慢性心力衰竭合并房颤证候分布与心脏结构及功能特征分析

Distribution of traditional Chinese medicine symptoms of chronic heart failure combined with atrial fibrillation and analysis of cardiac structure and functional characteristics

目的:研究慢性心力衰竭(CHF)合并心房颤动(AF)患者中医证候分布与心脏结构及功能特征。方法:通过临床横断面调查研究,收集235例符合纳入标准的CHF合并AF患者的一般资料、合并心血管相关疾病、一般体征、超声心动图指标、心脏瓣膜反流情况、心功能分级、中医证型,采用相关性分析探讨CHF合并AF证候分布与心脏结构及功能之间整体相关性。结果:CHF合并AF年龄均值>70岁,气阴虚血瘀证较气虚血瘀证及气阳虚血瘀证年龄高;合并冠心病比例最高的是气阴虚血瘀证,合并高血压病、糖尿病气阳虚血瘀证比例最高,合并持续性房颤则气虚血瘀证比例最高。心功能分级在Ⅲ~Ⅳ级比例气阴虚血瘀证、气阳虚血瘀证比例高,一般体征中,动脉收缩压气阳虚血瘀证较气阴虚血瘀证、气虚血瘀证高(P<0.05);心脏构型不同证型组间比较差异无统计学意义,左心房前后径、左心室舒张末内径、右心房上下径及左右径按气虚血瘀证、气阴虚血瘀证、气阳虚血瘀证逐渐增大,左室射血分数(EF)逐渐减低、肺动脉收缩压逐渐增加;左室舒张功能相关指标e’则提示气阴虚血瘀证偏低,气虚血瘀证、气阳虚血瘀证较高,E/e’则提示气虚血瘀证偏低,气阴虚血瘀证、气阳虚血瘀证较高;不同证型各瓣膜中度以上反流占比比较差异无统计学意义,中度以上三尖瓣反流以气虚血瘀证比例最低,其次为气阳虚血瘀证;中度以上二尖瓣反流以气阳虚血瘀证最低,其次为气虚血瘀证、气阴虚血瘀证、气阴虚血瘀证;中度以上主动脉瓣反流则以气虚血瘀证比例最低,其次为气阴虚血瘀证、气阳虚血瘀证。结论:CHF合并AF气虚血瘀证、气阴虚血瘀证、气阳虚血瘀证的心脏构型及功能改变、瓣膜损伤逐渐加重,呈一定的数据趋势,但仍需扩大样本量进一步验证。

Objective:To study the distribution of medical syndrome and cardiac structure and functional characteristics in patients with chronic heart failure(CHF)and atrial fibrillation(AF).Methods:Through clinical cross-sectional investigation,the general data,general signs,echocardiographic indexes,heart valve regurgitation,cardiac function grade,and TCM symptom type of 235 patients with CHF complicated with AF who met the inclusion criteria were collected,and the overall correlation between the distribution of CHF combined with AF syndrome and cardiac structure and function was explored.Results:The mean age of CHF combined with AF>70 years,and the evidence of qi yin deficiency and blood stasis was higher than that of qi deficiency age of blood stasis and qi yang deficiency blood stasis.The highest proportion of coronary heart disease was qi yin deficiency and blood stasis,hypertension and diabetes were the highest proportion of qi yang deficiency and blood stasis,and persistent atrial fibrillation had the highest proportion of qi deficiency blood stasis.The cardiac function grade is in the proportion of grade 2 to 4,qi yin deficiency and blood stasis,and qi yang deficiency and blood stasis high,in general signs,arterial systolic blood pressure qi yang deficiency blood stasis is higher than qi yin deficiency blood stasis and qi deficiency blood stasis evidence(P<0.05).There were no obvious differences between the groups with different cardiac configurations,and the anterior and posterior diameter of the left atrium,the end-diastolic inner diameter of the left ventricle,the upper and lower diameter of the right atrium and the left and right diameters gradually increased according to the evidence of qi deficiency blood stasis,qi yin deficiency blood stasis,qi yang deficiency blood stasis,left ventricular ejection fraction(EF)gradually decreased,and pulmonary artery systolic blood pressure gradually increased.The index e'related to left ventricular diastolic function showed that the evidence of qi yin deficiency and blood stasis was low,and the evidence of qi yang deficiency and blood stasis was high.E/e'indicates that the evidence of qi deficiency and blood stasis is low,and the evidence of qi yin deficiency and blood stasis is higher.There was no significant difference in the proportion of moderate or higher regurgitation in each valve of different types,and the proportion of moderate and above tricuspid regurgitation was the lowest in qi deficiency and blood stasis,followed by qi yang deficiency and blood stasis.Moderate aortic regurgitation had the lowest proportion of qi deficiency and blood stasis,followed by qi yin deficiency and blood stasis.Mitral regurgitation above moderate had the lowest proportion of qi yang deficiency and blood stasis,followed by qi deficiency and blood stasis.Conclusion:The cardiac configuration and function changes and valve damage of CHF combined with AF qi deficiency blood stasis,qi yin deficiency blood stasis,qi yang deficiency blood stasis,and valve damage gradually worsened,showing a certain data trend,but it is still necessary to expand the sample size for further verification.