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
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摘要
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.
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.
引文
[1]OWAN TE,HODGE DO,HERGES RM,et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction[J]. N Engl J Med,2006,355(3):251-259.
[2]中华医学会心血管病学分会中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12):1076-1095.
[3]第二届中国心力衰竭论坛.射血分数正常心力衰竭诊治的中国专家共识[J].中国医刊,2010,45(11):63-67.
[4]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[5]LANG RM,BIERIG M,DEVEREUX RB,et al. Recommendations for chamber quantification[J]. Eur J Echocardiogr,2006,7(2):79-108.
[6] GOLDMAN L,HASHIMOTO B,COOK EF,et al. Comparative reproducibility and validity of systems for assessing cardiovascular functional class:advantages of a new specific activity scale[J]. Circulation,1981,64(6):1227-1234.
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[8]国家技术监督局.中医临床诊疗术语:证候部分[S].北京:中国标准出版社,1997:1-12.
[9]朱文锋.中医诊断学[M].北京:中国中医药出版社,2002:176-181.
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[11]吴崇胜,陈家旭,胡立胜. Delphi法建立中医证候诊断标准中权重系数确定法新探:双百分法[J].中国中医基础医学杂志,2006,12(4):254-255.
[12]赵志强,毛静远,王贤良,等.慢性心力衰竭急性加重期中医证候特征的多中心调查分析[J].中医杂志,2013,54(12):1038-1042.
[13]MCMURRAY JJ,ADAMOPOULOS S,ANKER SD,et al.ESC Guidelines for the diagnosis andtreatment of acute and chronic heart failure 2012:the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association(HFA)of the ESC[J]. Eur Heart J,2012,33(14):1787-1847.
[14]Meta-analysis Global Group in Chronic Heart Failure(MAGGIC). The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction:an individual patient data meta analysis[J]. Eur Heart J,2012,33(14):1750-1757.
[15]LAM CS,DONAL E,KRAIGHER-KRAINER E,et al.Epidemiology and clinical course of heart failure with preserved ejection fraction[J]. Eur J Heart Fail,2011,13(1):18-28.
[16]LEE DS,GONA P,VASAN RS,et al. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction:insights from the framingham heart study of the national heart,lung,and blood institute[J]. Circulation,2009,119(24):3070-3077.
[17]PARISSIS JT,IKONOMIDIS I,RAFOULI-STERGIOU P,et al. Clinical characteristics and predictors of inhospital mortality in acute heart failure with preserved left ventricular ejection fraction[J]. Am J Cardiol,2011,107(1):79-84.
[18]FONAROW GC,STOUGH WG,ABRAHAM WT,et al.Characteristics,treatments,and outcomes of patients with preserved systolic function hospitalized for heart failure:a report from the OPTIMIZE-HF Registry[J]. J Am Coll Cardiol,2007,50(8):768-777.
[19]KITZMAN DW,LITTLE WC,BRUBAKER PH,et al.Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure[J].JAMA,2002,288(17):2144-2150.
[20]Steinberg B A Z X H P. Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction:prevalence,therapies,and outcomes[J]. Circulation,2012,126(1):65-75.
[21]BURSI F,WESTON SA,REDFIELD MM. Systolic and diastolic heart failure in the community[J]. JAMA,2006,296(18):2209-2216.
[22]BROUWERS FP,DE BOER RA,VAN DER HARST P.Incidence and epidemiology of new onset heart failure with preserved vs. reduced ejection fraction in a communitybased cohort:11-year follow-up of PREVEND[J]. Eur Heart J,2013,34(19):1424-1431.
[23]OLSSON LG,SWEDBERG K,DUCHARME A,et al. Atrial fibrillation and risk of clinical events inchronic heart failure with and without left ventricular systolic dysfunction:results from the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity(CHARM)program[J]. J Am Coll Cardiol,2006,47(10):1997-2004.
[24]ANDERSSON C,VASAN RS. Epidemiology of heart failure with preserved ejection fraction[J]. Heart Fail Clin,2014,10(3):377-388.
[25]张环,李涛.舒张性心力衰竭与收缩性心力衰竭临床特征的比较[J].心脏杂志,2014,26(4):440-442.
[26]O'MAHONY MS,SIM MF,HO SF,et al. Diastolic heart failure in older people[J]. Age Ageing,2003,32(5):519-524.
[27]XU SD,SU GH,LU YX,et al. Elevated soluble ST2and depression increased the risk of all-cause mortality and hospitalization in patients with heart failure[J]. Int Heart J,2014,55(5):445-450.
[28]汤岐梅,赵志强,王贤良,等.射血分数正常心力衰竭的辨证及治疗[J].中医杂志,2017,58(14):1241-1243.
