1.辽宁中医药大学附属医院,辽宁省沈阳市皇姑区北陵大街33号,110031
2.辽宁中医药大学
3.辽宁省辽阳县中医院
851290967@qq.com
收稿:2023-01-07,
修回:2023-12-25,
纸质出版:2024-02-02
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杜毅,李峥,杨关林等.1676例心力衰竭住院患者中医证候特征研究[J].中医杂志,2024,65(03):299-307.
DU Yi,LI Zheng,YANG Guanlin,et al.Study on Traditional Chinese Medicine Syndrome Characteristics of 1676 Heart Failure Inpatients: A Cross-Sectional Survey Based on Real-World Electronic Medical Record Information[J].Journal of Traditional Chinese Medicine,2024,65(03):299-307.
杜毅,李峥,杨关林等.1676例心力衰竭住院患者中医证候特征研究[J].中医杂志,2024,65(03):299-307. DOI: 10.13288/j.11-2166/r.2024.03.013.
DU Yi,LI Zheng,YANG Guanlin,et al.Study on Traditional Chinese Medicine Syndrome Characteristics of 1676 Heart Failure Inpatients: A Cross-Sectional Survey Based on Real-World Electronic Medical Record Information[J].Journal of Traditional Chinese Medicine,2024,65(03):299-307. DOI: 10.13288/j.11-2166/r.2024.03.013.
目的
2
基于电子病历信息分析心力衰竭(简称“心衰”)住院患者的中医证型的临床特征。
方法
2
采用横断面研究方法,收集出院日期为2019年1月1日至2020年12月31日在辽宁中医药大学附属医院心内科住院的所有心衰患者临床资料,提取电子病历信息建立临床中医资料数据库,包括患者基本情况、中医证型及证素、理化指标。分析心衰患者中医证型、证素的分布情况,并对排名前7位不同中医证型患者的基本信息及生化指标进行比较。
结果
2
共纳入1676例心衰住院患者,排名前7位的中医证型依次是痰浊血瘀证477例(28.46%)、气虚血瘀证439例(26.19%)、气虚血瘀水停证274例(16.35%)、阳虚水泛证145例(8.65%)、气阴两虚证104例(6.21%)、气阴两虚兼血瘀证80例(4.77%)和心阳亏虚证59例(3.52%)。1676例患者证素分析显示,占比超过5%的证素共有6个,以血瘀占比最高,共1292例(77.09%),其他证素依次为气虚919例(54.83%)、痰498例(29.71%)、水停434例(25.89%)、阳虚215例(12.82%)和阴虚191例(11.40%)。1676例患者中急性心衰1308例,中医证型以痰浊血瘀证为主,共386例(29.51%);慢性心衰368例,中医证型以气虚血瘀证为主,共118例(32.07%)。痰浊血瘀证患者病程最短,为0.3个月;心阳亏虚证病程最长,为15个月。心衰合并冠心病患者中痰浊血瘀证占比最高,心衰合并房颤患者中气虚血瘀水停证占比最高,气虚血瘀水停证及阳虚水泛证患者住院期间应用利尿剂的比例最高,超过86%。7种中医证型在合并疾病(冠心病、陈旧性心肌梗死、房颤等),入院前后药物使用率(静脉型血管扩张剂、强心剂、利尿剂),血氯离子、血尿素、血肌酐、血碳酸氢盐、血白蛋白、血总胆红素水平方面差异有统计学意义(
P
<0.05)。
结论
2
心衰患者中医证型以痰浊血瘀证和气虚血瘀证最为多见,不同中医证型在性别构成、合并疾病、入院前后用药、血液指标等方面具有不同的特征。
Objective
2
To analyse the clinical characteristics of different traditional Chinese medicine (TCM) syndromes in patients with heart failure based on information from electronic medical record.
Methods
2
A cross-sectional study was conducted to collect clinical data of all inpatients with heart failure in the Department of Cardiology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from January 1, 2019 to December 31, 2020. A database of clinical TCM data was established to explore the characteristics of clinical data of basic information, syndromes and syndrome element types, and biochemical indexes. The distribution of TCM syndromes and syndrome elements in heart failure patients were also analysed, and the basic information and biochemical indexes of the patients with top 7 different TCM syndrome types were compared.
