Research On The Distribution Law Of TCM Syndrome Types Of HFpEF And Its Correlation With Comorbidities And Biological Indicators

STUDY ⅠOBJECTIVE:To investigate the distribution characteristics and combination rules of TCM symptoms and syndromes in patients with heart failure(HFpEF),and to explore the standardized TCM syndrome differentiation system of HFpEF.Methods:Through epidemiological investigation methods,170 cases of HFpEF patients were collected demographic data,cardiac function grading,comorbidities,and TCM four diagnosis information,and semi-quantitative methods were used to syndrome differentiation of TCM syndromes.The results were analyzed using descriptive statistics.Results:1.170 women with HFpEF were the majority(58.8%),with an average age of 75.22±10.43 years,and 42.9%of patients aged>80 years.The average number of comorbidities was 4.55±1.54,and the cardiac function was graded at the highest level.The common comorbidities were hypertension(84.1%),atrial fibrillation(52.4%),anemia(49.4%),coronary heart disease.(48.2%),hyperlipidemia(46.5%),especially with hypertension;2.The most common symptoms of patients in this study were chest tightness(96.5%),fatigue(78.8%),shortness of breath(72.9%),no supine at night(57.6%),and asthma(52.9%).Lower extremity edema(51.2%),and movement is even(50.6%);3.In this study,the analysis of the syndromes involved 9 diseases,including the heart,kidney,lung,spleen,stomach,table,bladder,liver and bones.The frequency of occurrence was the most heart(97.1%)and spleen(31.8%).);the syndrome analysis involves 12,from the most to the least for qi deficiency,water stop,blood stasis,turbidity,cold,yin deficiency,blood deficiency,yang deficiency,damp heat,impotence,dryness,heat,which appears The frequency was at most qi deficiency(97.1%),followed by water stop(51.2%),blood stasis(41.2%)and turbidity(28.8%);4.Analyze the syndrome syndrome combination syndrome:In the combination of syndrome and deficiency,37 cases(21.8%)were simple deficiency syndrome,5 cases(2.9%)were simple evidence,and 128 cases(75.3%)were based on this virtual standard evidence.Among the number combinations,the two syndromes were the most common in 71 cases(41.8%),of which qi deficiency and water stop(18.2%)were the most,followed by qi deficiency and blood stasis(14.7%),qi deficiency and turbidity(7.6%).),blood stasis and water stop(1.2%);a total of 47 cases(27.6%)of the three syndrome combinations,from large to small,followed by qi deficiency,water stop and blood stasis(13.5%),qi deficiency,water stop and turbidity(9.4%),qi deficiency,blood stasis and turbidity(4.7%);four syndromes were qi deficiency,water stop,blood stasis and phlegm were all seen at 7.1%.Conclusions:1.The most common symptoms of HFpEF are chest tightness,fatigue,shortness of breath,lack of supine at night,asthma,lower extremity edema,and breathing.2.The HFpEF is located in the five internal organs,mainly heart and spleen.The basic etiology and pathogenesis is the virtual standard.The qi deficiency is the basis,the water stops,the blood stasis and the turbidity are the standard,and the TCM syndrome type is mainly based on the qi deficiency water.STUDY IIOBJECTIVE:To analyze the correlation between HFpEF TCM syndrome and comorbidities and clinical biological indicators,to explore the possible biological basis of TCM syndrome,and to provide scientific basis for the objectification of TCM syndrome differentiation.METHODS:According to the results of a study on the distribution of TCM syndromes in 170 patients with HFpEF,the group was classified according to the severity of the syndrome and whether it had the syndrome.Sixty patients with non-heart failure were included as the control group.Analysis of TCM syndrome and cardiac function classification,combined disease,N-terminal B-type natriuretic peptide(NT-proBNP),troponin T(cTnT),hypersensitive C-reactive protein(HsCRP),plasma homocysteine(Hcy),blood uric acid(UA),total number of monocytes(MONO),total number of monocytes/high density lipoprotein cholesterol(MHR)and other laboratory indicators,ejection fraction(LVEF),mitral valve diastolic peak early blood Flow velocity/mitral valve diastolic peak blood flow velocity(E/A),mitral valve diastolic peak early blood flow velocity/mitral annulus lateral diastolic early maximum velocity(E/e’),left ventricular mass Correlation of echocardiographic indicators such as index(LVMI).Results:1.HFpEF TCM syndrome and classification of cardiac function:qi deficiency and severe disease group had lower frequency of grade Ⅱ cardiac function than qi deficiency and mild disease group,and grade Ⅲ and Ⅳ cardiac function appeared more frequently(P<0.05);water stop syndrome group There was no significant difference in cardiac function grading between the non-water-stopping group,the blood stasis syndrome group and the non-blood stasis syndrome group,the phlegm-stagnation syndrome group and the non-phlegm-stagnation syndrome group(P>0.05).2.HFpEF TCM syndrome and combined disease analysis:qi deficiency and severe disease were more frequent than qi deficiency and mild disease group and control group(56.1%vs 38.8%vs 8.3%,P=0.029,P=0.000);water stop syndrome group The frequency of chronic kidney disease was higher in the non-water-stop group and the control group(50.6%vs 30.1%vs 6.7%,P=0.036,P=0.000),and the frequency of hyperlipidemia was lower(33.3%vs 60.2).