慢性心力衰竭患者舌象特征与NYHA心功能分级相关性临床研究

Clinical Study on Correlation Between Characteristics of Tongue Manifestation and NYHA Cardiac Function Classification in Patients with Chronic Heart Failure

目的:观察181例慢性心力衰竭患者的舌象特征,并探讨其与纽约心脏病协会(NYHA)心功能分级的关系。方法:应用中医传统望舌方法,采集181例慢性心力衰竭住院患者的舌诊资料,包括舌色、舌形、苔色、苔质。比较不同心功能分级患者的舌质、舌苔特征。结果:①舌色分布频率由高到低依次为青紫舌、绛舌、红舌、淡红舌、淡白舌。NYHA心功能Ⅱ级患者主要为淡红舌,心功能Ⅲ、Ⅳ级患者主要为青紫舌。不同NYHA心功能分级之间舌色分布差异有统计学意义(P<0.05)。两两比较,心功能Ⅱ、Ⅲ级淡白舌比率低于心功能Ⅳ级者(P<0.05);心功能Ⅲ、Ⅳ级淡红舌比率低于心功能Ⅱ级者(P<0.05),青紫舌比率高于心功能Ⅱ级者(P<0.05)。②舌形分布频率由高到低依次为裂纹舌、瘦薄舌、胖大舌、正常舌。NYHA心功能Ⅱ级患者主要为瘦薄舌,心功能Ⅲ、Ⅳ级患者以裂纹舌多见。不同NYHA心功能分级之间舌形分布差异有统计学意义(P<0.05)。两两比较,心功能Ⅲ、Ⅳ级正常舌比率低于心功能Ⅱ级患者(P<0.05),裂纹舌比率高于心功能Ⅱ级者(P<0.05)。③苔色分布频率由高到低依次为黄苔、灰黑苔、白苔。心功能Ⅱ级患者主要为白苔,心功能Ⅲ级患者中黄苔、灰黑苔较常见,心功能Ⅳ级患者以灰黑苔多见。不同NYHA心功能分级之间苔色分布差异有统计学意义(P<0.05)。两两比较,心功能Ⅲ、Ⅳ级白苔比率低于心功能Ⅱ级者(P<0.05),灰黑苔比率高于心功能Ⅱ级者(P<0.05)。④苔质厚薄程度分布频率由高到低依次为少/无苔、腻苔、厚苔、薄苔。NYHA心功能Ⅱ级患者主要为薄苔,心功能Ⅲ、Ⅳ级患者以少/无苔多见。不同NYHA心功能分级之间舌苔质厚薄程度分布差异有统计学意义(P<0.05)。两两比较,心功能Ⅲ、Ⅳ级薄苔比率低于心功能Ⅱ级者(P<0.05),少/无苔比率高于心功能Ⅱ级者(P<0.05);心功能Ⅳ级腻苔比率高于心功能Ⅱ级者(P<0.05)。⑤舌苔润燥程度分布频率由高到低依次为干苔、润苔。心功能Ⅱ级患者主要为润苔,心功能Ⅲ、Ⅳ级患者以干苔多见。不同NYHA心功能分级之间舌苔润燥程度分布差异有统计学意义(P<0.05)。两两比较,心功能Ⅲ、Ⅳ级干苔比率高于心功能Ⅱ级者(P<0.05),润苔比率低于心功能Ⅱ级者(P<0.05)。结论:心功能Ⅲ、Ⅳ级患者以青紫舌、裂纹舌、瘦薄舌,灰黑苔,少/无苔,干苔多见;心功能Ⅱ级患者常表现为淡红舌、白苔、薄苔、润苔。舌诊可作为评估慢性心力衰竭(CHF)病情轻重程度的一个客观评价指标。

