肺动脉高压中医证候分布特点及与疾病预后指标相关性的临床研究初探

发布时间：2018-04-20 17:38

本文选题：肺动脉高压 + 中医证候　；参考：《北京中医药大学》2017年硕士论文

【摘要】：背景:肺动脉高压(Pulmonary Hypertension,PH)是以肺血管阻力进行性升高为特征,进而右心室肥厚扩张,甚至右心衰竭的一种肺血管病,发病率、致残率及病死率较高。严重影响患者生活质量及寿命。近年现代医学对此病在诊断方面明确了病因及分类,治疗上靶向药的问世也提高了疗效,但仍存在一些问题,如某些类型的肺动脉高压治疗疗效欠佳,靶向药价格昂贵,副作用大,预后不好等。临床发现,中医药在治疗肺动脉高压有一定疗效,但近年研究缺乏大规模的临床研究数据支持,且对于证候学研究证据不足。目的:探索肺动脉高压病人中医证候分布特点及与疾病预后指标的相关性,以明确肺动脉高压优势证候及与疾病预后的相关性,为临床辨证施治提供依据。方法:1.收集肺动脉高压病人中医临床证候学资料,进行临床辨证分析,初步探索肺动脉高压证候特点及辨证分型。2.分析肺动脉高压病人证型与预后指标如六分钟步行距离、心功能分级、NT-proBNP的相关性。结果:1.在病性证素方面:32例肺动脉高压病人的证候发生率依次是气虚(100.00%)=血瘀(100.00%)水饮(50.00%)阳虚(40.62%)阴虚(40.62%)痰浊(15.62%)气滞(18.75%)血虚(9.38%),进一步分别对动脉性肺动脉高压和慢性血栓栓塞性肺动脉高压两类病人病性证素分布进行统计分析,发现两类病人病性证素分布在统计学上无显著差异,气虚证、血瘀证是肺动脉高压发生率最高的证候,约半数病人伴有水饮证,部分病人同时兼有阳虚、阴虚、痰浊、气滞、血虚等。2.在病位证素方面:肺、脾、肾、心在肺动脉高压发病中起重要作用。其中动脉性肺动脉高压病位证素分布频率依次是肺(100.00%)脾(58.33%)肾(41.67%)心(41.67%)肝(16.67%),慢性血栓栓塞性肺动脉高压病位证素分布频率依次是肺(100.00%)脾(60.00%)肾(55.00%)心(25.00%)肝(20.00%),两类病人病位证素分布在统计学上有显著差异,动脉性肺动脉高压与慢性血栓栓塞性肺动脉高压相比,肺所占比例相当,心在动脉性肺动脉高压中所占比例较大,而脾、肾在慢性血栓栓塞性肺动脉高压中所占比例较大。3.证型分布:可分为气虚血瘀证(31.25%),阳虚血瘀水泛证(28.13%),阴虚血瘀水停证(21.88%),气阴两虚兼血瘀证(18.75%)4组。将动脉性肺动脉高压和慢性血栓栓塞性肺动脉高压两类病人的四个证型进行统计分析,发现两类病人的证型分布在统计学上无显著差异。气虚血瘀证是肺动脉高压的主要证型。4.证型与NT-ProBNP、六分钟步行距离、心功能分级的关系:分别对四组证型病人的NT-ProBNP、六分钟步行距离、心功能分级进行统计分析,发现,阴虚血瘀水停证的NT-ProBNP水平最高,其次是阳虚血瘀水泛证、气虚血瘀证、气阴两虚兼血瘀证NT-ProBNP水平最低;气阴两虚兼血瘀证六分钟步行距离最长,其次是气虚血瘀证、阳虚血瘀水泛证,阴虚血瘀水停证六分钟步行距离最短。四组证型的心功能分级差异无统计学意义。5.证型与NT-ProBNP和六分钟步行距离的相关性逻辑回归分析:将水饮证与NT-ProBNP和六分钟步行距离做二元Logistic回归分析,结果表明,NT-ProBNP与水饮证呈正相关,六分钟步行距离与水饮证呈负相关。结论:肺动脉高压病人以气虚血瘀证为基本病机,随着疾病进展出现水饮证,根据阴阳偏盛偏衰的不同,可分为气虚血瘀证、气阴两虚兼血瘀证、阳虚血瘀水泛证、阴虚血瘀水停证4个证型。其中水饮证与NT-ProBNP呈正相关,和六分钟步行距离呈负相关,且在水饮证中,阴虚血瘀水停证的NT-ProBNP更大,六分钟步行距离更短,提示病情可能更危重。
[Abstract]:Background: Pulmonary Hypertension (PH) is a kind of pulmonary vascular disease characterized by elevated pulmonary vascular resistance, and then right ventricular hypertrophy, even right heart failure, a kind of pulmonary vascular disease, the incidence, the rate of disability and the mortality are high. The quality of life and life of the patients are seriously affected. In recent years modern medicine has made clear the cause of the disease in the diagnosis of the disease. But there are still some problems, such as some types of pulmonary hypertension treatment is not good, the target drug is expensive, the side effect is large, the prognosis is not good. Clinical findings, Chinese medicine has a certain effect in the treatment of pulmonary hypertension, but in recent years there is a lack of large-scale clinical research data. Support, and lack of evidence for the study of syndrome. Objective: To explore the characteristics of the distribution of TCM syndromes and the correlation with the prognosis of the patients with pulmonary hypertension in order to clarify the correlation between the dominant syndromes of pulmonary hypertension and the prognosis of the disease, and to provide the basis for clinical syndrome differentiation. 1. Data, clinical syndrome differentiation and analysis, preliminary exploration of characteristics of pulmonary hypertension syndrome and syndrome differentiation.2. analysis of pulmonary hypertension patients' syndrome and prognostic indicators such as six minutes walking distance, cardiac function classification, NT-proBNP correlation. Results: 1. in the disease syndrome factor: 32 cases of pulmonary arteria hypertension patients in turn is Qi deficiency (100%) = blood stasis (100%) water (50%) Yang deficiency (40.62%) yin deficiency (40.62%) phlegm (15.62%) and Qi Stagnation (18.75%) blood deficiency (9.38%). The distribution of the syndromes of the two patients with arterial pulmonary hypertension and chronic thromboembolic pulmonary hypertension was analyzed, and there was no significant difference between the two types of patients with the distribution of the syndromes in the