慢性心力衰竭中医证候规律的临床流行病学调查研究

作者	单位
邹旭	广东省中医院心血管科
吴瑜	广东省中医院心血管科
盛小刚	广东省中医院心血管科
潘光明	广东省中医院心血管科
赖仁奎	广东省中医院心血管科

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中文摘要:

目的通过临床流行病学调查研究慢性心力衰竭(chronic heart failure,CHF)的中医证候分布规律。方法对512例CHF患者进行病例调查,采集心力衰竭各时点的症状信息168项、舌脉信息48项,构建CHF中医证候数据库,提取9个病性证素和5个病位证素,对所有症状、舌象、脉象进行频数统计分析,删除各指标中构成比<10·0%的变量。分析其临床流行病学特点、证型、证候要素、主要症状及舌脉分布。结果 (1)CHF的病性证素有气虚、阴虚、阳虚(本虚)及血瘀、痰浊、水饮(标实),其中出现频数最多的是气虚和血瘀(均>85·0%);病位证素以心(97·9%)、脾(88·1%)为主,其次为肾(43·0%)、肺(30·1%)、肝(7·0%)。(2)CHF证型分布中最多的是气虚痰瘀证(59·2%),其次为气阴两虚、痰瘀内阻证(20·3%),心阳不振、痰瘀阻络证(7·0%)及阳虚水泛证(5·5%)。(3)CHF心功能Ⅱ、Ⅲ、Ⅳ级的中医证型均以气虚痰瘀证为主,另外心功能Ⅲ级还常见气阴两虚、痰瘀内阻证,心功能Ⅳ级常见心阳不振、痰瘀阻络证及阳虚水泛证。结论 CHF病机特点为本虚标实,以气虚、阴虚、阳虚为本,血瘀、痰浊、水饮为标;病位在五脏,以心、脾为主,与肺、肾、肝相关;中医证型以气虚痰瘀证为主,并随着病情加重呈现一定的演变规律。

英文摘要:

Objective To study the distribution laws of Chinese medicine syndromes in patients with chronic heart failure(CHF) by clinical epidemiologic investigation.Methods 512 CHF patients were studied,including 168 items of symptoms and 48 items of tongue and pulse pictures.A database of Chinese medicine syndromes was established,and 9 disease nature elements and 5 disease location elements were extracted.Frequency analysis was performed on all symptoms,tongue and pulse pictures.The variables with frequency constituent ratio less than 10.0% were deleted.Then the features of clinical epidemiology,syndrome patterns,syndrome elements,main symptoms,as well as tongue and pulse pictures were analyzed.Results(1) The disease nature elements of CHF covered qi deficiency,yin deficiency,and yang deficiency(categorized as the essential deficiency),as well as blood stasis,turbid phlegm,and the retained fluid(categorized to the superficiality excess).Among them,frequencies of qi deficiency and blood stasis(both more than 85.0%) were the highest.The disease location elements of CHF were ordered in frequency as Xin(97.9%),Pi(88.1%),followed by Shen(43.0%),Fei(30.1%),and Gan(7.0%).(2) In the distribution of syndrome patterns in CHF patients,qi deficiency phlegm-stasis syndrome was the most(59.2%),followed by qi-yin deficiency with phlegm-stasis intermingle syndrome(20.3%),Xin-yang decline with phlegm-stasis obstruction syndrome(7.0%),and yang-deficiency with water overflowing syndrome(5.5%).(3) Patients with heart function grade Ⅱ,Ⅲ,and Ⅳ mainly manifested as qi-deficiency with phlegm-stasis syndrome.Besides,qi-yin deficiency with phlegm-stasis intermingle syndrome could be often seen in those with grade Ⅲ.And Xin-yang decline with phlegm-stasis obstruction syndrome and yang-deficiency with water overflowing syndrome could often be seen in those with grade Ⅳ.Conclusions The pathogenesis of CHF is essential deficiency and superficiality excess.The essentiality consists of qi deficiency,yin deficiency,and yang deficiency,and the superficiality consists of blood stasis,turbid phlegm,and retained fluid.The disease was located at the five zang-organs,mainly dominated at Xin and Pi,and associated with Fei,Shen,and Gan.Qi deficiency phlegm-stasis syndrome was dominated in Chinese medicine syndrome patterns.Along with the aggravation of CHF,Chinese medicine syndrome pattern shows certain development laws.

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