摘要
目的:探究不同中医证型非瓣膜性房颤患者抗凝出血、卒中危险度及心脏结构重构、电重构的特点。方法:选取我院2019年11月至2021年11月收治的102例非瓣膜性房颤患者。比较不同中医证型非瓣膜性房颤患者的凝血功能、出血风险(HAS-BLED)评分、卒中危险(CHA2DS2-VASc)评分、心脏结构重构及电重构指标。结果:非瓣膜性房颤患者以气阴两虚证、气滞血瘀证、痰瘀内阻证、水饮凌心证、心阳不振证为主,其中气滞血瘀证患者多伴有高血压,水饮凌心证患者多伴有冠心病(P<0.05);气滞血瘀证、痰瘀内阻证型的非瓣膜性房颤患者凝血酶原时间(PT)及活化部分凝血活酶时间(APTT)均短于其他三种证型,血清纤维蛋白原(FIB)水平及D-二聚体(D-D)水平均高于其他三种证型(P<0.05);气滞血瘀证、痰瘀内阻证型的非瓣膜性房颤患者HAS-BLED评分均高于其他三种证型(P<0.05);气滞血瘀证、痰瘀内阻证及水饮凌心证型的非瓣膜性房颤患者CHA2DS2-VASc评分均高于其他两种证型(P<0.05);气滞血瘀证、水饮凌心证型非瓣膜性房颤患者的左房内径(LAD)、舒张末期左心室内径(LVDd)均高于其他三种证型,左室射血分数(LVEF)低于其他三种证型(P<0.05);气滞血瘀证、水饮凌心证型非瓣膜性房颤患者的PR间期、QRS时限均长于其他三种证型,气滞血瘀证、水饮凌心证型非瓣膜性房颤患者的PR间期、QRS时限均长于其他三种证型,基础有效不应期(AERP)短于其他三种证型(P<0.05)。结论:非瓣膜性房颤患者的中医证型以气阴两虚证、气滞血瘀证、痰瘀内阻证、水饮凌心证为主,其中气滞血瘀证、痰瘀内阻证型患者存在明显高凝状态,且卒中风险较高;水饮凌心证型患者心脏结构重构及电重构存在较大变化,变现为LAD及LVDd扩大,LVEF降低,PR间期、QRS时限及AERP明显缩短,需重视对气滞血瘀证、痰瘀内阻证抗凝出血治疗,预防脑卒中,减轻水饮凌心证患者心脏负荷。
Objective:To explore the characteristics of anticoagulation bleeding,stroke risk,cardiac structural remodeling and electrical remodeling in patients with non-valvular atrial fibrillation of different TCM syndromes.Methods:102 patients with non-valvular atrial fibrillation treated in the hospital were selected between November 2019 and November 2021.The coagulation function,bleeding risk(HAS-BLED)score,stroke risk(CHA2DS2-VASc)score and indicators of cardiac structural remodeling and electrical remodeling were compared among patients with non-valvular atrial fibrillation of different TCM syndromes.Results:The patients with non-valvular atrial fibrillation were mainly manifested as Qi-Yin deficiency syndrome,Qi stagnation and blood stasis syndrome,phlegm-stasis internal obstruction syndrome,syndrome of fluid retention invading heart and heart-Yang hypoactivity syndrome,and the patients with Qi stagnation and blood stasis syndrome were mostly accompanied by hypertension and the patients with syndrome of fluid retention invading heart were mostly complicated with coronary heart disease(P<0.05).The prothrombin time(PT)and activated partial thromboplastin time(APTT)in patients with non-valvular atrial fibrillation of Qi stagnation and blood stasis syndrome and phlegm-stasis internal obstruction syndrome were shorter than those of the other three syndromes,and the levels of serum fibrinogen(FIB)and D-dimer(D-D)were higher than those of the other three syndromes(P<0.05).The HAS-BLED score of patients with non-valvular atrial fibrillation of Qi stagnation and blood stasis syndrome or phlegm-stasis internal obstruction syndrome was higher than that of the other three syndromes(P<0.05).The CHA2DS2-VASc score of patients with non-valvular atrial fibrillation of Qi stagnation and blood stasis syndrome,phlegm-stasis internal obstruction syndrome and syndrome of fluid retention invading heart was higher than that of the other two syndromes(P<0.05).The left atrial diameter(LAD)and left ventricular end-diastolic diameter(LVDd)of patients with Qi stagnation and blood stasis syndrome and syndrome of fluid retention invading heart were higher than those of the other three syndromes while the left ventricular ejection fraction(LVEF)was lower than that of the other three syndromes(P<0.05).The PR interval and QRS time limit of patients with non-valvular atrial fibrillation of Qi stagnation and blood stasis syndrome and syndrome of fluid retention invading heart were longer than those of the other three syndromes while the atrial effective refractory period(AERP)was shorter than that of the other three syndromes(P<0.05).Conclusion:The TCM syndromes of patients with non-valvular atrial fibrillation are mainly Qi-Yin deficiency syndrome,Qi stagnation and blood stasis syndrome,phlegm-stasis internal obstruction syndrome and syndrome of fluid retention invading heart.Patients with Qi stagnation and blood stasis syndrome and phlegm-stasis internal obstruction syndrome have obvious hypercoagulability and high risk of stroke.Patients with syndrome of fluid retention invading heart have great changes in cardiac structural remodeling and electrical remodeling,which are shown as expanded LAD and LVDd,decreased LVEF and significantly shortened PR interval,QRS time limit and AERP.It is necessary to pay attention to the anticoagulation bleeding treatment of Qi stagnation and blood stasis syndrome and phlegm-stasis internal obstruction syndrome to prevent the stroke and relieve the cardiac load in patients with syndrome of fluid retention invading heart.
作者
孙盼
朱征
卿慧玲
陈晨
SUN Pan;ZHU Zheng;QING Huiling(Hubei Provincial Hospital of Traditional Chinese Medicine\the Affiliated Hospital of Hubei University of Traditional Chinese Medicine and Hubei Academy of Traditional Chinese Medicine,Wuhan Hubei 430070,China)
出处
《四川中医》
2023年第2期67-71,共5页
Journal of Sichuan of Traditional Chinese Medicine
关键词
非瓣膜性房颤
中医证型
凝血功能
卒中危险度
心脏重构
Non-valvular atrial fibrillation
TCM syndromes
Coagulation function
Stroke risk
Cardiac remodeling
