射血分数保留和射血分数减低心力衰竭中医四诊及证候特征研究

Research on TCM Diognostic and Syndrome Characteristics of Heart Failure with Preserved and Reduced Ejection Fraction

目的探讨射血分数保留心力衰竭(HFpEF)和射血分数减低心力衰竭(HFrEF)的中医四诊和证候分布特征。方法依据心力衰竭病人左室射血分数(LVEF)分为HFpEF组和HFrEF组,对两组病人基本信息、中医四诊和证候进行对比分析。结果 HFpEF组女性、冠心病、合并高脂血症和脑血管意外者较多,常见心功能Ⅱ级和Ⅲ级,HFrEF组男性、扩张性心脏病病人显著增多,常见心功能Ⅲ级和Ⅳ级,且差异具有统计学意义(P<0.05或P<0.01);慢性心力衰竭临床常见39项四诊条目,HFpEF组易出现晕眩、口唇青紫、胸闷、胸痛、口淡和夜尿频多,HFrEF组易出现呼吸困难、畏寒、自汗、盗汗、喘息、腹胀、手足不温、浮肿、齿痕舌、沉迟脉其差异具有统计学意义(P<0.05或P<0.01);本研究出现10种证候、7种证型,气虚证、血瘀证、水停证、痰浊证、阴虚证和阳虚证为心力衰竭常见证候;二证型、三证型和四证型为主要证型,HFpEF组易出现单证型,HFrEF组则较易出现血瘀证、水停证、痰浊证、阳虚证和湿证及五证型、六证型、七证型,且差异具有统计学意义(P<0.05或P<0.01)。结论 HFpEF组病人处于心力衰竭初期、中期阶段,与心、气、瘀关系较为密切,常见心气不足、气虚血瘀等证;HFrEF组病人处于心力衰竭病程终末期(较为严重阶段),该病程与心、脾、肾、血、水、痰、阳关系更为密切,易出现因虚致瘀、气损及阳、水湿不利、痰湿内阻等证。

Objective To investigate the distribution characteristics of the diagnosis and syndromes of traditional Chinese medicine(TCM) for heart failure with preserved ejection fraction(HFpEF) and reduced ejection fraction reduction(HFrEF). Methods The patients with heart failure were divided into HFpEF group and HFrEF group according to left ventricular ejection fraction(LVEF).The basic information,TCM diagnostic,and syndrome characteristics were analyzed. Results Female Patiens,coronary heart disease,hyperlipoidemia and cerebral vascular accident increased markerly in the HFpEF group,the cardiac function was grade Ⅱ or Ⅲ,and the difference was statistically significant( P <0.05 or P <0.01).Male patiens with a dilated cardiomyopathy increased obviously in HFrEF group,the cardiac function was grade Ⅲ or Ⅳ,and the difference was statistically significant( P <0.05 or P <0.01).Patiens with chronic heart failure(CHF) had 39 TCM diagnostic entries commonly.The symptoms were dizziness,cyanosis of the lips,chest tightness,chest pain,bland taste and nocturia in HFpEF group,and dyspnea,chills,spontaneous perspiration,night perspiration,wheezing,abdominal distension,cold hands and feet,edema,tooth-marked tongue,and sink-retarded pulse in HFrEF group.The difference was statistically significant( P <0.05 or P <0.01).There were 10 syndromes and 7 syndrome types in CHF,such as qi,deficiency,blood stasis,water stagnation,phlegm,yin deficiency and yang deficiency.Two,three and four syndromes combination were the main syndrome types.Single syndrome type was more easily appeared in HFpEF group.Blood stasis,water stagnation,phlegm,yang deficiency,dampness syndrome,five syndrome type,six syndrome type and seven syndrome type were more easily appeared in HFrEF group( P <0.05 or P <0.01). Conclusion Patients in HFpEF group were in the early and middle stages of heart failure.The TCM syndrome types were heart qi,deficiency syndrome and blood stasis syndrome in HFpEF group,which was closely related to heart,qi and blood stasis.Patients in HFrEF group were at the end stage of heart failure,and the disease was more severe.The TCM syndrome types were qi deficiency and blood stasis syndrome,yang deficiency syndrome,phlegm and dampness syndrome,which was closely related to heart,spleen,kidney,blood,water,sputum,and yang.