Results
2
A total of 1676 inpatients with heart fai-lure were included. The top 7 TCM syndromes of heart failure were syndrome of phlegm turbidity and blood stasis (477 cases, 28.46%), syndrome of
qi
deficiency and blood stasis (439 cases, 26.19%), syndrome of
qi
deficiency and blood stasis with water retention (274 cases, 16.35%), syndrome of
yang
deficiency with water retention (145 cases, 8.65%), syndrome of
qi
and
yin
deficiency (104 cases, 6.21%), syndrome of
qi
and
yin
deficiency with blood stasis (80 cases, 4.77%), syndrome of heart
yang
deficiency (59 cases, 3.52%). Among the 1676 patients, 6 syndrome elements accounted for more than 5%. Blood stasis accounted for the highest proportion of TCM syndrome element type (1292 cases, 77.09%), followed by
qi
deficiency (919 cases, 54.83%), phlegm (498 cases, 29.71%), water retention (434 cases, 25.89%),
yang
deficiency (215 cases, 12.82%) and
yin
deficiency (191 cases, 11.40%). Among the 1676 patients, 1308 cases of acute heart failure mainly showed syndrome of phlegm turbidity and blood stasis (386 cases, 29.51%), and 368 of chronic heart fai-lure mainly showed syndrome of
qi
deficiency and blood stasis (118 cases, 32.07%). Patients with syndrome of phlegm turbidity and blood stasis had the shortest disease duration of 0.3 months, while those with syndrome of heart
yang
deficiency had the longest disease duration of 15 months. The proportion of syndrome of phlegm turbidity and blood stasis was the highest in patients with heart failure combined with coronary artery disease, the proportion of syndrome of
qi
deficiency and blood stasis with water retention was the highest in patients with heart failure combined with atrial fibrillation, and the proportion of patients with syndrome of
qi
deficiency and blood stasis with water retention and syndrome of
yang
deficiency with water retention in those applying diuretics during the hospital stay was the highest with more than 86%. The different 7 TCM syndromes showed statistically difference in patients with complications including coronary artery disease, old myocardial infarction, atrial fibrillation, pre and post-admission medication usage including intravenous vasodilators, cardiac stimulants, diuretics, and level of blood chloride, blood urea, blood creatinine, blood bicarbonate, blood albumin, and blood total bilirubin (
P
<0.05).
Conclusion
2
The most common TCM syndromes in patients with heart failure are syndrome of phlegm turbidity and blood stasis and syndrome of
qi
deficiency and blood stasis. Different TCM syndromes have different characteristics in gender, disease complications, medication before and after admission, and blood indexes.
中华医学会心血管病学分会心力衰竭学组 , 中国医师协会心力衰竭专业委员会 , 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2018 [J]. 中华心力衰竭和心肌病杂志 , 2018 , 2 ( 4 ): 196 - 225 .
中国心血管健康与疾病报告编写组 . 2019中国心血管健康与疾病报告2019概要 [J]. 中国循环杂志 , 2020 , 35 ( 9 ): 833 - 854 .
赵志强 , 王贤良 , 张萍 , 等 . 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 [J]. 中医杂志 , 2019 , 60 ( 9 ): 773 - 778 .
国家技术监督局 . 中医临床诊疗术语:证候部分 [M]. 北京 : 中国标准出版社 , 1997 .
朱文锋 . 证素辨证学 [M]. 北京 : 人民卫生出版社 , 2008 : 162 - 228 .
邹旭 , 潘光明 , 盛小刚 , 等 . 慢性心力衰竭中医证候规律的临床流行病学调查研究 [J]. 中国中西医结合杂志 , 2011 , 31 ( 7 ): 903 - 908 .
孙玉洁 . 慢性心力衰竭中医证候回顾性调查研究 [D]. 郑州 : 河南中医学院 , 2015 .
李姿颖 . 慢性心力衰竭的中医证候与MUSIC评分的相关性研究 [D]. 广州 : 广州中医药大学 , 2019 .
张洁 , 仇盛蕾 . 慢性心力衰竭患者中医证候要素相关性研究 [J]. 中医学报 , 2017 , 32 ( 8 ): 1555 - 1558 .
