慢性心力衰竭患者中医证候与原发病的相关性研究

The correlations between traditional Chinese medicine syndromes of chronic heart failure and its protopathy

目的探讨慢性心力衰竭(chronic heart failure,CHF)患者主要证候与原发病的相关性,把握不同原发病导致的CHF中医证候分布规律。方法将符合CHF诊断标准的580例患者的基线资料、原发病及中医四诊信息等,进行中医证候判别,采用逻辑回归方法对CHF原发病与证候进行相关性分析。结果中医证候描述性分析结果显示,CHF患者主要证候按出现频次由高到低依次为气虚证、血瘀证、水停证、阴虚证、痰浊证、阳虚证等;CHF常见原发病中冠心病居首位,其次为高血压性心脏病、扩张性心肌病等,进一步进行逻辑回归分析发现,冠心病为原发病时,血瘀证、阳虚证、阴虚证与CHF的发生相关(χ^2值分别为0.480、4.445、0.192,P值均<0.05);高血压为原发病时,血瘀证和痰浊证与CHF的发生相关(χ^2值分别为12.344,10.990,P值均<0.05);扩张型心肌病为原发病时,血瘀证和阳虚证与慢性心力衰竭的发生有关(χ^2值分别为5.222、3.456,P值均<0.05)。结论不同原发病导致的CHF中医证候分布类型不同,与CHF的病因病机有一定的关联规律。

Objective To investigate the interaction between traditional Chinese medicine syndromes of patients with chronic heart failure (CHF) and the primary pathogenesis of CHF, so as to grasp the distribution regularity of TCM syndrome caused by different primary diseases and provide reference for better intervention of CHF. Methods A total of 580 patients with CHF were included in the clinical cross-sectional study. The baseline data of the patients, the primary disease and the four diagnosis information of TCM were collected. The syndromes of TCM were judged and the logistic regression method was used to analyze the correlation of CHF and the distribution of syndromes. Results Analysis of TCM Syndromes of CHF showed that the main syndromes were Qi deficiency syndrome, blood stasis syndrome, water retention syndrome, yin deficiency syndrome, phlegm syndrome, and yang deficiency syndrome. Further analysis showed that the above causes of CHF were related to the distribution of TCM syndromes. When coronary heart disease is the primary disease, blood stasis syndrome, yang deficiency syndrome, and yin deficiency syndrome are related to the occurrence of CHF (χ^2 values are 0.480, 4.445, 0.192, P<0.05). When hypertension is the primary disease, blood stasis syndrome and phlegm syndrome are related to the occurrence of CHF (χ^2 values are 12.344, 10.990, P<0.05);dilated cardiomyopathy is the primary disease, blood stasis syndrome and yang deficiency syndrome and chronic heart failure It is related (χ^2=5.222, 3.456, P<0.05). Conclusions The distribution patterns of TCM Syndromes of CHF caused by different primary diseases were different, which was related to the pathogenesis of CHF. It is of great significance for better application of traditional Chinese medicine CHF syndrome differentiation during treatment, so as to form optimal treatment to reduce re-admitted into hospitalization rate and mortality in patients with CHF.