Clinical Characteristics And Related Factors Of Blood-stasis Pattern In Type ? Cardiorenal Syndrome

Objective:To explore the clinical characteristics of blood-stasis pattern in type?cardiorenal syndrome?CRS?,and to analyze the related prognostic factors.Combining syndrome differentiation and syndrome,this paper tries to combine modern medical indicators with TCM syndrome differentiation theory,To explore the relationship between the two and the law for type?cardiorenal syndrome theory of traditional Chinese medicine to provide modern medical theory support and objective basis.Methods:Selected from August 2014 to January 2017 in Shandong Province,the hospital admitted to type?cardiorenal syndrome patients 74 cases of information.Reference to the Guidelines for the diagnosis and treatment of common diseases of traditional Chinese medicine on the heart failure and renal failure syndrome differentiation criteria,Chinese medicine clinical treatment terminology syndrome,traditional Chinese medicine treatment of chronic renal failure and chronic heart failure clinical research guidelines 2002 that the establishment of cardiorenal syndrome TCM standards and observation records.Collect and record the basic information of patients including symptoms,signs,tongue veins,NYHA classification,acute kidney injury staging,clinical indicators including serum creatinine,ejection fraction,NT-proBNP related information to determine the syndrome type of syndrome of cardiopulmonary syndrome.Finally,statistical analysis was carried out.Results:?1?type?cardiorenal syndrome with coronary heart disease,hypertension is the most common,there are 49 cases?66.22%?,followed by arrhythmia in 16 cases?21.62%?,there are a small number of heart valve disease and heart disease.?2?Distribution of patterns:Qi deficiency pattern in 50 cases?67.57%?,yin deficiency pattern in 25 cases?33.78%?,yang deficiency pattern in 10 cases?13.51%?,blood-stasis pattern in 51 cases?68.91%?,phlegm pattern in 34 cases?45.95%?.?3?survival:32 cases died of type?cardiorenal syndrome and 42 cases survived,among which 18 cases were blood-stasis pattern?56.25%?,12 cases?37.50%?were phlegm pattern,25 cases?78.13%?were deficiency of qi,Yang deficiency in 2 cases?6.25%?.?4?End event analysis:The correlation coefficient of blood stasis and type?cardiorenal syndrome was0.527,P=0.00<0.05,the difference was statistically significant.There was a positive correlation between the factors of blood-stasis pattern and death.Logistic regression analysis showed that the variables blood-stasis pattern P<0.05,the difference was statistically significant,the partial regression coefficient was 3.529,OR 34.100,OR 95%confidence interval was 4.254²73.324,the probability was 77.92%,that is,77.92%of death patients were combined blood-stasis pattern.Type?cardiorenal syndrome survival analysis,first univariate Cox regression analysis showed that only the blood stasis syndrome elements and age P<0.05,and then use a step-by-step approach to introduce Cox risk proportional model,the establishment of the equation:h?t?=h₀exp?1.043×age+21.424×blood-stasis pattern?.The correlation between the death of type?cardiorenal syndrome and the left ventricular ejection fraction?LVEF?,hemoglobin concentration and NT-proBNP combined with serum creatinine were-0.854,0.462,0.252,P<0.05,the difference was statistically significant Significance,negative correlation with LVEF,and hemoglobin concentration,NT-proBNP combined serum creatinine;and NT-proBNP,serum creatinine has nothing to do.According to the combination of BNP and serum creatinine,the area under the ROC for the end point of CRS was 0.647,indicating that the combined index was valuable for the prediction of CRS death with a correct index of 31%.?5?The relationship between related factors and blood-stasis pattern:The correlation coefficient of blood-stasis pattern,phlegm pattern,qi deficiency pattern and yin deficiency pattern were-0.318?0.408?0.233?0.162,blood-stasis pattern and qi deficiency pattern,phlegm pattern P<0.05,the difference was statistically significant,indicating that blood-stasis pattern and qi deficiency pattern,phlegm pattern has some relevance,is positively correlated with qi deficiency pattern,negative correlation with phlegm.Logistic regression analysis of blood-stasis pattern,qi deficiency