高血压致慢性心力衰竭中医证型危险因素的Logistic分析
|
摘要
目的:探讨高血压所致慢性心力衰竭患者中医证候分型规律,并对其进行相关因素的Logistic回归分析。方法:选取符合标准的506例慢性心力衰竭患者进行中医辨证分型,并详细记录患者的有关资料。1)通过利用Pearson相关性分析,研究中医证型分布与年龄、性别、病程、收缩压、舒张压、NYHA分级、EF值、心肌重构(心房重构、心室重构、房室重构)、心律失常及NT-proBNP、SCR、BUN、hs-CRP等检查指标之间的相关性。2)采用二分类Logistics回归分析对年龄、性别、病程、收缩压、舒张压、NYHA分级、EF值、心肌重构(心房重构、心室重构、房室重构)、心律失常及NT-proBNP、SCR、BUN、Hs-CRP等因素对中医证型分布情况的影响进行回归分析。结果:随着年龄的增长,高血压心力衰竭患者易表现为气虚血瘀证、气阴两虚证;随着病程的进展,患者易出现气虚血瘀证、阳虚水泛证;随着心功能的下降,患者易出现阳虚水泛证;随着肌酐(Scr)和尿素氮(BUN)的升高,患者易出现痰浊闭阻证;随着高敏C反应蛋白(hs-CRP)的升高,患者易出现痰瘀互结证。结论高血压导致慢性心力衰竭的主要证型为气阴两虚证和痰瘀互结证。年龄为气虚血瘀证、气阴两虚证的危险因素;病程为气虚血瘀证和阳虚水泛证的危险因素; NT-proBNP为阳虚水泛证的危险因素; SCR、BUN为痰浊闭阻证的危险因素; hs-CRP为痰瘀互结证的危险因素;心功能为阳虚水泛证的保护性因素。
Objective: To discuss the laws of TCM differentiation patterns in patients with chronic heart failure caused by hypertension,and to conduct logistic regression analysis of related factors. Methods: A total of 506 patients with chronic heart failure were classified according to TCM pattern differentiation,and relevant data were recorded in detail. Results: It was found that,with age,hypertensive heart failure patients tend to develop into the pattern of qi deficiency and blood stasis,and the pattern of deficiency of both qi and yin. With the progress of the disease course,patients were prone to qi deficiency and blood stasis pattern,and yang deficiency with water flooding pattern. With the decline of cardiac function,patients were prone to the pattern of yang deficiency with water flooding. With the increase of SCR and BUN,patients are prone to the pattern of sputum turbidity and obstruction. With the increase of Hs-CRP,patients were prone to phlegm stasis binding pattern. Conclusion: The study of pattern classification laws of chronic heart failure caused by hypertension,and the logistic regression analysis of its related factors,certain references were provided for the rationality and norms of the prevention and treatment of such disease via Chinese medicine.
Objective: To discuss the laws of TCM differentiation patterns in patients with chronic heart failure caused by hypertension,and to conduct logistic regression analysis of related factors. Methods: A total of 506 patients with chronic heart failure were classified according to TCM pattern differentiation,and relevant data were recorded in detail. Results: It was found that,with age,hypertensive heart failure patients tend to develop into the pattern of qi deficiency and blood stasis,and the pattern of deficiency of both qi and yin. With the progress of the disease course,patients were prone to qi deficiency and blood stasis pattern,and yang deficiency with water flooding pattern. With the decline of cardiac function,patients were prone to the pattern of yang deficiency with water flooding. With the increase of SCR and BUN,patients are prone to the pattern of sputum turbidity and obstruction. With the increase of Hs-CRP,patients were prone to phlegm stasis binding pattern. Conclusion: The study of pattern classification laws of chronic heart failure caused by hypertension,and the logistic regression analysis of its related factors,certain references were provided for the rationality and norms of the prevention and treatment of such disease via Chinese medicine.
引文
[1]Braunwald E.The war against heart failure:the Lancet lecture[J].Lancet,2015,385(9970):812-824.
[2]Costalunga A,Gavazzi A.Effect of carvedilol on outcome after myocardial infarction in patients with left ventricular dysfunction:the CAPRICORN randomized trial[J].Ital Heart J Suppl,2001,2(11):1246-1247.
[3]中国心血管病报告编写组.《中国心血管病报告2016》概要[J].中国循环杂志,2017,32(6):521-530.
[4]杨建波,王晓峰.慢性心力衰竭的中医研究概况[J].新疆中医药,2008,26(2):71-74.
[5]国家食品药品监督管理局.中药新药临床研究指导原则试行)[S].北京:中国医药科技出版社,2002:84-85.
[6]中华人民共和国卫生部.中药新药临床研巧指导原则(试行)[S].北京:中国医药科技出版社,2002:73-77.
