基于前瞻性临床流行病学调查的射血分数正常心力衰竭中医证候特征分析

Characteristics of Traditional Chinese Medicine Syndrome in Patients of Heart Failure with Normal Ejection Fraction: Based on a Prospective Clinical Epidemiological Survey

目的探讨射血分数正常心力衰竭(HFNEF)患者的中医证候特征,并与射血分数减少心力衰竭(HFREF)患者进行比较。方法选择HFNEF、HFREF患者各60例,分别组成HFNEF和HFREF组,采用现场问卷调查方式,制定调查量表,采集人口学特征、疾病相关信息、中医四诊信息及中医证候要素等数据,建立数据库。采用双百分法对中医证候要素进行权重系数分析。结果一般流行病学特征:HFNEF组患者平均年龄、女性、高血压病、心房颤动比例均高于HFREF组,吸烟、饮酒、冠心病、陈旧心肌梗死、糖尿病患者比例均低于HFREF组(P <0. 05)。中医证候要素分布:两组患者主要本虚性证候要素为气虚、阴虚、阳虚,主要标实性证候要素为血瘀、痰浊、水饮、热蕴、阳亢等;对两组中医证候要素权重系数进行比较,HFNEF组阴虚、痰浊、水饮、热蕴、津亏、阳亢权重系数(195. 87、149. 58、105. 45、71. 16、50. 00、21. 16)均高于HFREF组(113. 68、133. 68、82. 62、45. 44、16. 03、9. 40); HFNEF组气虚、血瘀、气滞、阳虚等权重系数(287. 85、254. 28、41. 67、22. 40)均低于HFREF组(305. 56、269. 23、79. 77、61. 83)。结论 HFNEF与HFREF中医证候特征均为本虚标实,气虚、血瘀均是两类患者的典型中医证候特征,但与HFREF相比,HFNEF患者本虚性证候要素中阴虚较为突出,标实性证候要素中痰浊、水饮、热蕴较为突出。

Objective To analyze the traditional Chinese medicine(TCM)syndrome characteristics of heart failure with normal ejection fraction(HFNEF)patients and compare with the patients of heart failure with reduced ejection fraction(HFREF).Methods A total of 60 patients with HFNEF and 60 patients with HFREF were selected as the HFNEF group and HFREF group.On-site questionnaire survey was used to collect demographic characteristics,disease-related information,the four diagnostic information of TCM,and the TCM syndrome elements to establish a database.The weight coefficient of TCM syndrome elements was analyzed by double percentage method.Results General epidemiological characteristics:the average age,proportion of female patients and proportion of patients with the history of hypertension or atrial fibrillation in HFNEF group were all higher than those in HFREF group.The proportion of smoking or drinking patients and those of patients with the history of coronary heart disease or old myocardial infarction or diabetes were all lower than those of HFREF group with significant difference(P<0.05).TCM syndrome elements distribution:qi deficiency,yin deficiency and yang deficiency were the main root deficiency syndrome elements in patients with HFNEF;blood stasis,phlegm turbidity,water retention,heat accumulation and yang hyperactivity.were the main manifestation excess syndrome elements.Comparison of the weight coefficient of TCM syndrome elements of both groups showed the weight coefficients of yin deficiency,phlegm turbidity,water retention,heat accumulation,fluid deficiency and yang hyperactivity in the HFNEF group(195.87,149.58,105.45,71.16,50.00,21.16)were respectively higher than those in the HFREF group(113.68,133.68,82.62,45.44,16.03,9.40);the weight coefficients of qi deficiency,blood stasis,qi stagnation and yang deficiency(287.85,254.28,41.67,22.40)were respectively lower than those in the HFREF group(305.56,269.23,79.77,61.83).Conclusion Deficiency in root and excess in manifestations are the main characteristics of TCM syndrome elements in either HFNEF group or HFREF group.Qi deficiency and blood stasis are the typical TCM syndrome characteristics of both groups.However,compared with HFREF,yin deficiency is more common in the root deficiency syndromes and the excess syndrome elements such as the phlegm turbidity,water retention and heat accumulation are more prominent in patients with HFNEF.