300例射血分数保留心力衰竭早期患者的中医证候分布规律研究

Distribution of Chinese medicine syndromes in 300 patients with early stage of heart failure with preserved ejection fraction

目的探讨射血分数保留心力衰竭(heart failure with preserved ejection fraction,HFpEF)早期中医证候分布规律。方法采集中国中医科学院西苑医院300例HFpEF早期患者的临床资料,统计描述患者性别、年龄、身体质量指数、基础疾病、左房内径、相对室壁厚度、E/A、E/e′;参考专家共识中气虚证、血瘀证、水饮证、阳虚证、痰浊证和阴虚证6种证候的诊断标准,对患者中医证候进行评定,不符合明确诊断标准的,则判定为相应的证候倾向。统计描述患者中医证候的分布情况和组合情况、证候倾向的分布情况和组合情况、主要中医证候与证候倾向的组合情况;采用卡方检验比较不同证候患者心脏结构和功能改变情况。结果(1)HFpEF早期患者中医证候以水饮证和痰浊证为主;(2)复合证候以水饮+痰浊二证候组合为主;(3)一些患者呈现出血瘀证和气虚证趋势;(4)水饮证患者相对室壁厚度增厚的频率更高(46.30%,P<0.05),痰浊证患者左房扩大的频率更高(71.10%,P<0.05)。结论HFpEF早期的核心病机为气化不利、水饮内停,基本证候分布以水饮证和痰浊证为主,有呈现血瘀和气虚的倾向。

Objective To investigate the distribution of Chinese syndromes in early stage of heart failure with preserved ejection fraction(HFpEF).Methods Clinical data of 300 patients with early stage of HFpEF in Xiyuan Hospital,China Academy of Chinese Medical Sciences were collected,and the patient’s gender,age,body mass index,basic disease,left atrial diameter,relative wall thickness,E/A,E/e′were statistically described;The diagnosis criteria for six syndromes in the expert consensus,including qi deficiency,blood stasis,water-fluid retention,yang deficiency,phlegm stasis,and yin deficiency,were used to evaluate the patient’s Chinese medicine syndromes.Those who did not meet the diagnostic criteria were determined to have a corresponding syndrome tendency.The distribution and combination of Chinese medicine syndromes of patients,the distribution and combination of Chinese medicine syndrome tendency,and the combination of main Chinese medicine syndromes and tendency were statistically described;Chi-square test was used to compare the changes of cardiac structure and function in patients with different Chinese medicine syndromes.Results(1)The distribution of Chinese medicine syndromes of 300 patients were mainly water-fluid retention pattern and phlegm stasis syndrome;(2)The compound Chinese medicine syndromes was mainly the combination of mainly water-fluid retention and phlegm stasis syndrome;(3)Some patients showed the trend of blood stasis syndrome and qi deficiency syndrome;(4)The frequency of relative wall thickness was higher in patients with water-fluid retention pattern(46.30%,P<0.05),and the frequency of left atrial enlargement was higher in patients with phlegm stasis syndrome(71.10%,P<0.05).Conclusion The core pathogenesis of early stage of HFpEF is disturbance of qihua and water-fluid retention,the distribution of Chinese medicine syndromes is dominated by water-fluid retention pattern and phlegm stasis syndrome,and there is a tendency to show blood stasis and qi deficiency.