慢性心力衰竭时心肾综合征患者中医证型分布及肾功能损伤特点

Distribution of traditional Chinese medicine syndrome types and characteristics of renal function injury in chronic heart failure patients with cardiorenal syndrome

关键词:  慢性心力衰竭  心肾综合征  中医证型  肾小球滤过率  NYHA分级

Key words:  chronic heart failure  cardiorenal syndrome  traditional Chinese medicine syndrome type  glomerular filtration rate  NYHA grade

摘要:

[目的] 研究慢性心力衰竭（CHF）时心肾综合征（CRS）患者中医证型分布，以及不同证型患者肾功能指标变化特点。[方法] 选择上海中医药大学附属曙光医院心血管门诊和心内科病房的CHF伴肾功能不全患者91例，进行问卷调查、中医辨证分型、检测肾功能指标（血肌酐、血尿素氮、血尿酸）并计算肾小球滤过率估测值。比较不同证型CHF心肾综合征患者肾功能指标变化特点。[结果] CHF各证型中以心肾阳虚证（35.16%）最多，气阴两虚证（6.59%）最少。心肾阳虚组及阳虚水泛组较其余各组肾小球滤过率明显下降（P<0.05）。按纽约心脏病学会（NYHA）分级比较，NYHAⅢ、Ⅳ级患者肾小球滤过率较NYHAⅡ级患者显著降低（P<0.01），校正年龄因素后上述差异仍然存在。logistic回归分析最终仅有NYHA分级（X）进入方程：logitP=-1.946+2.248X₁+1.841X₂，可见NYHA分级增加是CHF患者发生显著肾功能损害的独立危险因素。[结论] 心肾阳虚证与阳虚水泛证为CHF发展到后期的严重阶段，肾小球滤过率较其他证型明显下降。NYHA分级增加是CHF患者发生显著肾功能损害的独立危险因素。

Abstract:

[Objective] To investigate the distribution of traditional Chinese medicine(TCM) syndromes in patients with cardiorenal syndrome (CRS) and the changes of renal function with different TCM syndromes.[Methods] The 91 patients with CHF and CRS in our clinic or ward were surveyed and required to determine renal function(Cr,BUN,UA).Estimated glomerular filtration rate(eGFR) was calculated according to MDRD formula. The changes of renal function in different groups divided by TCM syndromes were analyzed.[Results] The number of hart-kidney yang deficiency was the largest(35.16%),and deficiency of both qi and yin was the least(6.59%). GFR of hart-kidney yang deficiency group and edema due to yang deficienlc group was lower than the other groups (P<0.05). Compared with NYHA grade Ⅱ,GFR of NYHA grade Ⅲ and Ⅳ was significantcy lower (P<0.01). After the adjustment for age factors,the differences still existed. NYHA grading entered the final logistic equation:logitP=-1.946+2.248X₁+1.841X₂. CHF patients with NYHA grade increase is an independent risk factor for significant renal impairment.[Conclusion] Hart-kidney yang deficiency syndrome and edema due to yang deficiency syndrome were the severe late stages for the CHF,of which GFR decreased compared with other syndromes. CHF patients with NYHA grade increase is an independent risk factor for significant renal impairment.