冠心病合并2型糖尿病患者中医证型分布及其与病死率的关联性研究

Distribution of TCM syndromes in patients with coronary heart disease complicated with type 2 diabetes and its association with mortality

关键词:  冠心病  2型糖尿病  中医证型  病死率

Key words:  coronary heart disease  type 2 diabetes  traditional Chinese medicine syndrome  mortality

摘要:

[目的] 探讨冠心病合并2型糖尿病患者的中医证型分布特征，并分析不同中医证型与全因死亡及心血管死亡风险的关联性，同时考察性别与年龄在其中的交互作用。[方法] 采用回顾性队列研究设计，从中医药治疗心血管疾病队列研究（CSCD-TCM^plus）数据库中，纳入2014年1月—2022年6月天津市6家医院的2 473例冠心病合并2型糖尿病患者。基于中医证候将患者分为5个风险层级（低危组-气滞血瘀证、中危组-主要证型、中危组-其他证型、高危组-其他证型、高危组-心肾阳虚证）。通过链接社会保障系统数据库确定终点事件，包括全因死亡与心血管死亡。采用Kaplan-Meier生存分析和多因素Cox比例风险回归模型评估证型与死亡风险的关联，并分析性别和年龄的交互作用。[结果] 研究共纳入2 473例患者，中位随访时间为4.5年。痰瘀互结证（38.0%）是最主要的中医证型。多因素COX回归分析显示，与低危组-气滞血瘀证相比，高危组-心肾阳虚证患者全因死亡（HR=3.08，95%CI：1.48~6.42）和心血管死亡（HR=3.15，95%CI：1.37~7.26）风险最高。交互作用分析发现显著的性别差异：中医证型对死亡风险的预测价值在男性患者中更为突出（P<0.05），而在女性患者中该关联整体减弱，部分证型甚至表现出与参照组相反的风险趋势。年龄分层分析显示，证型对心血管死亡的风险在<65岁患者中更强，而对全因死亡的风险则在≥65岁患者中更为突出。[结论] 在冠心病合并2型糖尿病人群中，中医证型与死亡风险显著相关。心肾阳虚证是预后不良的关键标志。证型与死亡风险的关联存在显著的性别和年龄异质性，提示在未来制定个体化中医防治策略时，需充分考虑患者的性别与年龄特征。

Abstract:

[Objective] To investigate the distribution characteristics of traditional Chinese medicine（TCM） syndromes in patients with coronary heart disease（CHD） complicated with type 2 diabetes mellitus（T2DM），and to analyze the association between different TCM syndromes and the risks of all-cause mortality and cardiovascular mortality，while examining the interaction effects of gender and age.[Methods] A retrospective cohort study design was adopted. A total of 2 473 patients with CHD and T2DM from 6 hospitals in Tianjin were enrolled from the CSCD-TCM^plus database between January 2014 and June 2022. Based on TCM syndrome differentiation，patients were divided into 5 risk strata. Endpoint events，including all-cause death and cardiovascular death，were determined by linking the social security system database. Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression models were used to assess the association between TCM syndromes and mortality risk，and interaction effects of gender and age were analyzed. [Results] Among the 2 473 patients included，the median follow-up time was 4.5 years. phlegm and blood stasis（38.0%） was the most common TCM syndrome. Multivariate Cox regression analysis showed that compared with the low-risk group（qi stagnation and blood stasis），the high-risk group（heart and kidney yang deficiency） had the highest risks of all-cause death（HR=3.08，95%CI：1.48-6.42） and cardiovascular death（HR=3.15，95%CI：1.37-7.26）. Interaction analysis revealed significant gender dimorphism：The predictive value of TCM syndromes for mortality risk was more prominent in male patients（P<0.05），while this association was generally attenuated in female patients，with some syndromes even demonstrating a risk trend opposite to that of the reference group. Age stratification analysis showed that the risk of cardiovascular death associated with TCM syndromes was stronger in patients <65 years old，while the risk of all-cause death was more prominent in patients ≥65 years old. [Conclusion] In patients with CHD and T2DM，TCM syndrome is significantly associated with mortality risk，and，and the syndrome of yang deficiency of the heart and kidney is a key marker of poor prognosis. The association between TCM syndromes and mortality risk exhibits significant heterogeneity by gender and age，suggesting that patients’ gender and age characteristics should be fully considered when formulating individualized TCM prevention and treatment strategies in the future.