先天性心脏病相关性肺动脉高压中医证素分析

Characteristics of TCM pattern factors in patients with pulmonary arterial hypertension associated with congenital heart disease

目的探讨先天性心脏病相关性肺动脉高压(PAH⁃CHD)中医证素特点,分析PAH⁃CHD中医优势证素与疾病预后指标的关系。方法收集2020年10月—2022年1月昆明医科大学附属延安医院心内科就诊的PAH⁃CHD患者,进行中医四诊信息及疾病相关指标数据采集,将患者依据平均肺动脉压(mPAP)程度分为轻度组(25 mmHg≤mPAP≤35 mmHg)、中度组(35 mmHg<mPAP≤50 mmHg)、重度组(mPAP>50 mmHg),使用因子分析及聚类分析研究PAH⁃CHD中医证素分布特点,差异性分析及多元线性回归分析研究中医证素与预后指标N末端B型脑利钠肽前体(NT⁃proBNP)、6 min步行距离(6 MWD)、三尖瓣环收缩期位移(TAPSE)之间的关系。结果研究共纳入146例PAH⁃CHD患者,其中轻度组43例,中度组29例,重度组74例。男性占比、血红蛋白、mPAP和肺血管阻力在重度组最高,其次是中度组,最后是轻度组;肺体循环血流量比在轻度组最大,其次中度组,最后是重度组。PAH⁃CHD患者的高频中医证素为气虚>痰浊>血瘀>水饮。水饮证素的出现伴随着NT⁃proBNP的升高,6 MWD及TAPSE的降低。气虚、水饮、血瘀和痰浊集合可以反映PAH⁃CHD患者最主要的疾病特征。结论气虚、痰浊、血瘀、水饮是PAH⁃CHD患者最主要的证素类别,水饮证素和本病预后有密切联系,把握和应用PAH⁃CHD患者的证素规律,将有助于PAH⁃CHD患者的临床诊疗。

Objective We aimed to investigate the characteristics of pattern factors of traditional Chinese medicine(TCM)in patients with pulmonary arterial hypertension(PAH)associated with congenital heart disease(CHD)and analyze the relationship between the dominant TCM pattern factors in patients with PAH⁃CHD and prognostic indicators.Methods PAH⁃CHD patients from the Department of Cardiology,Yan'an Affiliated Hospital of Kunming Medical University were enrolled from October 2020 to January 2022,and information on the four diagnostic criteria of TCM and disease⁃related indicators was collected.According to the mean pulmonary arterial pressure(mPAP),PAH⁃CHD patients were divided into the mild group(25 mmHg≤mPAP≤35 mmHg),the moderate group(35 mmHg<mPAP≤50 mmHg),and the severe group(mPAP>50 mmHg).Factor analysis and cluster analysis were conducted to study the distribution characteristics of PAH⁃CHD pattern factors,and difference analysis and multiple linear regression analysis were conducted to investigate the relationship between pattern factors and prognostic indicators[N⁃terminal pro⁃B⁃type natriuretic peptide(NT⁃proBNP),6⁃minute walking distance,tricuspid annular plane systolic excursion(TAPSE)].Results A total of 146 PAH⁃CHD patients were included in the study,including 43 in the mild group,29 in the moderate group,and 74 in the severe group.The proportions of males,Hb,mPAP,and pulmonary vascular resistance(PVR)were the highest in the severe group,followed by the moderate group and finally the mild group.The pulmonary/systemic circulation blood flow ratio(Qp/Qs)was the highest in the mild group,followed by the moderate group and finally the severe group.The high⁃frequency pattern factors of PAH⁃CHD patients in each group were qi deficiency>phlegm turbidity>blood stasis>water fluid.The appearance of water fluid is accompanied by an increase in NT⁃proBNP,a decrease in 6-minute walking distance,and a decrease in TAPSE.Qi deficiency,water fluid,blood stasis,and phlegm turbidity are the main disease characteristics of PAH⁃CHD patients.Conclusion Qi deficiency,phlegm turbidity,blood stasis,and water fluid are the main types of pattern factors in PAH⁃CHD patients.Water fluid is closely related to disease prognosis.Understanding the laws of TCM pattern factors in PAH⁃CHD patients will be helpful for the diagnosis and treatment of PAH⁃CHD patients.