by hypertension

目的比较合并高血压对冠心病慢性心力衰竭患者证候要素及应证组合是否产生影响,为冠心病慢性心力衰竭患者的辨证分型提供一定参考。方法通过多中心横断面研究,收集和分析14家临床协作单位252例冠心病慢性心力衰竭患者,根据是否合并高血压,将患者分为冠心病慢性心力衰竭合并高血压组和冠心病慢性心力衰竭不合并高血压组,比较2组患者的性别、年龄、心力衰竭类型、心功能等级、病性类证候要素、病位类证候要素及应证组合分布规律,完成统计分析并探讨其规律。结果 2组患者性别、年龄和心功能比较无差异;2组患者中出现频次最高的病性类证候要素均为气虚、血瘀、阴虚,但合并高血压组患者中气虚的出现频率低于不合并高血压组(P<0.01);2组患者的主要病位类证候要素均为心,同时涉及到脾、肺、肾、肝,且2组间无显著差异(P>0.05);2组患者的应证组合均以多个证候要素组合最为多见,但合并高血压组两证组合多于不合并高血压组(P<0.05);气虚血瘀和气阴两虚兼血瘀是冠心病慢性心力衰竭合并高血压组最常见的证候类型。结论冠心病慢性心力衰竭患者合并高血压时,其病性证候要素中气虚比例减少,其应证组合中,多以两证组合为主,且气虚血瘀和气阴两虚兼血瘀是最常见的证候类型。

Objective To compare the influences of hypertension on TCM pattern factors and pattern combinations in patients with eoronary heart disease-induced chronic heart failure （CHD-CHF）, and provide some reference for pattern differentiation and classification of CHD-CHF. Methods The patients with CHD-CHF （n = 252 ） were chosen from 14 cooperation clinical units through multi-center cross-section study, and then all patients were divided, according to whether they are complicated by hyperten- sion or not, into CHD-CHF ＋ hypertension group and CHD-CHF group. The distribution rules of sex, age, types of heart failure, cardiac grades, pattern factors related to disease nature, pattern factors related to disease locations and pattern combinations were compared between 2 groups for conducting statistical analysis and rules investigation. Results The comparisons in sex, age and heart function had no difference between 2 groups. The pattern factors related to disease nature with the highest occurrence frequency were qi deficiency, blood deficiency and yin deficiency in 2 groups, but occurrence frequency of qi deficiency was lower in CHD-CHF ＋ hypertension group than that in CHD-CHF group （P 〈 0.01 ）. The pattern factors related to disease locations were heart and meanwhile involved spleen, lung, kidney and liver, and there was no significant difference between 2 groups （P 〉 0. 05 ）. The pattern combinations were almost multi-factor combinations in 2 groups, and 2-factor combination was more in CHD-CHF ＋ hypertension group than that in CHD-CHF group （P 〈 0.05）. The most common pattern types were pattern of qi deficiency and blood stasis, and pattern of dual deficiency of qi and yin with blood stasis in CHD-CHF ＋ hypertension group. Conclusion The percentage of qi deficiency reduces in pattern factors related to disease nature, 2-factor combination is more in pattern combinations, and pattern of qi deficiency and blood stasis and pattern of dual deficiency of qi and yin with blood stasis are the most common pattern types in patients with CHD-CHF complicated by hypertension.