首页|慢性心力衰竭不同中医证型患者生存质量评价及与危险因素的相关性研究

慢性心力衰竭不同中医证型患者生存质量评价及与危险因素的相关性研究

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目的:探讨慢性心力衰竭(CHF)不同中医证型患者心功能指标和生存质量的差异,以及不同中医证型与CHF危险因素的相关性.方法:选取我院2018年6月~2023年6月期间收治的60~90岁慢性心力衰竭患者100例作为对象,其中气虚血瘀证31例、阳气亏虚血瘀证23例、心阳不振血瘀证22、气阴两虚血瘀证18例、痰瘀内阻血瘀证6例.收集各证型患者症状、舌苔脉象、心功能分级、心力衰竭分层、心功能相关指标检测数据以及健康量表36(SF-36量表)评分等相关信息,并对收集到的数据进行统计分析,探讨不同中医证型患者的生存质量及其与危险因素的相关性.结果:(1)5个不同类型的中医辨证论治之间,各类型的心功能等级及各类型的心衰层次的分布比例有显著性(P<0.05).Ⅰ级、Ⅲ级和Ⅳ级的心功能评分18.00%、51.00%、31.00%,其中Ⅱ级患者以阳气亏虚血瘀证占比最高(10,43.48%)、Ⅲ级患者气虚血瘀证占比最高(17,54.84%)、Ⅳ级患者以心阳不振血瘀证占比最高(9,40.91%);心力衰竭分层中,射血分数下降心衰(HFrEF)患者以气阴两虚血瘀证占比最高(6,33.33%)、射血分数临界值心衰(HFmrEF)患者以气虚血瘀证占比最高(16,51.61%)、射血分数保留心衰(HFpEF)以心阳不振血瘀证占比最高(10,45.45%).(2)5种证型患者LVDD、LVEF水平比较无统计学意义(P>0.05),N端-B型钠尿肽原(NT-proBNP)水平比较差异具有统计学意义(P<0.05).(3)各证型患者SF-36量表评分中气虚血瘀证PF评分显著高于其他证型(P<0.05);气阴两虚血瘀证GH评分显著低于其他证型(P<0.05);气虚血瘀证VT评分显著高于气阴两虚血瘀证(P<0.05).(4)在"血瘀证"中,冠心病(OR=2.236)、心律失常(OR=1.582)为其主要的风险因子(P<0.05或P<0.01).其中冠心病的影响程度较大,且CHF患者的中医证型与冠心病和心脏瓣膜病之间存在着显著的相关性(P<0.05或P<0.01).结论:在CHF中,气虚血瘀证是一个较为稳定的时期,以Ⅲ级为主,NT-proBNP含量偏低.在气虚血瘀证向着其他证候类型的转换过程中,心功能Ⅳ类的比例逐渐增加,而NT-proBNP的含量则呈上升趋势;心功能分级及中医证型与心力衰竭患者生活质量密切相关;心衰伴冠心病、心律失常者多见血瘀;高血压伴冠心病、心瓣膜病者多见气虚;合并高血压和扩张型心肌病者多见阳虚.
Evaluation of quality of life and its correlation with risk factors in patients with chronic heart failure with different TCM syndromes
Objective:To investigate the differences in cardiac function indicators and quality of life in patients with chronic heart failure(CHF)with different TCM syndrome types,and the correlation between different TCM syndrome types and CHF risk factors.Methods:100patients with chronic heart failure aged 60~90who were admitted to our hospital from June 2018to June 2023were selected as the research objects,including 31cases of Qi deficiency and blood stasis syndrome and 23cases of Yang Qi deficiency and blood stasis syndrome 22cases of heart-yang deficiency and blood stasis syndrome,18cases of Qi and Yin deficien-cy and blood stasis syndrome,and 6cases of phlegm and blood stasis syndrome.Collect relevant information such as symptoms,tongue and pulse,heart function classification,heart failure stratification,heart function-related index detection data and health scale 36(SF-36scale)scores of patients with various syndrome types,and make statistics on the collected data To analyze and explore the quality of life of patients with different TCM syndrome types and its correlation with risk factors.Results:(1)Among the 5different types of TCM syndrome differentiation and treatment,the distribution ratio of each type of heart function level and each type of heart failure level was significant(P<0.05).The heart function scores of grades Ⅰ,Ⅲ and Ⅳ were 18.00%,51.00%,and 31.00%,among which the patients with grade Ⅱ had the highest proportion of Yang Qi deficiency and blood stasis syndrome(10,43.48%),and the patients with grade Ⅲ had Qi deficiency and blood stasis syndrome.The proportion was the highest(17,54.84%),and the highest proportion was heart yang deficiency and blood stasis in patients with grade Ⅳ(9,40.91%);in the stratification of heart failure,patients with heart failure with reduced ejection fraction(HFrEF)were divided into Qi and Yin Deficiency and blood stasis syndrome accounted for the highest proportion(6,33.33%),patients with heart fail-ure with borderline ejection fraction(HFmrEF)had the highest proportion of qi deficiency and blood stasis syndrome(16,51.61%),heart failure with preserved ejection fraction(HFpEF)The heart-yang deficiency and blood stasis syndrome accoun-ted for the highest proportion(10,45.45%).(2)There was no statistical significance in the levels of LVDD and LVEF among the five syndrome types(P>0.05),but there was a statistically significant difference in the levels of N-terminal-proB-type na-triuretic peptide(NT-proBNP)(P<0.05).(3)The PF score of Qi deficiency and blood stasis syndrome in the SF-36scale score of each syndrome type was significantly higher than that of other syndrome types(P<0.05);the GH score of Qi deficiency and blood stasis syndrome was significantly lower than that of other syndrome types(P<0.05);the VT score of Qi deficiency and blood stasis syndrome was significantly higher than that of Qi and Yin deficiency and blood stasis syndrome(P<0.05).(4)In"blood stasis syndrome",coronary heart disease(OR=2.236)and arrhythmia(OR=1.582)were the main risk factors(P<0.05or P<0.01).Among them,coronary heart disease has a greater impact,and there is a significant correlation between the TCM syndrome types of CHF patients and coronary heart disease and heart valve disease(P<0.05or P<O.01).Conclusion:In CF,qi deficiency and blood stasis syndrome is a relatively stable period,mainly grade Ⅲ,and NT-proBNP content is low.Dur-ing the transition from qi-deficiency and blood-stasis syndrome to other syndrome types,the proportion of cardiac function catego-ry Ⅳ gradually increased,while the content of NT-proBNP showed an upward trend;cardiac function classification and TCM syn-drome types are closely related to the quality of life of heart failure patients Blood stasis is more common in heart failure with coro-nary heart disease and arrhythmia;qi deficiency is more common in hypertension with coronary heart disease and valvular disease;yang deficiency is more common in hypertension with DCM.

chronic heart failurerisk factorsquality of lifeTCM syndrome types

尚元宝、杜正银、吴凡

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怀远县中医院老年病科,安徽怀远 233400

安徽中医药大学,安徽合肥 230012

中医证型 生存质量 危险因素 心力衰竭

安徽省中医药传承创新科研项目

2020ccyb02

2024

四川中医
四川省中医药学会,四川省中西医结合学会,四川省针灸学会,四川省中医药科学院

四川中医

CSTPCD
影响因子:0.522
ISSN:1000-3649
年,卷(期):2024.42(2)
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