%vs 38.3%,P=0.000,P=0.001);blood stasis syndrome group had higher frequency of coronary heart disease than non-blood stasis syndrome group and control group(80.0%vs 26.0%vs 36.7%,P=0.000,P=0.000);phlegm and blood stasis syndrome group had higher frequency of hyperlipidemia than non-turbidity syndrome group and control group(61.2%vs 40.5%vs 38.3%,P=0.036,P=0.000),and the frequency of obesity was higher.(28.6%vs 14.0%vs 23.3%,P=0.031,P=0.023);further logistic regression analysis revealed qi deficiency syndrome and anemia[B:0.214,95%CI(0.111,0.447),P=0.000],diabetes[B:0.054,95%CI(0.006,0.113),P=0.036],chronic kidney disease[B:0.057,95%CI(0.001,0.114),P=0.046]was positive Correlation;water discontinuation syndrome was positively correlated with chronic kidney disease[B:0.152,95%CI(0.004,0.300),P=0.045],and negatively correlated with hyperlipidemia[B:-0.277,95%CI(-0.423),-0.131),P＝0.000];blood stasis syndrome and anemia[B:0.134,95%CI(0.008,0.259),P= 0.037].,coronary heart disease[B:0.525,95%CI(0.400,0.651),P=0.000]was positively correlated;phlegm syndrome and hyperlipidemia[B:0.123,95%CI(0.029,0.274),P=0.002],obesity[B:0,133,95%CI(0.122,0.248),P=0.024]is positively correlated.3.HFpEF TCM syndrome and laboratory indicators analysis:1Hcy water stop syndrome group Hcy higher than non-water stop syndrome group and control group(18.32±8.21 vs 14.92±8.89 vs 12.97±4.62,P=0.029,P= 0.000)2HsCRP in the blood stasis syndrome group was higher than that in the non-blood stasis syndrome group and the control group(7.70±7.59 vs 5.60±6.78 vs 4.63±4.09,P=0.034,P=0.001);3 phlegm and blood stasis syndrome group was more than non-turbidity syndrome group Compared with the control group,MONO was higher(0.72±0.40 vs 0.51±0.22 vs 0.44±0.14,P=0.033,P=0.006),and MHR was higher(0.67±0.54 vs 0.51±0.25 vs 0.48±0.43,P=0.013,P=0.001).4.HFpEF TCM syndrome and echocardiographic index analysis:1 qi deficiency and severe disease group EF lower than qi deficiency and mild disease group 57.97± 7.29 vs 62.33±7.81 vs 67.65±6.08,P=0.037,P＝0.006),e’more Low(4.37±1.08 vs 4.88±1.12vs 7.54±1.10,P=0.041,P=0.000),E/e’ was higher(23.74±8.14 vs 19.09±9.12 vs 11.81±2.90,P=0.012,P=0.000);2water stop syndrome group was higher than non-water stop syndrome group and control group LAd(49.51±7.75 vs 42.94±10.58 vs 37.10±4.54,P=0.035,P=0.000),LVMI was higher(117.51±37.65 vs 97.43± 25.74 vs 84.16±20.10,P=0.035,P=0.000);3 phlegm syndrome group was lower than E/A in non-turbidity syndrome group(0.90±0.28 vs 1.07±0.24,P=0.029).The non-turbidity syndrome group and the control group had higher E/e’(23.86±10.12 vs 18.30±8.00 vs 11.81±2.90,P=0.021,P=0.000).Conclusions:1.The degree of qi deficiency syndrome will increase with the deterioration of heart function,suggesting that the classification of cardiac function can reflect the degree of qi deficiency syndrome to a certain extent.2.Qi deficiency syndrome is positively associated with anemia,diabetes,and chronic kidney disease.Water withdrawal syndrome is positively correlated with chronic kidney disease,negatively correlated with hyperlipidemia,blood stasis syndrome is positively correlated with coronary heart disease,phlegm syndrome and hyperlipidemia obesity Positive correlation,suggesting that the combined disease has guiding value for TCM clinical syndrome differentiation of HFpEF patients.3.The Hcy of the water-stopping group was higher,the HsCRP of the blood stasis syndrome was higher,and the MONO and MHR of the phlegm-stagnation group were higher,suggesting that the chronic inflammatory reaction of the body may be the pathological mechanism of blood sputum formation in patients with HFpEF.4.The EF value,e’is lower,E/e’ is higher in the qi deficiency group,and the E/A is lower and the E/e’is higher in the phlegm syndrome group,suggesting that qi deficiency syndrome and phlegm syndrome may be impaired in diastolic function.Related;LAd and LVMI are higher in the water stop syndrome group,suggesting that the water stop syndrome may be related to ventricular remodeling,indicating that the echocardiographic index can provide a basis for TCM syndrome differentiation of HFpEF patients.