中医证型、理化指标与慢性心力衰竭预后的相关性分析
Correlation of TCM Syndrome Types and Physicochemical Indices with the Prognosis of Chronic Heart Failure
  
DOI:
中文关键词:  慢性心力衰竭  中医证型  理化指标  COX比例风险回归模型  巢式病例对照研究
英文关键词:Chronic heart failure  TCM syndrome type  Physicochemical indices  Cox proportional-hazards regression model  Nested case-control study
基金项目:国家自然科学基金项目(81774047)
作者单位
姚久秀,戴国华,赵 雪,蔡贞浩,张嘉禛 1.山东中医药大学第一临床医学院山东 济南 2500142.山东中医药大学附属医院山东 济南 250014 
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中文摘要:
      目的 分析慢性心力衰竭(chronic heart failure,CHF)患者中医证型、理化指标与终点事件发生的相关性。方法 开展巢式病例对照研究,回顾山东中医药大学附属医院住院治疗的623例CHF患者,选取随访期间发生心源性死亡的62例患者为病例组,以1∶2比例匹配性别相同、年龄差异不大于2岁且未死亡的124例患者为对照组。两组分别从中医辨证分型、N末端B型脑钠肽前体(N-terminal brain natriuretic propeptide,NT-proBNP)、心肌肌钙蛋白Ⅰ(cardiac troponin Ⅰ,cTnⅠ)、血红蛋白(hemoglobin,Hb)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)等方面进行分析。采用对数秩检验(log-rank)进行单因素分析,COX比例风险模型进行多因素分析。结果 基线资料表明,两组NT-proBNP、cTnⅠ、LDL-C、Hb、左室射血分数、纽约心脏病协会分级和中医证型分布比较,差异有统计学意义(P<0.05);单因素分析表明,NT-proBNP、cTnⅠ、LDL-C、Hb、阳气亏虚血瘀证是CHF患者预后的相关因素;多因素分析发现,NT-proBNP(OR值为1.531,95% CI为1.210~1.936)、cTnⅠ(OR值为3.236,95% CI为1.818~5.760)、阳气亏虚血瘀证(OR值为1.798,95% CI为1.026~3.149)是CHF患者预后的独立危险因素。结论 NT-proBNP、cTnⅠ、阳气亏虚血瘀证是预测CHF患者心源性死亡的独立危险因素,可用于评估患者预后。
英文摘要:
      Objective To investigate the correlation of TCM syndrome types and physicochemical indices with end events in patients with chronic heart failure (CHF). Methods A nested case-control study was performed for the retrospective analysis of 623 patients with CHF who were hospitalized in The Affiliated Hospital of Shandong University of Traditional Chinese Medicine; 62 patients with cardiac death during follow-up were selected as case group, and 124 patients without death, matched for sex and age (±2 years) at a ratio of 1∶2, were enrolled as control group. The two groups were analyzed in terms of TCM syndrome differentiation, N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin Ⅰ (cTnⅠ), low-density lipoprotein cholesterol (LDL-C), and hemoglobin (Hb). The log-rank test was used for univariate analysis, and the Cox proportional-hazards regression model was used for multivariate analysis. Results Baseline data showed that there were significant differences between the two groups in NT-proBNP, cTnⅠ, LDL-C, Hb, left ventricular ejection fraction, NYHA class, and distribution of TCM syndrome types (P<0.05). The univariate analysis showed that NT-proBNP, cTnⅠ, LDL-C, Hb, and syndrome of Yang Qi deficiency and blood stasis were factors associated with the prognosis of patients with CHF, and the multivariate analysis showed that NT-proBNP [odds ratio (OR)=1.531, 95% confidence interval (CI): 1.210-1.936], cTnⅠ (OR=3.236, 95% CI: 1.818-5.760), and syndrome of Yang Qi deficiency and blood stasis (OR=1.798, 95% CI: 1.026-3.149) were independent risk factors for the prognosis of patients with CHF. Conclusion NT-proBNP, cTnⅠ, and syndrome of Yang Qi deficiency and blood stasis are independent risk factors for predicting cardiac death in patients with CHF and can thus be used to assess the prognosis of patients.
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