心房颤动病人中医证型分布特点及与心房大小、心房容积指数、预后的关系

The Distribution Characteristics of TCM Syndromes in Patients with Atrial Fibrillation and the Relationship with Atrial Size,Atrial Volume Index and Prognosis

目的探究心房颤动病人中医证型分布特点及与心房大小、心房容积指数、预后的关系。方法选取2019年1月—2021年1月于广东省中医院住院治疗的280例心房颤动病人进行中医辨证分型。比较不同中医证型病人性别、年龄、体质指数、病程、心脏超声参数[左心房内径(LAD)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心房容积指数(LAVI)]、中医证候积分,分析心房颤动病人心脏超声参数与中医证候积分的相关性;比较不同中医证型病人治疗前、治疗后1个月、治疗后3个月心房颤动负荷、简明健康状况量表(SF-36)评分及治疗前和治疗后3个月心房颤动负荷、SF-36评分差值绝对值;比较不同中医证型病人术后6个月内心房颤动复发情况。结果280例心房颤动病人中医证型分布由高到低依次为心阳虚衰证(37.86%)、气阴两虚证(26.43%)、痰浊阻滞证(14.64%)、心脉瘀阻证(12.14%)、心肾阳虚证(8.93%);心阳虚衰证病人LAD、LAVI、LVESD、LVEDD、中医证候积分均高于气阴两虚证、痰浊阻滞证、心脉瘀阻证、心肾阳虚证病人,且痰浊阻滞证病人LAVI高于气阴两虚证、心脉瘀阻证、心肾阳虚证病人(P<0.05);LAD、LAVI、LVESD、LVEDD与中医证候积分呈正相关(P<0.05)。心阳虚衰证病人治疗前、治疗后1个月、3个月心房颤动负荷均高于气阴两虚证、痰浊阻滞证、心脉瘀阻证、心肾阳虚证病人,SF-36评分均低于气阴两虚证、痰浊阻滞证、心脉瘀阻证、心肾阳虚证病人(P<0.05);心阳虚衰证病人治疗前和治疗后3个月心房颤动负荷差值绝对值较气阴两虚症、痰浊阻滞、心脉瘀阻证、心肾阳虚证病人高,SF-36评分差值绝对值均低于气阴两虚证、痰浊阻滞证、心脉瘀阻证、心肾阳虚证病人(P<0.05);心阳虚衰证病人复发率(21.70%)高于气阴两虚证、痰浊阻滞证、心脉瘀阻证、心肾阳虚证病人,但差异无统计学意义(P>0.05)。结论心房颤动病人中医证型以心阳虚衰证为主,其次为气阴两虚证,心阳虚衰证病人左心功能降低更明显,预后相对其他证型差。

Objective To explore the distribution characteristics of traditional Chinese medicine(TCM)syndromes in patients with atrial fibrillation and the relationship with atrial size,atrial volume index and prognosis.Methods A total of 280 patients with atrial fibrillation were retrospectively selected and classified by TCM syndrome differentiation.Gender,age,body mass index,course of disease,left atrial diameter(LAD),left ventricular end-systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD),left atrial volume index(LAVI),and TCM syndrome score of patients with different TCM syndromes were compared.The correlation between cardiac ultrasound parameters and TCM syndrome score in patients with atrial fibrillation was analysed.Atrial fibrillation load,Short-Form 36 Health Survey Scale(SF-36)score and the absolute difference between atrial fibrillation load and SF-36 score before treatment,at 1 month and 3 months after treatment were compared among patients with different TCM syndrome types.The recurrence of atrial fibrillation after operation were analysed.Results The distribution of TCM syndrome types in 280 patients with atrial fibrillation were as follow:Heart-yang Deficiency Syndrome(37.86%),Qi-yin Deficiency Syndrome(26.43%),Phlegm-turbid Blocking Syndrome(14.64%),Stasis Syndrome(12.14%),Heart and Kidney Yang Deficiency Syndrome(8.93%).LAD,LAVI,LVESD,LVEDD,and the scores of TCM syndrome with Heart-yang Deficiency Syndrome were all higher than those with Qi-yin Deficiency Syndrome,Phlegm-turbid Blocking Syndrome,Pulse Stasis Syndrome,and Heart and Kidney Yang Deficiency Syndrome,and LAVI of the patients with Phlegm-turbid Blocking Syndrome was higher than those of Qi-yin Deficiency Syndrome,Pulse Stasis Syndrome and Heart and Kidney Yang Deficiency Syndrome(P<0.05).LAD,LAVI,LVESD,and LVEDD were positively correlated with TCM syndrome scores(P<0.05).Atrial fibrillation load of patients with Heart-yang Deficiency Syndrome was higher than those of patients with both Qi-yin Deficiency Syndrome,Phlegm-turbid Blocking Syndrome,Pulse Stasis Syndrome,and Heart and Kidney Yang Deficiency Syndrome before treatment,at 1 month and 3 months after treatment(P<0.05).SF-36 score of patients with Heart-yang Deficiency Syndrome was lower than those of patients with both Qi-yin Deficiency Syndrome,Phlegm-turbid Blocking Syndrome,Pulse Stasis Syndrome,and Heart and Kidney Yang Deficiency Syndrome before treatment,at 1 month and 3 months after treatment(P<0.05).Before and 3 months after treatment,the absolute value of atrial fibrillation load difference in patients with Heart-yang Deficiency Syndrome was higher than those in patients with both Qi-yin Deficiency Syndrome,Phlegm-turbid Blocking Syndrome,Pulse Stasis Syndrome,and Heart and Kidney Yang Deficiency Syndrome,and the absolute value of SF-36 score difference was lower than those in patients with Qi-yin Deficiency Syndrome,Phlegm-turbid Blocking Syndrome,Pulse Stasis Syndrome,and Heart and Kidney Yang Deficiency Syndrome(P<0.05).The recurrence rate of Heart-yang Deficiency Syndrome(21.70%)was higher than those of Qi-yin Deficiency Syndrome,Phlegm-turbid Blocking Syndrome,Pulse Stasis Syndrome,and Heart and Kidney Yang Deficiency Syndrome,but there were no statistical significance(P>0.05).Conclusion The TCM syndrome type of atrial fibrillation patients are mainly Heart-yang Deficiency Syndrome,followed by both Deficiency Syndrome.The left heart function of Heart-yang Deficiency Syndrome patients are more significantly reduced,and the prognosis are worse than that of other syndrome types.