中医药防治射血分数保留心力衰竭的研究范式思考

Research paradigm reflection on the prevention and treatment of heart failure with preserved ejection fraction with traditional Chinese medicine

射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)发病率逐年递增,患病人数庞大,如何发挥中医药防治HFpEF优势、提升中医药防治HFpEF能力成为关键。针对HFpEF自身发病特点和目前存在的问题,本文对中医药防治HFpEF的研究范式进行了探讨:(1)建立HFpEF病名、诊断、疗效评价于一体的标准化体系,从顶层设计确保研究的可比性,促进中医药研究走向国际化;(2)立足于规模化群防群治,在病证结合思路指导下分疾病阶段、抓核心病机形成核心方进行序贯治疗,在规模化防治中总结和提升疗效;(3)多学科交叉合作,对不同亚型的HFpEF诊治方案和临床转归做出精准决策;(4)在健康中国战略思维指导下,着眼长期可持续性发展,从“以预防为主,防治结合,中西医并重”的治疗理念逐渐发展到“以健康为中心”的治未病理念,从治疗HFpEF到关注HFpEF患者,再到从全局关注全生命周期的健康逐步转变。

The incidence rate of heart failure with preserved ejection fraction(HFpEF)is increasing year by year and the number of patients is huge.At present,the prevention and treatment methods of Western medicine are limited,which makes it crucial to exert and enhance the prevention and treatment advantages of traditional Chinese medicine(TCM).Pinpointing to the characteristics and current problems of HFpEF,this article reviewed the research paradigm of TCM on the prevention and treatment of HFpEF.(1)A standardized system that integrates HFpEF disease name,diagnosis and efficacy evaluation should be established,which will ensure the comparability among research by top-level design,and promote the internationalization of TCM research.(2)Based on the principle of large-scale mass prevention and treatment,guided by the combination of disease and syndrome,sequential treatment should be carried out by dividing the disease into different stages and focusing on the core pathogenesis to form a core formula,during which,summarize and improve the clinical therapeutic effect.(3)Multi disciplinary collaboration should be emphasized to make precise decisions on the diagnosis,treatment and prognosis of different subtypes of HFpEF.(4)Under the guidance of the healthy China strategic thinking,with a focus on long-term sustainable development,the treatment concept should gradually evolve from prevention first,prevention and treatment combined,and equal emphasis on TCM and Western medicine’to a‘health and wellness centered’prevention concept,from treating HFpEF to focusing on HFpEF patients,and then shift gradually from focusing on overall health to throughout the entire lifecycle.