300例射血分数保留心力衰竭患者的中医证候分布规律

Distribution of traditional Chinese medicine syndrome of 300 patients with heart failure with preserved ejection fraction

目的基于射血分数保留心力衰竭(heart failure with preserved ejection fraction,HFpEF)基本证候要素的病证结合诊断标准分析HFpEF的证候特征及分布规律。方法纳入300例符合标准的HFpEF患者,收集证候诊断所需信息及相关临床资料,统计单个证素、证素组合的频数分布,并采用两步聚类法探讨主要证型的划分。结果(1)300例HFpEF患者单个证素的出现频率依次为:气虚(97.0%)、血瘀(92.7%)、水饮(79.7%)、痰浊(55.0%)、阴虚(44.7%)、阳虚(36.3%)。(2)同时具有4证素和5证素的患者最多,分别占39.0%和30.3%。(3)患者以虚实夹杂证(94.0%)为主,纯虚证(3.0%)和纯实证(3.0%)较少。(4)300例患者共出现15种证素组合,通过两步聚类可分为8类,每类患者均有气虚、血瘀。结论HFpEF的病机关键为气虚、血瘀、水饮,气虚是始动因素,气虚血瘀为基本证候,可分为气虚血瘀、气阴两虚血瘀、阳气亏虚血瘀和阴阳两虚血瘀4种证型。

Objective To analyze the characteristics and distribution of traditional Chinese medicine(TCM)syndromes of heart failure with preserved ejection fraction(HFpEF)based on the diagnostic criteria for basic syndrome elements of HFpEF.Methods 300 eligible patients with HFpEF were included.The information required for diagnosis of syndrome and related clinical data were collected.The frequency distribution of single syndrome element and syndrome element combination were counted,and the classification of main syndrome types was discussed by two-step cluster analysis.Results(1)The occurrence frequency of single syndrome element in 300 HFpEF patients was as follows:qi deficiency(97.0%),blood stasis(92.7%),fluid retention(79.7%),phlegm(55.0%),yin deficiency(44.7%)and yang deficiency(36.3%).(2)The patients with 4 syndrome elements and 5 syndrome elements were the most,accounting for 39.0%and 30.3%respectively.(3)The excess syndrome,deficiency syndrome and combination of both were respectively accounted for 3.0%,3.0%and 94.0%.(4)There were 15 combinations of syndrome elements in 300 patients,which could be divided into 8 categories by two-step cluster analysis and each category of patients had qi deficiency and blood stasis.Conclusion Qi deficiency,blood stasis and fluid retention are the critical pathogenesis of HFpEF.Qi deficiency is the initial factor,and deficient qi combined blood stasis is the basic syndrome of HFpEF.The TCM syndrome types of HFpEF can be divided into deficient qi combined blood stasis,deficient qi and yin combined blood stasis,deficient qi and yang combined blood stasis and deficient yin and yang combined blood stasis.