风湿性心脏病并发慢性心力衰竭患者中医证型与左心室重构及瓣膜病变的关系研究

Relationship of Traditional Chinese Medicine Syndrome Types with Left Ventricular Remodeling and Valve Lesions in Patients with Rheumatic Heart Disease Complicated by Chronic Heart Failure

【目的】探究风湿性心脏病(RHD)并发慢性心力衰竭(CHF)患者中医证型与心脏彩超指标及二尖瓣、主动脉瓣病变程度的关系。【方法】采用回顾性研究方法,选取99例RHD并发CHF患者作为观察组,另选取40例非RHD的CHF患者作为对照组。收集2组患者一般资料(如年龄、性别、症状、舌脉等)以及临床超声资料,包括左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)、室间隔厚度(IVST)、左室后壁厚度(LVPW)等左心室重构指标、二尖瓣及主动脉瓣的狭窄及关闭不全情况。根据患者临床特征将观察组病例分为气虚血瘀证、气阴两虚血瘀证、阳气亏虚血瘀证3组,根据瓣膜病变情况将瓣膜病变程度分为无、轻度、中度、重度4个级别。统计分析观察组与对照组以及观察组3种不同证型间LVEDd、LVESd、IVST、LVPW及二尖瓣、主动脉瓣的病变程度是否有统计学差异。【结果】(1)观察组气虚血瘀证33例(33.3%),气阴两虚血瘀证31例(31.3%),阳气亏虚血瘀证35例(35.4%),不同证型间的性别比较差异无统计学意义(P>0.05),而在年龄分布上差异有统计学意义(P<0.05),表现在气阴两虚血瘀证年龄大于气虚血瘀证(P<0.05)。(2)观察组与对照组左心室重构指标进行比较,差异均无统计学意义(P>0.05)。(3)观察组与对照组在二尖瓣及主动脉瓣病变程度上差异均有统计学意义(P<0.05)。(4)3组证型间比较,LVEDd与LVESd均存在差异(P<0.05),而IVST与LVPW差异无统计学意义(P>0.05)。组间两两比较,阳气亏虚血瘀证的LVEDd水平高于气虚血瘀证,LVESd水平高于气阴两虚血瘀证,差异均有统计学意义(P<0.05)。(5)3组证型的二尖瓣及主动脉瓣的病变程度比较,差异均有统计学意义(P<0.01)。组间两两比较,无论是二尖瓣还是主动脉瓣,气虚血瘀证、气阴两虚血瘀证、阳气亏虚血瘀证的瓣膜病变程度均呈递增趋势,差异均有统计学意义(P<0.01)。【结论】瓣膜病变是RHD并发CHF的主要病理特点,年龄、左心室重构及瓣膜病变程度或可对RHD并发CHF的中医证型有一定的指向性。

Objective To investigate the relationship of traditional Chinese medicine(TCM)syndrome types with echocardiography indexes and the degree of mitral and aortic valve lesions in patients with rheumatic heart disease(RHD)complicated by chronic heart failure(CHF).Methods A retrospective study method was conducted in99 patients with RHD complicated by CHF(serving as the observation group)and in 40 patients with non-RHD CHF(serving as the control group).General data(e.g.age,gender,symptoms,tongue and pulse manifestations)and clinical echocardiography data of left ventricular end-diastolic diameter(LVEDd),left ventricular endsystolic diameter(LVESd),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPW)which reflected the left ventricular remodeling,and the mitral and aortic valve stenosis and insufficiency were collected from the two groups.According to the clinical characteristics,the patients in the observation group were differentiated as qi deficiency and blood stasis syndrome,qi-yin deficiency and blood stasis syndrome,and yang-qi insufficiency and blood stasis syndrome.The degree of valve lesions was classified into four levels of being zero,mild,moderate,and severe.Statistical analysis was performed to determine whether there was statistical difference in LVEDd,LVESd,IVST,LVPW,and the degree of mitral and aortic valve lesions between the observation group and control group and between the 3 syndrome types of the observation group.Results(1)In the observation group,33 cases(33.3%)were classified into qi deficiency and blood stasis syndrome,31 cases(31.3%)were classified into qi-yin deficiency and blood stasis syndrome,and 35 cases(35.4%)were classified into yang-qi insufficiency and blood stasis syndrome.The difference in gender among the 3 syndrome types was not statistically significant(P>0.05),while the difference in age distribution was statistically significant(P<0.05),shown as the age in patients with qi-yin deficiency and blood stasis syndrome being older than that in qi deficiency and blood stasis syndrome(P<0.05).(2)There were no statistically significant differences in the indexes of left ventricle remodeling between the observation group and the control group(P>0.05).(3)There was statistically significant difference in the degree of mitral and aortic valve lesions between the observation group and the control group(P<0.05).(4)Among the three groups,there was significant difference in LVEDd and LVESd(P<0.05),while the difference in IVST and LVPW was not statistically significant(P>0.05).The pairwise comparisons showed that patients with yang-qi insufficiency and blood stasis syndrome had higher LVEDd than patients with qi deficiency and blood stasis syndrome and had higher LVESd than patients with qi-yin deficiency and blood stasis syndrome(P<0.05).(5)The differences in the degree of mitral and aortic valve lesions were statistically significant among the three syndrome types(P<0.01).The pairwise comparisons showed that there was statistically significant difference in both mitral and aortic valve lesions,and the lesions became severe from the qi deficiency and blood stasis syndrome to the qi-yin deficiency and blood stasis syndrome and yang-qi insufficiency and blood stasis syndrome(P<0.01).Conclusion Valvular lesion is the primary pathological feature of RHD complicated by CHF,and age,left ventricular remodeling,and the degree of valvular lesion may be indicative of the differentiation of TCM syndrome types of RHD patients complicated by CHF.