two patients. Qi deficiency syndrome, blood stasis syndrome is the highest incidence of pulmonary arterial hypertension, about half of the patients have water drinking syndrome. Some patients also have Yang deficiency, yin deficiency, phlegm, qi stagnation, blood deficiency and other.2. in the disease position syndrome: lung, spleen, kidney, heart play an important role in the pathogenesis of pulmonary artery hypertension. The pulmonary (100%) spleen (58.33%) kidney (41.67%) heart (41.67%) liver (16.67%), the frequency of the chronic thromboembolic pulmonary hypertension syndrome distribution frequency is the lung (100%) spleen (60%) kidney (55%) heart (20%) (20%), and the distribution of the syndrome factors of the two patients is statistically significant, the arterial hypertension and the chronic thromboembolic lung. The proportion of the pulmonary hypertension is comparable, the proportion of the heart in the arterial hypertension is larger, and the proportion of the spleen and the kidney in the chronic thromboembolic pulmonary hypertension is.3., which can be divided into Qi deficiency and blood stasis syndrome (31.25%), Yang deficiency and blood stasis water syndrome (28.13%), yin deficiency and blood stasis water stop (21.88%), Qi Yin deficiency and blood stasis syndrome (18) .75%) 4 groups. Statistical analysis was made on the four types of two types of patients with arterial pulmonary hypertension and chronic thromboembolic pulmonary hypertension. There was no significant difference between the two types of patients' syndrome distribution. Qi deficiency and blood stasis syndrome was the main syndrome type of pulmonary hypertension and NT-ProBNP, six minutes walking distance, and the classification of cardiac function. NT-ProBNP, six minutes walking distance and the classification of cardiac function of four groups of patients were statistically analyzed. It was found that the level of NT-ProBNP was the highest in Yin deficiency and blood stasis water, followed by Yang deficiency and blood stasis water syndrome, Qi deficiency and blood stasis syndrome, and the lowest NT-ProBNP level of Qi Yin deficiency and blood stasis syndrome, and the longest walking distance of Qi Yin deficiency and blood stasis syndrome for six minutes. The second is Qi deficiency and blood stasis syndrome, Yang deficiency and blood stasis water flooding syndrome, and the shortest walking distance of yin deficiency and blood stasis water stop for six minutes. There is no statistically significant correlation between the four groups of syndrome types of cardiac function classification difference between.5. syndrome and NT-ProBNP and six minutes walking distance: the water drink syndrome and NT-ProBNP and the six minute walking distance are two yuan Logistic regression The results showed that NT-ProBNP was positively related to water drinking syndrome, and the walking distance of six minutes was negatively correlated with water drinking syndrome. Conclusion: the basic pathogenesis is Qi deficiency and blood stasis syndrome in patients with pulmonary hypertension. With the development of deficiency of yin and Yang, the syndrome of qi deficiency and blood stasis can be divided into Qi deficiency and blood stasis syndrome, Qi Yin deficiency and blood stasis syndrome, Yang deficiency and blood stasis water flooding. Syndrome, yin deficiency and blood stasis water stop 4 syndrome types, of which water drinking syndrome is positively related to NT-ProBNP, and six minutes walking distance is negative correlation, and in water drinking syndrome, the NT-ProBNP of yin deficiency and blood stasis water stop syndrome is greater, six minutes walk distance is shorter, suggesting that the condition may be more critical.

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

【参考文献】