孟佳 . NT-pro BNP和Cys-C与慢性心力衰竭中医辨证分型及心功能分级的关系 [D]. 济南 : 山东中医药大学 , 2019 .
王娟 , 陈婵 , 张鹏 , 等 . 630例慢性心衰患者中医证候分布规律研究 [J]. 北京中医药大学学报 , 2013 , 36 ( 8 ): 567 - 571 .
韩红 . 急性心力衰竭患者72例中医证型特点及临床分析 [J]. 中国医药指南 , 2015 , 13 ( 32 ): 206 .
姜红岩 , 廖星 , 谢雁鸣 , 等 . 84697例冠心病患者入院及死亡时间和节气关系的分析 [J]. 中国中医基础医学杂志 , 2014 , 20 ( 10 ): 1364 - 1366 .
葛永彬 , 毛静远 . 6155例冠心病患者中医证型分布规律分析 [J]. 北京中医药 , 2014 , 33 ( 7 ): 533 - 534 .
HAN A , SUN T , MING J , et al . Are the Chinese moving toward a healthy diet? Evidence from macro data from 1961 to 2017 [J]. Int J Environ Res Public Health , 2020 , 17 ( 15 ): 5294 .
高尚社 . 国医大师邓铁涛教授辨治冠心病心绞痛验案赏析 [J]. 中国中医药现代远程教育 , 2012 , 10 ( 12 ): 5 - 7 .
赵永佳 , 刘攀 , 戴小华 . 慢性心力衰竭合并心房颤动病人中医证候分布规律及危险因素分析 [J]. 中西医结合心脑血管病杂志 , 2022 , 20 ( 8 ): 1453 - 1456 .
高国川 . 慢性心力衰竭合并心房颤动的中医证候分布与生物标志物、心功能、心脏彩超相关性研究 [D]. 广州 : 广州中医药大学 , 2022 .
杨阳柳林 . 不同年龄段慢性心衰患者阴虚证临床特征及预后价值 [D]. 北京 : 北京中医药大学 , 2018 .
庞国明 , 曹秋平 , 李鹏辉 , 等 . 纯中药“辨病-辨证-辨体诊疗模式”治疗2型糖尿病患者546例临床特征分析:一项真实世界回顾性研究 [J]. 中医杂志 , 2022 , 63 ( 18 ): 1766 - 1772 .
TESTANIJM , HANBERG JS , ARROYO JP , et al . Hypochloraemia is strongly and independently associated with mortality in patients with chronic heart failure [J]. Eur J Heart Fail , 2016 , 18 ( 6 ): 660 - 668 .
TER MAATEN JM , DAMMAN K , HANBERG JS , et al . Hypochloremia, diuretic resistance, and outcome in patients with acute heart failure [J]. Circ Heart Fail , 2016 , 9 ( 8 ): e003109 . doi: 10.1161/CIRCHEARTFAILURE.1116.003109 http://dx.doi.org/10.1161/CIRCHEARTFAILURE.1116.003109 .
KATAOKA H . Dynamic changes in serum chloride concentrations during worsening of heart failure and its recovery following conventional diuretic therapy: a single-center study [J]. Health Sci Rep , 2018 , 1 ( 11 ): e94 .
KATAOKA H . Proposal for heart failure progression based on the ‘chloride theory’: worsening heart failure with increased vs. non-increased serum chloride concentration [J]. ESC Heart Fail , 2017 , 4 ( 4 ): 623 - 631 .
何洁茹 , 邓金凤 . 痰湿体质和酸性体质的相关性思考 [J]. 江西中医药大学学报 , 2010 , 22 ( 2 ): 15 - 17 .
何嫣婷 , 夏晓冬 , 舒迎霜 , 等 . 加味四君子汤对脾虚犬生理生化指标及消化吸功能的影响 [J]. 西北农林科技大学学报(自然科学版) , 2019 , 47 ( 7 ): 15 - 22,31 .
吕勇 , 鲍容 , 张磊 , 等 . 加味参苓白术散对持续性不卧床腹膜透析患者胃肠功能障碍及蛋白质-能量消耗的干预作用 [J]. 中国实验方剂学杂志 , 2022 , 28 ( 3 ): 116 - 122 .
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