1676例心力衰竭住院患者中医证候特征研究——一项基于真实世界电子病历信息的横断面调查

Study on Traditional Chinese Medicine Syndrome Characteristics of 1676 Heart Failure Inpatients:A Cross-Sectional Survey Based on Real-World Electronic Medical Record Information

目的基于电子病历信息分析心力衰竭(简称“心衰”)住院患者的中医证型的临床特征。方法采用横断面研究方法,收集出院日期为2019年1月1日至2020年12月31日在辽宁中医药大学附属医院心内科住院的所有心衰患者临床资料,提取电子病历信息建立临床中医资料数据库,包括患者基本情况、中医证型及证素、理化指标。分析心衰患者中医证型、证素的分布情况,并对排名前7位不同中医证型患者的基本信息及生化指标进行比较。结果共纳入1676例心衰住院患者,排名前7位的中医证型依次是痰浊血瘀证477例(28.46%)、气虚血瘀证439例(26.19%)、气虚血瘀水停证274例(16.35%)、阳虚水泛证145例(8.65%)、气阴两虚证104例(6.21%)、气阴两虚兼血瘀证80例(4.77%)和心阳亏虚证59例(3.52%)。1676例患者证素分析显示,占比超过5%的证素共有6个,以血瘀占比最高,共1292例(77.09%),其他证素依次为气虚919例(54.83%)、痰498例(29.71%)、水停434例(25.89%)、阳虚215例(12.82%)和阴虚191例(11.40%)。1676例患者中急性心衰1308例,中医证型以痰浊血瘀证为主,共386例(29.51%);慢性心衰368例,中医证型以气虚血瘀证为主,共118例(32.07%)。痰浊血瘀证患者病程最短,为0.3个月;心阳亏虚证病程最长,为15个月。心衰合并冠心病患者中痰浊血瘀证占比最高,心衰合并房颤患者中气虚血瘀水停证占比最高,气虚血瘀水停证及阳虚水泛证患者住院期间应用利尿剂的比例最高,超过86%。7种中医证型在合并疾病(冠心病、陈旧性心肌梗死、房颤等),入院前后药物使用率(静脉型血管扩张剂、强心剂、利尿剂),血氯离子、血尿素、血肌酐、血碳酸氢盐、血白蛋白、血总胆红素水平方面差异有统计学意义(P<0.05)。结论心衰患者中医证型以痰浊血瘀证和气虚血瘀证最为多见,不同中医证型在性别构成、合并疾病、入院前后用药、血液指标等方面具有不同的特征。

Objective To analyse the clinical characteristics of different traditional Chinese medicine(TCM)syndromes in patients with heart failure based on information from electronic medical record.Methods A crosssectional study was conducted to collect clinical data of all inpatients with heart failure in the Department of Cardiology,Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from January 1,2019 to December 31,2020.A database of clinical TCM data was established to explore the characteristics of clinical data of basic informa⁃tion,syndromes and syndrome element types,and biochemical indexes.The distribution of TCM syndromes and syn⁃drome elements in heart failure patients were also analysed,and the basic information and biochemical indexes of the patients with top 7 different TCM syndrome types were compared.Results A total of 1676 inpatients with heart failure were included.The top 7 TCM syndromes of heart failure were syndrome of phlegm turbidity and blood stasis(477 cases,28.46%),syndrome of qi deficiency and blood stasis(439 cases,26.19%),syndrome of qi deficiency and blood stasis with water retention(274 cases,16.35%),syndrome of yang deficiency with water retention(145 cases,8.65%),syndrome of qi and yin deficiency(104 cases,6.21%),syndrome of qi and yin deficiency with blood stasis(80 cases,4.77%),syndrome of heart yang deficiency(59 cases,3.52%).Among the 1676 patients,6 syndrome elements accounted for more than 5%.Blood stasis accounted for the highest proportion of TCM syndrome element type(1292 cases,77.09%),followed by qi deficiency(919 cases,54.83%),phlegm(498 cases,29.71%),water retention(434 cases,25.89%),yang deficiency(215 cases,12.82%)and yin deficiency(191 cases,11.40%).Among the 1676 patients,1308 cases of acute heart failure mainly showed syndrome of phlegm turbidity and blood stasis(386 cases,29.51%),and 368 of chronic heart fai-lure mainly showed syndrome of qi defi⁃ciency and blood stasis(118 cases,32.07%).Patients with syndrome of phlegm turbidity and blood stasis had the shortest disease duration of 0.3 months,while those with syndrome of heart yang deficiency had the longest disease duration of 15 months.The proportion of syndrome of phlegm turbidity and blood stasis was the highest in patients with heart failure combined with coronary artery disease,the proportion of syndrome of qi deficiency and blood stasis with water retention was the highest in patients with heart failure combined with atrial fibrillation,and the proportion of patients with syndrome of qi deficiency and blood stasis with water retention and syndrome of yang deficiency with water retention in those applying diuretics during the hospital stay was the highest with more than 86%.The different 7 TCM syndromes showed statistically difference in patients with complications including coronary artery disease,old myocardial infarction,atrial fibrillation,pre and post-admission medication usage including intravenous vasodilators,cardiac stimulants,diuretics,and level of blood chloride,blood urea,blood creatinine,blood bicarbonate,blood albumin,and blood total bilirubin(P<0.05).Conclusion The most common TCM syndromes in patients with heart failure are syndrome of phlegm turbidity and blood stasis and syndrome of qi deficiency and blood stasis.Different TCM syndromes have different characteristics in gender,disease complications,medication before and after admission,and blood indexes.