射血分数保留心力衰竭气虚证与并发症及超声心动图的相关性

彭菊琴 张艺楠 彭娴

摘要 目的：探討射血分数保留心力衰竭（HFpEF）气虚证与并发症、超声心动图指标的相关性。方法：采用横断面研究方法，选取2017年12月至2018年12月中日友好医院收治的HFpEF气虚证患者165例作为研究对象，按照中医四诊、并发症信息，并计算气虚证积分，根据气虚证积分分为气虚重证组（n=98）和气虚轻证组（n=67），同时纳入非心力衰竭非气虚证患者60例作为对照组。所有患者均完善多普勒超声心动图检查。结果：气虚证与并发症Logistic回归分析发现，贫血（OR=0.214，95%CI为0.111～0.447，P=0.000）、糖尿病（OR=0.054，95%CI为0.006～0.113，P=0.036）、慢性肾脏病（OR=0.057，95%CI为0.001～0.114，P=0.046），是气虚证形成的危险因素。气虚证与超声心动图指标的相关性研究发现，气虚重证组较气虚轻证组、对照组二尖瓣环侧壁舒张早期最大速度（e′）更低（4.37 vs. 4.88 vs. 5.54，P=0.041，P=0.000），二尖瓣口舒张早期峰值血流速度（E）/e′更高（22.74 vs. 18.09 vs. 11.96，P=0.012，P=0.000）。结论：HFpEF气虚证形成与并发症分布以及心脏舒张功能受损有关。

关键词 射血分数保留心力衰竭;气虚证;并发症;超声心动图;舒张功能;相关性

Abstract Objective：To explore the relationship between qi-deficiency syndrome of heart failure with preserved ejection fraction（HFpEF）with comorbidities and echocardiography.Methods：Using a cross-sectional study method，the information about four diagnostic methods of TCM and comorbidities in 165 HFpEF patients with qi-deficiency syndrome admitted by China-Japan Friendship Hospital from December 2017 to December 2018 were collected.According to the results of calculating scores of qi-deficiency syndrome，the patients were divided into qi-deficiency severe syndrome group（98 cases）and qi deficiency slight syndrome group（67 cases）.And 60 patients without heart failure and qi-deficiency syndrome were enrolled as the control group.The measurement of Doppler echocardiography was finished in all patients.Results：The result of logistic regression analysis of qi-deficiency syndrome and comorbidities was that anemia [OR=0.214，95%CI（0.111 to 0.447），P=0.000]，diabetes [OR=0.054，95%CI（0.006 to 0.113），P=0.036]，chronic kidney disease [OR=0.057，95%CI（0.001 to 0.114），P=0.046] were risk factors for the formation of qi-deficiency syndrome in HFpEF patient.The correlation analysis between qi-deficiency syndrome and echocardiography indicators showed that the maximum speed（e′）of the early dilation of the mitral annulus side was lower in qi-deficiency severe group than that in qi-deficiency slight group and control group（4.37 vs. 4.88 vs. 5.54，P=0.041，P=0.000），and the early peak systolic velocity of mitral orifice dilation（E）/e′ was highest（22.74 vs. 18.09 vs. 11.96，P=0.012，P=0.000）in qi-deficiency severe group.Conclusion：HFpEF qi-deficiency syndrome is associated with the distribution of comorbidities and impaired diastolic function.

Keywords Heart failure with preserved ejection fraction（HFpEF）; Qi-deficiency syndrome; Comorbidity; Echocardiography; Diastolic function; Relativity

中图分类号：R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.07.021

射血分数保留心力衰竭（Heart Failure with Preserved Ejection Fraction，HFpEF）是近20年提出的一种新类型的心力衰竭，是由于舒张期左室主动松弛能力受损、室壁僵硬度增加，导致左室舒张功能出现障碍。流行病学研究指出，HFpEF与射血分数减低心力衰竭的病死率接近[1]，但是随着人类预期寿命的延长以及肥胖、糖尿病、高血压和心房颤动发病率的增加，HFpEF在未来可能成为心力衰竭的主要类型[2]。HFpEF患者常伴有多种并发症，易出现多器官系统受累以及多种病理生理学异常，使得其临床特征具有异质性，增加了临床诊断、治疗以及管理的难度。……