| Objective:Based on clinical practice,this study analyzed the risk factors and potential pathogenic risks of chronic heart failure combined with hyperuricemia by studying the distribution characteristics of TCM evidence patterns in patients with chronic heart failure combined with hyperuricemia,while using patients with chronic heart failure without hyperuricemia as a control group,to provide more accurate evidence-based treatment for chronic heart failure combined with hyperuricemia in TCM,and to provide ideas and solutions for the development of more reasonable Chinese and Western medicine treatment intervention strategies in the future.Methods:Patients with chronic heart failure hospitalized in the cardiovascular disease department of Kunming Traditional Chinese Medicine Hospital from December 2020 to December 2022 were collected,and chronic heart failure patients were divided into those with chronic heart failure combined with hyperuricemia(referred to as the hyperuricemia group)and those with chronic heart failure without hyperuricemia(referred to as the non-hyperuricemia group)according to the presence of hyperuricemia;by collecting medical history data,information from the four Chinese medicine consultations,NYHA cardiac function classification,BNP,SUA,and evidence-based staging.The study contents included: 1.basic conditions of patients;2.distribution of comorbidities of underlying cardiovascular diseases in patients with chronic heart failure;3.comparison of the differences in NYHA cardiac function,SUA,and BNP between the hyperuricemic group and the non-hyperuricemic group;4.characteristics of TCM evidence distribution between the hyperuricemic group and the non-hyperuricemic group,and comparison of the differences between TCM evidence distribution and objective indicators such as BNP,SUA,and NYHA cardiac function.To ensure the reliability and accuracy of the data,this study was recorded by double double recording,and all statistical information was entered into an excel sheet and processed using the statistical software of SPSS24.0.Results:(1)A total of 222 patients with chronic heart failure were finally included in this study,including 157 cases in the hyperuric acid group,accounting for 70.72% of the patients with chronic heart failure;65 cases in the non-hyperuric acid group,accounting for 29.28% of the patients with chronic heart failure.(2)General conditions: There was no statistical difference between the two groups in terms of gender and age(P > 0.05);the percentages of smoking,alcohol consumption and family history were higher in the hyperuric acid group than in the non-hyperuric acid group,and the difference was statistically significant(P < 0.05).(3)Disease duration: there was a statistically significant difference between the two groups in the disease duration of less than 1 year,1-5 years,and more than 10 years(P <0.05);there was no statistically significant difference between the two groups in the disease duration of 6-10 years(P > 0.05);the proportion of patients with disease duration of less than 1 year in the hyperuric acid group was significantly higher than that in the non-hyperuric acid group;the proportion of patients with disease duration of 1-5years,6-10 years,and more than 10 years in the non-hyperuric acid group were The proportion of patients in the non-hyperuric acid group was higher than that in the high uric acid group.(4)Basic cardiovascular diseases: The differences between the two groups were statistically significant in the comparison of diabetes mellitus,hyperlipidemia,coronary heart disease,arrhythmia,and peripheral arteriosclerosis(P < 0.05);the differences between the two groups were not statistically significant in the comparison of hypertension,pulmonary heart disease,dilated cardiomyopathy,rheumatic heart disease,hypertrophic cardiomyopathy,heart valve disease,and renal insufficiency(P > 0.05);Except for hypertrophic cardiomyopathy and renal insufficiency in which the proportion of patients in the non-hyperuric acid group was greater than that in the hyperuric acid group,the proportion of patients in the hyperuric acid group was greater than that in the non-hyperuric acid group in the comparison of each underlying disease.(5)BNP,SUA,and NYHA cardiac function: In the comparison of BNP and SUA levels between the two groups,the differences were statistically significant(P < 0.05)and were significantly higher in the high-uric acid group than in the non-hyperuric acid group;as the NYHA cardiac function level increased,both BNP and SUA increased significantly,and the differences were statistically significant(P < 0.05).In addition,the levels of SUA and BNP were positively correlated.(6)Characteristics of evidence distribution: the overall distribution of evidence types in chronic heart failure patients was from small to large in the order of Qi deficiency and blood stasis evidence(25.2%),Qi and Yin deficiency and blood stasis evidence(34.7%),and Yang Qi deficiency and blood stasis evidence(40.1%);the Chinese medicine evidence type in the hyperuricemic group was dominated by Yang Qi deficiency and blood stasis evidence(45.9%),followed by Qi and Yin deficiency and blood stasis evidence(36.9%),Qi deficiency and blood stasis evidence(In the non-hyperuric acid group,the TCM evidence type was dominated by Qi deficiency and blood stasis(44.6%),followed by Qi and Yin deficiency and blood stasis(29.2%)and Yang deficiency and blood stasis(26.2%);the comparison between the two groups was statistically different(P < 0.05).In the comparison of phlegm-drink evidence,the overall distribution of evidence types in chronic heart failure was from small to large: Qi deficiency and blood stasis with phlegm-drink evidence(26.9%),Qi-yin deficiency and blood stasis with phlegm-drink evidence(27.5%),and Yang deficiency and blood stasis with phlegm-drink evidence(45.5%);in the hyperuricemic group,the Chinese medical evidence types were mainly Yang deficiency and blood stasis with phlegm-drink evidence(51.6%),followed by Qi deficiency and blood stasis with phlegm-drink evidence(26.2%)and Yang deficiency and blood stasis with phlegm-drink evidence(26.2%),In the non-hyperuric acid group,the TCM symptoms were mainly Qi-Yin deficiency with phlegm-drinking(43.9%),followed by Qi deficiency with blood stasis with phlegm-drinking(29.3%)and Yang deficiency with blood stasis with phlegm-drinking(26.8%);the difference between the two groups was statistically different(P < 0.05).