Objective:To observe the characteristics of tongue manifestation in 181 cases of patients with chronic heart failure(CHF),and to explore its relationship with New York Heavy Artillery(NYHA)cardiac function classification.Methods:Traditional inspection of the tongue of Chinese medicine was applied to collect the tongue diagnosis data of 181 patients with CHF,including tongue color,form of the tongue,coating color,and texture of coating.The characteristics of tongue body and tongue coating in patients with different cardiac function grades were compared.Results:①According to the distribution frequency from high to low,the tongue color included bluish purple tongue,crimson tongue,red tongue,pale red tongue,and pale tongue.Patients with NYHA cardiac function gradeⅡmainly had pale red tongue,and patients with cardiac function gradeⅢandⅣmainly had bluish purple tongue.There were significant differences in the distribution of tongue color among patients with different NYHA cardiac function grades(P<0.05).Pairwise comparison showed that the rate of pale tongue in patients with cardiac function gradeⅡandⅢwas lower than that in patients with cardiac function gradeⅣ(P<0.05),the rate of pale red tongue in patients with cardiac function gradeⅢandⅣwas lower than that in patients with cardiac function gradeⅡ(P<0.05),and the rate of bluish purple tongue was higher than that in patients with cardiac function gradeⅡ(P<0.05).②According to the distribution frequency from high to low,the form of the tongue included fissured tongue,thin tongue,enlarged tongue,and normal tongue.Patients with NYHA cardiac function gradeⅡmainly had thin tongue,and patients with cardiac function gradeⅢandⅣmainly had fissured tongue.There were significant differences in the distribution of the form of the tongue among patients with different NYHA cardiac function grades(P<0.05).Pairwise comparison showed that the rate of normal tongue in patients with cardiac function gradeⅢandⅣwas lower than that in patients with cardiac function gradeⅡ(P<0.05),and the rate of fissured tongue was higher than that in patients with cardiac function gradeⅡ(P<0.05).③According to the distribution frequency from high to low,the coating color included yellow coating,gray and black coating,and white coating.White coating was mainly found in patients with cardiac function gradeⅡ;yellow coating,and gray and black coating were common in patients with cardiac function gradeⅢ;gray and black coating was more common in patients with cardiac function gradeⅣ.There were significant differences in the distribution of coating color among patients with different NYHA cardiac function grades(P<0.05).Pairwise comparison showed that the rate of white coating in patients with cardiac function gradeⅢandⅣwas lower than that in patients with cardiac function gradeⅡ(P<0.05),and the rate of gray and black coating was higher than that in patients with cardiac function gradeⅡ(P<0.05).④According to the distribution frequency from high to low,the texture of coating included less/no coating,slimy coating,thick coating,and thin coating.Patients with NYHA cardiac function gradeⅡmainly had thin coating,and patients with cardiac function gradeⅢandⅣmainly had less/no coating.There were significant differences in the distribution of the texture of coating among patients with different NYHA cardiac function grades(P<0.05).Pairwise comparison showed that the rate of thin coating in patients with cardiac function gradeⅢandⅣwas lower than that in patients with cardiac function gradeⅡ(P<0.05),and the rate of less/no coating was higher than that in patients with cardiac function gradeⅡ(P<0.05);the rate of slimy coating in patients with cardiac function gradeⅣwas higher than that in patients with cardiac function gradeⅡ(P<0.05).⑤According to the distribution frequency of moistening degree of tongue coating from high to low,it included dry coating and moist coating.Moist coating was mainly found in patients with cardiac function gradeⅡ,and dry coating was more common in patients with cardiac function gradeⅢandⅣ.There were significant differences in the distribution of tongue coating among patients with different NYHA cardiac function grades(P<0.05).Pairwise comparison showed that the rate of dry coating in patients with cardiac function gradeⅢandⅣwas higher than that in patients with cardiac function gradeⅡ(P<0.05),and the rate of moist coating was lower than that in patients with cardiac function gradeⅡ(P<0.05).Conclusion:Patients with cardiac function gradeⅢandⅣwere more common with bluish purple tongue,fissured tongue,thin tongue,gray and black coating,less/no coating and dry coating;Patients with cardiac function gradeⅡoften present with pale red tongue,white coating,thin coating,and moist coating.Tongue diagnosis can be used as an objective evaluation index to evaluate the severity of chronic heart failure.