慢性心力衰竭不同原发病与中医证型特点分析

目的分析不同原发病所致慢性心力衰竭(CHF)的中医证型特点和规律,为CHF病机探索和认识提供参考。方法对117例CHF患者进行回顾性分析,根据不同原发病和心功能分级情况进行证型归纳和统计分析,分析中医证型与原发病、心功能分级的相关性。结果原发病中冠心病占31.6%,高血压占30.8%,肺心病占13.7%,风心病占11.1%,心肌病占6.8%,老年性心脏瓣膜病占4.3%;冠心病组中气虚血瘀证、心脾肾阳虚水泛兼血瘀证最多,高血压病组气虚血瘀证比例最大,风心病心脾肾阳虚水泛兼血瘀证最多,肺心病组心肺气虚证为多,心肌病以心脾阳虚兼血瘀水停证为多,老年瓣膜病以气虚血瘀证为多;心功能Ⅱ级中以心肺气虚证为主,心功能Ⅲ级中以气虚血瘀和心脾阳虚兼血瘀水停证居多,心功能IV级中以心脾肾阳虚水泛兼血瘀证居多,心功能等级以心肺气虚、心气阴虚兼血瘀,气虚血瘀,心脾阳虚兼血瘀水停,心脾肾阳虚水泛兼血瘀逐级递增(r=0.508,P<0.001);血浆脑钠肽(BNP水平)按心肺气虚、心气阴虚兼血瘀,气虚血瘀,心脾阳虚兼血瘀水停,心脾肾阳虚水泛兼血瘀逐级递增(r=0.773,P<0.001);结论引起CHF最常见的原发病是冠心病,其中气虚血瘀证和心脾肾阳虚水泛兼血瘀证常见,说明气虚、阳虚、血瘀是CHF的最突出的病理改变。

Chronic Heart Failure of Different Etiology and Syndrome Type of Traditional Chinese Medicine Characteristic Analysis

Objective Analysis of different primary disease induced by chronic heart failure features of TCM syndromes and rule,for chronic heart failure pathogenesis exploration and understanding of reference Methods A retrospective analysis of the 117 cases with CHF,depending on the primary disease and NYHA cardiac function classification type summarized the situation permits,to observe the relationship between syndrome type with primary disease and cardiac function.Results The coronary heart disease is the most common primary disease in 117 cases(31.6%);qi deficiency and blood stasis syndrome,yang deficiency and blood stasis of heart and spleen and kidney syndrome up to the group of coronary heart disease(13.7%);the largest proportion of qi deficiency and blood stasis syndrome in hypertension group(30.8%);in RHD group(11.1%),yang deficiency and blood stasis of heart and spleen and kidney syndrome most extended;in pulmonary heart disease group(6.8%),qi deficiency of heart and lung for many;in cardiomyopathy group(4.3%) yang deficiency and blood stasis of heart and spleen and kidney syndrome for many;in SDVHD group,qi deficiency and blood stasis syndrome for many.The cardiac function were positively correlated with TCM Syndrome typing(r=0.508,P<0.001);the BNP concentrations were positively correlated with TCM Syndrome typing(r=0.773,P<0.001).Conclusion For CHF,the most common primary disease are CHD,syndrome type are qi deficiency and blood stasis syndrome and yang deficiency and blood stasis of heart and spleen and kidney syndrome,which can show that qi deficiency yang deficiency and blood stasis are most prominent pathological change.