摘要
目的研究心力衰竭积分在中医证型与心功能分级对应关系中的运用,比较慢性心力衰竭中医证型与心功能分级、B型钠尿肽(brain natriuretic peptide,BNP)水平的相关性,并通过心力衰竭积分评价不同慢性心力衰竭中医证型方药疗效。方法回顾性分析上海市浦东新区光明中医医院、上海市浦东新区中医医院2016年1月-2019年12月符合纳入排除标准的慢性心力衰竭住院患者的病历,收集患者住院时的中医证型、BNP水平、心功能分级、中医方药,并根据病历出入院小结及病程记录进行心力衰竭积分评分。结果心功能Ⅱ级的患者中气阴两虚证和心血瘀阻证较多,心功能Ⅲ级的患者在各个中医证型的分布较平均,心功能Ⅳ级的患者在阳虚水泛证组中分布最广泛;中医证型5组间BNP水平不完全相同,气阴两虚证组BNP值低于其他4组且气虚血瘀证组低于痰浊壅肺证、阳虚水泛证组(P<0.05);心力衰竭积分在5组间由气阴两虚证、气虚血瘀证、心血瘀阻证、痰浊壅肺证、阳虚水泛证这一顺序逐渐升高;气阴两虚证、气虚血瘀证、心血瘀阻证和阳虚水泛证方药组有效率高于常规组且差异有统计学意义(P<0.05)。结论慢性心力衰竭中医证型与NYHA心功能分级具有一定的相关性;心力衰竭积分可以作为慢性心力衰竭中医辨证分型的参考指标且可以对中医方药疗效进行一定评价,能反映中医证型与心功能之间的关系;BNP水平可以作为慢性心力衰竭中医辨证分型的参考指标。
Objective To study the application of heart failure scores in the relationship between Traditional Chinese Medicine(TCM)syndrome types and cardiac function classifications.Methods The medical records of patients with chronic heart failure admitted in Shanghai Guangming TCM Hospital and Pudong New Area TCM Hospital from 2016 to 2019 were retrospectively reviewed.The TCM syndrome types,brain natriuretic/peptide(BNP)levels,cardiac function classifications,TCM prescriptions,and the heart failure score of patients were collected.Results There were more syndromes of deficiency of both qi and yin and heart-blood stasis in patients with heart function levelⅡ,patients with heart function levelⅢhad a more even distribution among different TCM syndrome types,and patients with heart function levelⅣhad syndrome of yang deficiency and water flooding.The BNP level in the qi and yin deficiency group was lower than the other four groups,and BNP level the qi deficiency and blood stasis group was lower than the phlegm and turbid lung syndrome and yang deficiency and water flooding syndrome group(P<0.05).The heart failure score among the five groups consecutively increased from qi deficiency syndrome,qi deficiency and blood stasis syndrome,heart blood stasis syndrome,phlegm turbidity in the lung syndrome,yang deficiency and water flooding syndrome.The effective rate of the prescription group of yin deficiency syndrome,qi deficiency and blood stasis syndrome,heart blood stasis syndrome and yang deficiency and water flooding syndrome was higher than that of the conventional group(P<0.05).Conclusion Chronic heart failure TCM syndrome has a certain correlation with NYHA cardiac function classification.Heart failure score can be used as a reference index for chronic heart failure TCM syndrome differentiation and can be used to evaluate the efficacy of TCM prescriptions.The relationship between heart function and BNP level can be used as a reference index for TCM syndrome differentiation of chronic heart failure.
作者
吴寒
李萍
吴燕婷
宫萍
WU Han;LI Ping;WU Yan-ting;GONG Ping(School of Medicine,Tongji University,Shanghai 200092,China;Guangming Hospital of Traditional Chinese Medicine,Pudong New Area,Shanghai 201300,China)
出处
《同济大学学报（医学版）》
2021年第4期472-477,共6页
Journal of Tongji University(Medical Science)
基金
上海市浦东新区卫生科技项目(PW2020D-3)。
关键词
慢性心力衰竭
心力衰竭积分
中医证型
心功能分级
中医
chronic heart failure
heart failure score
Traditional Chinese Medicine syndrome
cardiac function classification
Chinese Medicine