[7]沈自尹,王文健.中医虚证辨证参考标准[J].中西医结合杂志,1986,6(10):598.
[8]王阶,陈可冀,翁维良等.血瘀证诊断标准的研究[J].中西医结合杂志,1988,8(10):585-589.
[9]李立志.陈可冀治疗充血性心力衰竭经验[J].中西医结合心脑血管病杂志学,2006,4(2):136-138.
[10]王振涛.充血性心力衰竭辨治体验[J].四川中医,2005,23(6):9-10.
[11]祝肇刚.施今墨学术思想概述[J].中医药图书情报,1989,8(3):1-2.
[12]于天星,李祥国.赵锡武老中医治疗慢性充血性心力衰竭的经验[J].新医药学杂志,1978,24(11):7-10.
[13]朱贤慧.唐蜀华教授衷中参西辨治心力衰竭临床经验[J].南京中医药大学学报,2013,29(3):277-279.
[14]陈灏珠.内科学[M].8版.北京:人民卫生出版社,2013:257.
[15]宫苏娜.补肾和脉方治疗社区高血压的疗效评价:诊室血压研究[D].济南:山东中医药大学,2017.
[16]赵庆高.原发性高血压患者不同中医体质间早期肾损害指标比较及相关性分析[D].北京:北京中医药大学,2013.
[17]隋辉,陈伟伟,王文.《中国心血管病报告2014》要点介绍[J].中华高血压杂志,2015,23(7):627-629.
[18]王增武,武阳丰,赵连成,等.中国中年人群高血压患病率及知晓率、治疗率、控制率的演变趋势[J].中华流行病学杂志,2004,25(5):407-411.
[19]贺泽龙,郭振球.充血性心力衰竭中医证候的临床回顾性调查研究[J].湖南中医学院学报,2003,23(5):33-36.
[20]孙艺英,李长生.充血性心力衰竭辨证分型与血浆BNP、血清CRP相关性研究[J].山东医药,2008,48(13):53-54.
[2]Costalunga A,Gavazzi A.Effect of carvedilol on outcome after myocardial infarction in patients with left ventricular dysfunction:the CAPRICORN randomized trial[J].Ital Heart J Suppl,2001,2(11):1246-1247.
[3]中国心血管病报告编写组.《中国心血管病报告2016》概要[J].中国循环杂志,2017,32(6):521-530.
[4]杨建波,王晓峰.慢性心力衰竭的中医研究概况[J].新疆中医药,2008,26(2):71-74.
[5]国家食品药品监督管理局.中药新药临床研究指导原则试行)[S].北京:中国医药科技出版社,2002:84-85.
[6]中华人民共和国卫生部.中药新药临床研巧指导原则(试行)[S].北京:中国医药科技出版社,2002:73-77.
[7]沈自尹,王文健.中医虚证辨证参考标准[J].中西医结合杂志,1986,6(10):598.
[8]王阶,陈可冀,翁维良等.血瘀证诊断标准的研究[J].中西医结合杂志,1988,8(10):585-589.
[9]李立志.陈可冀治疗充血性心力衰竭经验[J].中西医结合心脑血管病杂志学,2006,4(2):136-138.
[10]王振涛.充血性心力衰竭辨治体验[J].四川中医,2005,23(6):9-10.
[11]祝肇刚.施今墨学术思想概述[J].中医药图书情报,1989,8(3):1-2.
[12]于天星,李祥国.赵锡武老中医治疗慢性充血性心力衰竭的经验[J].新医药学杂志,1978,24(11):7-10.
[13]朱贤慧.唐蜀华教授衷中参西辨治心力衰竭临床经验[J].南京中医药大学学报,2013,29(3):277-279.
[14]陈灏珠.内科学[M].8版.北京:人民卫生出版社,2013:257.
[15]宫苏娜.补肾和脉方治疗社区高血压的疗效评价:诊室血压研究[D].济南:山东中医药大学,2017.
[16]赵庆高.原发性高血压患者不同中医体质间早期肾损害指标比较及相关性分析[D].北京:北京中医药大学,2013.
[17]隋辉,陈伟伟,王文.《中国心血管病报告2014》要点介绍[J].中华高血压杂志,2015,23(7):627-629.
[18]王增武,武阳丰,赵连成,等.中国中年人群高血压患病率及知晓率、治疗率、控制率的演变趋势[J].中华流行病学杂志,2004,25(5):407-411.
[19]贺泽龙,郭振球.充血性心力衰竭中医证候的临床回顾性调查研究[J].湖南中医学院学报,2003,23(5):33-36.
[20]孙艺英,李长生.充血性心力衰竭辨证分型与血浆BNP、血清CRP相关性研究[J].山东医药,2008,48(13):53-54.