pattern and phlegm pattern by using forward input showed that the model of blood stasis and deficiency of qi and phlegm was significant.The blood-stasis pattern and qi deficiency pattern had significant difference?P=0.03<0.05?,partial regression coefficient OR of1.688,OR of 5.411,odds ratio of 95%,and confidence interval of 1.753-16.698,with a probability of 84.40%.The blood-stasis pattern and phlegm pattern P=0.034<0.05,the difference was statistically significant,partial regression coefficient was-1.221,OR With a value of 0.295,95%confidence interval?OR?of 0.095 to 0.914,and a probability of22.78%.The correlation coefficients of LVEF,hemoglobin and blood-stasis pattern were-0.782 and 0.801 respectively?P<0.05?,the difference was statistically significant,indicating that blood-stasis pattern was positively correlated with hemoglobin concentration and negatively correlated with LVEF.Logistic regression analysis of blood-stasis pattern,LVEF,hemoglobin concentration equation and the establishment of blood-stasis pattern and hemoglobin concentration equation,P>0.05,the difference was not statistically significant.However,blood-stasis pattern and LVEF alone established equations,the OR was 0.184,95%confidence interval of 0.057⁰.589,that is,with the decrease of left ventricular ejection fraction,the probability of worsening blood-stasis pattern was 15.5%.?6?Analysis of the correlation factors and hemoglobin concentration:Spearman correlation analysis of patterns and hemoglobin concentration showed that the correlation coefficient between qi deficiency pattern,phlegm pattern and hemoglobin concentration was 0.364,-0.381,P<0.05,the difference was statistically significant.Acute Kidney Injury?AKI?staging and hemoglobin concentration analysis of variance and LSD multiple comparisons,the most common AKI staging 1 is blood-stasis pattern?27cases,65.9%?and qi deficiency pattern?27 cases,65.9%?,AKI staging 2 stage common is blood-stasis pattern?9 cases,75.0%?,AKI staging 3 stage is qi deficiency pattern?15cases,71.4%?and blood-stasis pattern?15 cases,71.4%?.AKI staging 1 and AKI staging 2,P<0.05,the difference was statistically significant,AKI staging 2 and AKI staging 3 P=0.01<0.05,the difference was statistically significant;AKIN2 the highest hemoglobin concentration.This shows that the distribution of blood-stasis pattern with the AKI staging increases,showing first increased and then decreased characteristics.Compared with the blood-stasis pattern and hemoglobin concentration,the NYHA?grade of 194.11±26.78,the NYHA?grade of 92.25±24.71,the NYHA?grade of87.38±16.09 and the NYHA?grade of 83.86±16.76;NYHA grading comparison P>0.05,the difference was not statistically significant.Changes in hemoglobin concentration in NYHA class and blood-stasis pattern vary inconsistently.The correlation coefficient of hemoglobin concentration and LVEF Spearman was-0.583,P<0.05,the difference was statistically significant.The following is the proportion of different types of heart failure blood-stasis pattern:HFpEF is 0.0%,HFmrEF is 78.6%,HFrEF is the inevitable syndrome elements.HFpEF hemoglobin concentration of 70.93±3.81,HFmrEF89.19±17.79,HFrEF100.11±17.09.HFpEF,HFmrEF,HFrEF differences between the groups were statistically significant.LVEF and hemoglobin concentration was negatively correlated,with the increase of LVEF,hemoglobin concentration decreased,the proportion of blood-stasis pattern decreased.Conclusion:?1?Blood-stasis pattern is the main factor in the development and development of type?cardiorenal syndrome,and it is also the main factor of patterns which affect the death of type?cardiorenal syndrome;?2?The characteristics of Blood-stasis pattern under different acute kidney injury staging are similar to those of hemoglobin concentration distribution,suggesting that there is some intrinsic relationship between hemoglobin and blood stasis,which also implies the pathological changes of heart and kidney from disease;?3?Blood-stasis pattern,NT-proBNP combined with serum creatinine established model,left ventricular ejection fraction,hemoglobin concentration have a role in type?CRS death,blood-stasis pattern and hemoglobin and left ventricular ejection fraction have correlation,but there was no correlation between blood-stasis pattern and NT-proBNP combined with serum creatinine.