CAJ | 학술논문

目的：分析不同中医证候慢性心力衰竭（ CHF）患者的远期预后差别。方法收集自2006年1月至2011年8月于广安门医院住院符合纳入标准的慢性心衰患者191例，采集其住院时的中医证候特征及相关数据，出院后进行长期门诊或电话随访，获取终点事件（全因死亡率）的发生及时间。结果5种证候要素慢性心衰患者的远期预后比较，从优排序依次为痰阻证、气虚证、阴虚证、血瘀证、阳虚证（P＜0．01），差异具有显著性。其中痰阻证者预后优于非痰阻证者（P＝0．017）；气虚证预后优于非气虚证（P＝0．011）；阴虚证预后与非阴虚证差异不显著（P＝0．633）；血瘀证总体预后与非血瘀证差异不明显（P＝0．182），但在500 d后预后差于非血瘀证；阳虚证预后差于非阳虚证（ P＝0．002）。结论慢性心衰患者远期预后较差，不同中医证候预后差异显著，其中气虚、痰阻可能为其早期常见证型。疾病发生发展过程中，阴虚可能贯穿于CHF的发展过程，血瘀在病程早期可能作用不明显，但随着病情的进展，血瘀证者预后较差，且晚期常表现为阳虚。
목적：분석불동중의증후만성심력쇠갈（ CHF）환자적원기예후차별。방법수집자2006년1월지2011년8월우엄안문의원주원부합납입표준적만성심쇠환자191례，채집기주원시적중의증후특정급상관수거，출원후진행장기문진혹전화수방，획취종점사건（전인사망솔）적발생급시간。결과5충증후요소만성심쇠환자적원기예후비교，종우배서의차위담조증、기허증、음허증、혈어증、양허증（P＜0．01），차이구유현저성。기중담조증자예후우우비담조증자（P＝0．017）；기허증예후우우비기허증（P＝0．011）；음허증예후여비음허증차이불현저（P＝0．633）；혈어증총체예후여비혈어증차이불명현（P＝0．182），단재500 d후예후차우비혈어증；양허증예후차우비양허증（ P＝0．002）。결론만성심쇠환자원기예후교차，불동중의증후예후차이현저，기중기허、담조가능위기조기상견증형。질병발생발전과정중，음허가능관천우CHF적발전과정，혈어재병정조기가능작용불명현，단수착병정적진전，혈어증자예후교차，차만기상표현위양허。
Objective To compare the long-term prognosis of chronic heart failure ( CHF) patients with different TCM syndrome elements of phlegm stagnation, qi deficiency, yin deficiency, blood statis and yang deficiency.Methods Subjects were 191 CHF inpatients in Guang’ anmen Hospital from January 2006 to August 2011. The clinic information of the patients were collected, including general information, incidence and TCM syndrome elements.After discharging from the hospital, all the patients were visited in outpatient or followed up by telephone for years to get the occurrence and duration of all-cause mortality.Results The long-term prognosis of CHF patients with TCM syndromes ranked from the best to the worst: phlegm stagnation, qi deficiency, yin deficiency, blood stasis and yang deficiency (P<0.01).The prognosis of patients with syndrome of phlegm stagnation was better than those without phlegm stagnation ( P=0.017);patients with syndrome of qi deficiency had a better prognosis than those without qi deficiency ( P=0 .011 ); there was no significant difference in patients with or without yin deficiency (P=0.633); the overall prognosis of blood stasis patients showed no significant difference with non blood-stasis patients (P=0.182), but went worse from the 500th day;the prognosis of patients with syndrome of yang deficiency was worse than patients without yang deficiency ( P =0 .002 ) . Conclusion The long-term prognosis of CHF patients is definitely poor.The prognosis of CHF patients with different TCM syndromes showed striking difference.Syndrome of qi deficiency and syndrome of phlegm stagnation would be ordinary in early stage of CHF, and syndrome of yin deficiency played a role through the whole progression of CHF.The effect of syndrome of blood stasis could be associated with CHF disease progression, and the prognosis of patients with blood statis was worse.The syndrome of yang deficiency would be the main syndrome in late stage.