(7)TCM evidence type and NYHA cardiac function: in NYHA cardiac function class II,Qi deficiency and blood stasis evidence was predominant(56.3%),followed by Qi and Yin deficiency and blood stasis evidence(37.5%)and Yang deficiency and blood stasis evidence(6.3%);in NYHA cardiac function class III,Yang deficiency and blood stasis evidence was predominant(42.7%),followed by Qi and Yin deficiency and blood stasis evidence(34.5%)and Qi deficiency and blood stasis evidence((22.8%);the difference between NYHA cardiac function and TCM evidence type was statistically significant(P < 0.05).(8)Comparison of different TCM evidence types with BNP and SUA in the two groups: the differences in the distribution of BNP and SUA among different TCM evidence types in the high uric acid group were statistically significant(P < 0.05),and the distribution of TCM evidence types with BNP and SUA levels from low to high were in the order of Qi deficiency and blood stasis,Qi and Yin deficiency and blood stasis,and Yang deficiency and blood stasis;the differences in SUA levels among different TCM evidence types in the non-hyperuric acid group were not statistically significant(P > 0.05).In the comparison between the two groups,the SUA level was significantly higher in the hyperuric acid group than in the non-hyperuric acid group,while the BNP level was higher in the non-hyperuric acid group than in the hyperuric acid group in the comparison between the Qi deficiency and blood stasis evidence,and higher in the hyperuric acid group than in the non-hyperuric acid group in the comparison between the Qi and Yin deficiency and blood stasis evidence and the Yang Qi deficiency and blood stasis evidence.The difference in BNP levels between the two groups was statistically significant(P < 0.05)in the comparison of Yang Qi deficiency and Blood stasis evidence,but not in the comparison of Qi deficiency and Blood stasis evidence and Qi Yin deficiency and Blood stasis evidence(P > 0.05);the difference in SUA levels between the two groups was statistically significant(P < 0.05)in the comparison of different TCM evidence types.(9)Comparison of TCM types with or without phlegm and bronchitis with BNP and SUA: the differences between TCM types with chronic heart failure and phlegm and bronchitis were statistically significant in the comparison of SUA and BNP levels(P <0.05);while the differences between TCM types with chronic heart failure without phlegm and bronchitis were statistically significant in the comparison of BNP(P < 0.05)and not statistically significant in the comparison of SUA(P > 0.05);the differences between TCM types with chronic heart failure and phlegm and bronchitis were statistically significant in the comparison of BNP(P < 0.05).(P > 0.05);in the comparison of the TCM evidence types of chronic heart failure with phlegm-drinking evidence,the BNP levels of the TCM evidence types with phlegm-drinking evidence were all higher than those of the evidence types without phlegm-drinking evidence,except for the BNP of the Qi-Yin two deficiency evidence with phlegm-drinking evidence,which was higher than that of the evidence with phlegm-drinking evidence;the SUA levels of the TCM evidence types with chronic heart failure with phlegm-drinking evidence were all higher than those of the evidence with chronic heart failure without phlegm-drinking evidence.Conclusion:(1)Hyperuricemia accounts for a large proportion of patients with chronic heart failure and should be taken seriously.(2)Chronic heart failure combined with hyperuricemia may have the same pathological mechanism and pathogenesis as diabetes mellitus,hyperlipidemia,coronary artery disease,arrhythmia,and peripheral arteriosclerosis,so patients with underlying cardiovascular diseases should be closely tested for blood uric acid level and given intervention in advance.(3)SUA is positively correlated with BNP and NYHA cardiac function classification,suggesting that SUA level can be used as an objective indicator of the severity and prognosis of chronic heart failure.(4)The overall TCM evidence patterns of chronic heart failure from mild to severe are mainly Qi deficiency and blood stasis,Qi and Yin deficiency and blood stasis,and Yang Qi deficiency and blood stasis;the hyperuricemia group is consistent with this pathogenesis pattern and is positively correlated with SUA and BNP,so these two tests can be used to provide clinical ideas of TCM evidence for chronic heart failure,especially for chronic heart failure patients with combined hyperuricemia.(5)The proportion of patients with chronic heart failure with hyperuricemia who exhibit more severe symptoms and signs may be higher than that of chronic heart failure patients without hyperuricemia,and in the comparison of the same evidence type of Qi-Yin deficiency and Blood stasis evidence and Yang-Qi deficiency and Blood stasis evidence,chronic heart failure patients with hyperuricemia have a worse condition and prognosis than chronic heart failure patients without hyperuricemia.(6)In the comparison of SUA and BNP for each TCM type of concurrent phlegm-drinking evidence,the overall results were higher than those of non-current phlegm-drinking evidence,suggesting that patients with concurrent phlegm-drinking evidence are more likely to have more severe heart failure and poorer prognosis than those with non-phlegm-drinking evidence. |
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