不同中医证型的老年慢性心力衰竭患者营养风险指数及糖脂代谢比较

Comparison of geriatric nutritional risk index and glycolipid metabolism indicators among elderly chronic heart failure pa⁃tients with different TCM syndrome types

目的比较不同证型慢性心力衰竭(CHF)老年患者营养指标及糖脂代谢特点。方法回顾性分析2021年6月至2023年10月在河南省滑县中医院就诊的126例老年CHF患者病历资料,按照中医辩证分为气阴两虚证组(n=42)、心肺气虚证组(n=28)、气虚血瘀证组(n=33)和心肾阳虚证组(n=23)。比较4组患者临床资料(年龄、性别、身体质量指数、血压)、心功能指标[心功能等级、6分钟步行试验(6MWT)距离、左室射血分数(LVEF)、左室收缩末期内径(LVESD)和左室舒张末期内径(LVEDD)]、糖脂代谢指标[空腹血糖(FBG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)]及营养指标[清蛋白(Alb)、老年营养风险指数(GNRI)]差异。结果心肾阳虚证组LVEF低于气阴两虚证组及心肺气虚证组(P均<0.05);气阴两虚证组Alb低于心肺气虚证组、气虚血瘀证组、心肾阳虚证组,GNRI低于心肺气虚证组与心肾阳虚证组,有营养不良风险患者比例高于心肺气虚证组、气虚血瘀证组、心肾阳虚证组(P<0.05);气虚血瘀证组TC及LDL-C均高于气阴两虚证组、心肺气虚证组、心肾阳虚证组,TG高于心肾阳虚证组(P<0.05)。结论不同中医证型CHF患者的营养风险及糖脂代谢特点不同,其中气阴两虚证患者营养风险较高,气虚血瘀证患者血脂水平相对较高,心肾阳虚证患者心功能相对较差,中医临床辨证治疗时可针对证型有所偏重。

Objective To compare the nutritional indexes and glycolipid metabolism indexes of elderly chronic heart failure(CHF)pa⁃tients with different tranditional Chinese medicine(TCM)syndromes.Methods The clinical data of 126 elderly patients with CHF who treated in Huaxian Hospital of TCM from June 2021 to October 2023 were analyzed retrospectively.According to TCM dialectical analysis,they were divided into the deficiency of both Qi and Yin group(n=42),Qi deficiency of heart and lung group(n=28),Qi deficiency and and blood-stasis group(n=33)and Yang deficiency of heart and kidney group(n=23).The differences in clinical data(age,sex,body mass index,blood pres⁃sure),cardiac function indexes[(cardiac function grade,6-minute walking test(6MWT)distance,left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD)and left ventricular end-diastolic diameter(LVEDD)],glycemic and lipid metabolism indexes(fast⁃ing blood glucose,HbA1c,total cholesterol(TC),triacylglycerol(TG),high density lipoprotein(HDL-C)and low density lipoprotein(LDL-C)and nutritional indexes[albumin(Alb)and geriatric nutritional risk index(GNRI)]among the four groups were compared.Results The LVEF of Yang deficiency of heart and kidney group was lower than that of deficiency of both Qi and Yin group and Qi deficiency of heart and lung group(all P<0.05).The Alb in deficiency of both Qi and Yin syndrome group was lower than that in Qi deficiency of heart and lung group,Qi defieiency and and blood-stasis group and Yang deficiency of heart and kidney group(all P<0.05),The GNRI was lower than that of Qi defi⁃ciency of heart and lung group and Yang deficiency of heart and kidney,and the proportion of patients with malnutrition risk was significantly higher than that of Qi deficiency of heart and lung group,Qi deficiency and blood stasis and Yang deficiency of heart and kidney group(all P<0.05);the TC and LDL-C in Qi-deficiency and blood-stasis group were higher than those in the deficiency of both Qi and Yin group,Qideficiency of heart and lung group and Yang deficiency of heart and kidney group(P<0.05),and the TG was higher than that of the Yang defi⁃ciency of heart and kidney group(P<0.05).Conclusions The nutritional risk and glucose and lipid metabolism characteristics of CHF pa⁃tients with different TCM syndrome types are different.Among them,the nutritional risk of patients with deficiency of both Qi and Yin syn⁃drome is higher,the blood lipid level of patients with Qi deficiency and blood-stasis syndrome is relatively higher,and the heart function of pa⁃tients with Yang deficiency of heart and kidney syndrome is relatively poor.Therefore,TCM clinical dialectical treatment can be specific to dif⁃ferent syndrome types.