| Objective:To explore the distribution characteristics of TCM syndromes elements,the evolution law of TCM pathogenesis and the risk factors of HF in patients with non-paroxysmal AF,and to provide the basis for early intervention of integrated traditional Chinese and western medicine to reduce the incidence of HF in patients with non-paroxysmal AF.Methods:In this research,observational research method was adopted to include the patients with non-paroxysmal AF,and who were admitted to the Cardiovascular Department of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from September2019 to September 2021.The information was collected including the general information,echocardiographic indexes,laboratory indexes and the four diagnostics information of TCM of all patients.The Patients were divided into two groups according to whether HF occurred or not,which named NHF group and HF group separately.The data collected above are processed by SPSS26.0 statistical software,to analyze the distribution characteristics by observing the distribution of TCM syndrome elements in all patients and analyze the evolution law of TCM pathogenesis of HF in patients with non-paroxysmal AF by observing the differences of TCM syndrome elements types between the two groups.The general information,echocardiographic indexes and laboratory indexes with significant differences between NHF group and HF group were screened out,and then the Logistic regression analysis model was used to obtain the risk factors of HF in patients with non-paroxysmal AF.Results:1.Basic information of patients: A total of 390 patients with non-paroxysmal AF were included in this research,including 222 males(56.9%)and 168 females(43.1%).The age of patients ranged from 37 to 84 years old with an average age of 70.39.Among them,200patients(51.3%)had occurred HF at the time of admission.2.In all non-paroxysmal AF patients,the distribution of disease location syndrome elements of TCM from high to low is as follows: 380 cases of heart(97.4%),322 cases of spleen(82.6%),222 cases of kidney(56.9%),154 cases of lung(39.5%)and 66 cases of liver(16.9%).The distribution of pathological syndrome elements of TCM from high to low is as follows: 357 cases of qi deficiency(91.5%),240 cases of blood stasis(61.5%),221 cases of phlegm turbidity(56.7%),215 cases of yin deficiency(55.1%),176 cases of yang deficiency(45.1%),125 cases of heat accumulation(32.1%),There were 109 cases of blood deficiency(28.0%),95 cases of retained fluid(24.4%)and 42 cases of qi stagnation(10.8%).3.Among patients in NHF group,the distribution of disease location syndrome elements of TCM from high to low is as follows: 184 cases of heart(96.8%),152 cases of spleen(80.0%),77 cases of kidney(40.5%),36 cases of lung(19.0%)and 28 cases of liver(14.7%).The distribution of pathological syndrome elements of TCM from high to low is as follows:171 cases of qi deficiency(90.0%),129 cases of yin deficiency(67.9%),111 cases of phlegm turbidity(58.4%),83 cases of heat accumulation(43.7%),76 cases of blood stasis(40.0%),55 cases of yang deficiency(29.0%),48 cases of blood deficiency(25.3%),26 cases of qi stagnation(13.7%)and 11 cases of retained fluid(5.8%).4.Among patients in HF group,the distribution of disease location syndrome elements of TCM from high to low is as follows: 196 cases of heart(98.0%),170 cases of spleen(85.0%),145 cases of kidney(72.5%),118 cases of lung(59.0%)and 38 cases of liver(19.0%).The distribution of pathological syndrome elements of TCM from high to low is as follows: 186 cases of qi deficiency(93.0%),164 cases of blood stasis(82.0%),121 cases of yang deficiency(60.5%),110 cases of phlegm turbidity(55.0%),86 cases of yin deficiency(43.0%),84 cases of retained fluid(42.0%),61 cases of blood deficiency(30.5%),42 cases of heat accumulation(21.0%)and 16 cases of qi stagnation(8.0%).5.The comparison of TCM syndromes elements between HF group and NHF group showed that there were significant differences between the two groups in disease location syndrome elements of TCM are kidney,lung and pathological syndrome elements of TCM are yin deficiency,yang deficiency,blood stasis,retained fluid,heat accumulation(P < 0.05).The different disease location syndrome elements of TCM in patients with non-paroxysmal AF,the incidence of HF is as follows: lung(76.6%)> kidney(65.3%).The different pathological syndrome elements of TCM in patients with non-paroxysmal AF,the incidence of HF is as follows: retained fluid(88.4%)> yang deficiency(68.8%)> blood stasis(68.3%)> yin deficiency(40.0%)> heat accumulation(33.6%).6.The comparison of clinical data between HF group and NHF group showed that the age,course of AF,systolic blood pressure,ventricular rate,LAD,IVST,LVEDD,LVPWT,Hb A1 c,Scr,Urea,UA and D-D in HF group were significantly higher than those in NHF group(P < 0.05).The Hb,ALB,e GFR,HDL-C and blood calcium in HF group were significantly lower than those in NHF group(P < 0.05).7.Logistic regression analysis showed that the course of AF,systolic blood pressure,ventricular rate,LAD,WBC and Hb may be independent risk factors for HF in patients with non-paroxysmal AF(P < 0.05).The patients with non-paroxysmal AF who have the longer course of AF(OR=1.363,95% CI=1.199 ～ 1.550),the higher systolic blood pressure(OR=1.048,95% CI=1.025 ～ 1.072),the faster ventricular rate(OR=1.046,95% CI=1.021 ～1.071),the longer LAD(OR = 1.211,95% CI = 1.126 ～ 1.302),the higher WBC level(OR=1.343,95% CI=1.074 ～ 1.680)and the lower Hb level(OR=1.343,95% CI=1.074 ～1.680)will occur the higher risk of HF.Conclusions:1.This research showed that the disease location syndrome elements of TCM of patients with non-paroxysmal AF are mainly heart,spleen and kidney.The deficiency syndrome elements of TCM are mainly qi deficiency and yin deficiency,while the excess syndrome elements of TCM are mainly blood stasis and phlegm turbidity.2.The TCM syndrome elements of heat accumulation and yin deficiency are more common in stage simple AF,and the TCM syndrome elements of lung,kidney,retained fluid,yang deficiency and blood stasis are more common in stage AF combined with HF.The non-paroxysmal AF advance to stage AF combined with HF from simple stage AF,and the location of the disease changes from heart and spleen to heart and spleen with lung and kidney.Deficiency is always based on qi deficiency,and with the development of the disease,the imbalance between yin and yang has gradually evolved from yin deficiency to yang deficiency.The excess syndrome gradually evolved from phlegm-heat to blood stasis,phlegm-dampness,and retained fluid.3.This research showed that the long course of AF,high systolic blood pressure,fast ventricular rate,increased LAD,high WBC level and low Hb level may be independent risk factors for HF in patients with non-paroxysmal AF. |
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