广州地区慢性心衰患者中医体质分布及与心脏相关指数、血脂水平的相关性研究

Studies on Distribution of Traditional Chinese Medicine Constitution and Its Correlation with Cardiac Indexes and Lipid Levels of Chronic Heart Failure Patients from Guangzhou Area

【目的】探讨广州地区慢性心衰患者的中医体质分布规律及其与血脂水平、心脏相关指数之间的相关性。【方法】对广东省中医院总院2016年12月至2017年12月收治的慢性心衰患者(观察组)及同期体检的健康人群(对照组)进行中医体质调查,并采集慢性心衰患者的血脂[总胆固醇(TC)、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)]及心脏彩超等相关检查数据,运用统计软件进行数据的分析研究。【结果】(1)本研究共计发放调查问卷500份,实际回收有效调查问卷403份(其中观察组205份,对照组198份),有效问卷回收率为80.6%。(2)观察组中以气虚质、阳虚质、血瘀质、痰湿质为主,对照组中以痰湿质、血瘀质、平和质、气虚质为主;2组比较,差异有统计学意义(P<0.05)。(3)根据ACC/AHA Stage心功能分期,B期患者中痰湿质最多,其次为血瘀质、气虚质、阳虚质、平和质;C期患者中气虚质最多,其次为痰湿质、血瘀质、阳虚质、平和质;D期患者中也是气虚质最多,其次为阳虚质、血瘀质、阴虚质、痰湿质;不同心功能分期的中医体质类型分布不同,差异有统计学意义(P<0.05)。(4)痰湿质与平和质患者的TC、TG比较,差异有统计学意义(P<0.05)。(5)各体质类型的慢性心衰患者各项心脏彩超指标比较,差异均无统计学意义(P>0.05)。【结论】广州地区慢性心衰患者的中医体质以气虚质、阳虚质、血瘀质、痰湿质为主;偏颇体质在慢性心衰患者中所占的比例随病程的进展增加,早期以痰湿质为主,中晚期以气虚质为主;痰湿质人群TC、TG水平偏高者较多。

Objective To investigate the distribution of traditional Chinese medicine（TCM）constitution in patients with chronic heart failure（CHF）from Guangzhou area and to explore its correlation with blood lipid levels andcardiac indexes. Methods From December of 2016 to December of 2017, the TCM constitution types of CHFpatients（served as observation group）and healthy volunteers received physical examination during the same stage（served as control group） admitted in Guangdong Provincial Hospital of TCM were investigated. Clinical outcomesof blood lipids including total cholesterol（TC）,triglyceride（TG）,and low density lipoprotein cholesterol（LDL-C）,etc.,and the cardiac indexes showed by Doppler ultrasonography were collected and then were analyzed bystatistical software. Results（1） A total of 500 questionnaire were released,and 403 were responded（205 fromthe observation group,198 from the control group）,with a respondent rate being 80.6%.（2）The observationgroup was dominated by Qi-deficiency physique,yang-deficiency physique,blood-stasis physique and phlegm-damp physique, and the control group was dominated by phlegm-damp physique, blood-stasis physique,harmony physique and Qi-deficiency physique,the difference being statistically significant between the two groups（P〈0.05）.（3）According to the criterion of American College of Cardiology（ACC）/American Heart Association（AHA） stages,the patients in stage B was dominated by phlegm-damp physique,following by blood-stasisphysique, Qi-deficiency physique, yang-deficiency and harmony physique; the patients in stage C wasdominated by Qi-deficiency physique, following by phlegm-damp physique, blood-stasis physique, yang-deficiency physique and harmony physique;the patients in stage D was dominated by Qi-deficiency physique,following by yang-deficiency physique, blood-stasis physique, yin-deficiency physique and phlegm-dampphysique. TCM constitutions of the patients varied at different stages of cardiac function, the difference beingsignificant（P〈0.05）.（4）The differences of TC and TG levels between the patients with phlegm-damp physiqueand those with harmony physique were significant（P〈0.05）.（5）The differences of the cardiac indexes showed byDoppler ultrasonography among various physique types of CHF patients were insignifiecant（P〉0.05）. Conclusion The TCM constitution of CHF patients from Guangzhou area is dominated by Qi-deficiency physique, yang-deficiency physique,blood-stasis physique and phlegm-damp physique. The proportion of patients with biasedconstitution increases with the progress of the disease,of which phlegm-damp physique is predominant at the earlystage,and Qi-deficiency physique is predominant at the middle and late stage. Most of the patients with phlegm-damp physique have higher levels of TC and TG.