[2]中华医学会心血管病学分会中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12):1076-1095.
[3]第二届中国心力衰竭论坛.射血分数正常心力衰竭诊治的中国专家共识[J].中国医刊,2010,45(11):63-67.
[4]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[5]LANG RM,BIERIG M,DEVEREUX RB,et al. Recommendations for chamber quantification[J]. Eur J Echocardiogr,2006,7(2):79-108.
[6] GOLDMAN L,HASHIMOTO B,COOK EF,et al. Comparative reproducibility and validity of systems for assessing cardiovascular functional class:advantages of a new specific activity scale[J]. Circulation,1981,64(6):1227-1234.
[7]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:72-73.
[8]国家技术监督局.中医临床诊疗术语:证候部分[S].北京:中国标准出版社,1997:1-12.
[9]朱文锋.中医诊断学[M].北京:中国中医药出版社,2002:176-181.
[10]JOHNSTON M,POLLARD B,HENNESSEY P. Construct validation of the hospital anxiety and depression scale with clinical populations[J]. J Psychosom Res,2000,48(6):579-584.
[11]吴崇胜,陈家旭,胡立胜. Delphi法建立中医证候诊断标准中权重系数确定法新探:双百分法[J].中国中医基础医学杂志,2006,12(4):254-255.
[12]赵志强,毛静远,王贤良,等.慢性心力衰竭急性加重期中医证候特征的多中心调查分析[J].中医杂志,2013,54(12):1038-1042.
[13]MCMURRAY JJ,ADAMOPOULOS S,ANKER SD,et al.ESC Guidelines for the diagnosis andtreatment of acute and chronic heart failure 2012:the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association(HFA)of the ESC[J]. Eur Heart J,2012,33(14):1787-1847.
[14]Meta-analysis Global Group in Chronic Heart Failure(MAGGIC). The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction:an individual patient data meta analysis[J]. Eur Heart J,2012,33(14):1750-1757.
[15]LAM CS,DONAL E,KRAIGHER-KRAINER E,et al.Epidemiology and clinical course of heart failure with preserved ejection fraction[J]. Eur J Heart Fail,2011,13(1):18-28.
[16]LEE DS,GONA P,VASAN RS,et al. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction:insights from the framingham heart study of the national heart,lung,and blood institute[J]. Circulation,2009,119(24):3070-3077.
[17]PARISSIS JT,IKONOMIDIS I,RAFOULI-STERGIOU P,et al. Clinical characteristics and predictors of inhospital mortality in acute heart failure with preserved left ventricular ejection fraction[J]. Am J Cardiol,2011,107(1):79-84.
[18]FONAROW GC,STOUGH WG,ABRAHAM WT,et al.Characteristics,treatments,and outcomes of patients with preserved systolic function hospitalized for heart failure:a report from the OPTIMIZE-HF Registry[J]. J Am Coll Cardiol,2007,50(8):768-777.
[19]KITZMAN DW,LITTLE WC,BRUBAKER PH,et al.Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure[J].JAMA,2002,288(17):2144-2150.
[20]Steinberg B A Z X H P. Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction:prevalence,therapies,and outcomes[J]. Circulation,2012,126(1):65-75.
[21]BURSI F,WESTON SA,REDFIELD MM. Systolic and diastolic heart failure in the community[J]. JAMA,2006,296(18):2209-2216.
[22]BROUWERS FP,DE BOER RA,VAN DER HARST P.Incidence and epidemiology of new onset heart failure with preserved vs. reduced ejection fraction in a communitybased cohort:11-year follow-up of PREVEND[J]. Eur Heart J,2013,34(19):1424-1431.
[23]OLSSON LG,SWEDBERG K,DUCHARME A,et al. Atrial fibrillation and risk of clinical events inchronic heart failure with and without left ventricular systolic dysfunction:results from the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity(CHARM)program[J]. J Am Coll Cardiol,2006,47(10):1997-2004.
[24]ANDERSSON C,VASAN RS. Epidemiology of heart failure with preserved ejection fraction[J]. Heart Fail Clin,2014,10(3):377-388.
[25]张环,李涛.舒张性心力衰竭与收缩性心力衰竭临床特征的比较[J].心脏杂志,2014,26(4):440-442.
[26]O'MAHONY MS,SIM MF,HO SF,et al. Diastolic heart failure in older people[J]. Age Ageing,2003,32(5):519-524.
[27]XU SD,SU GH,LU YX,et al. Elevated soluble ST2and depression increased the risk of all-cause mortality and hospitalization in patients with heart failure[J]. Int Heart J,2014,55(5):445-450.
[28]汤岐梅,赵志强,王贤良,等.射血分数正常心力衰竭的辨证及治疗[J].中医杂志,2017,58(14):1241-1243.