發(fā)布時間：2018-04-20 17:38

  本文選題：肺動脈高壓 + 中醫(yī)證候　； 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：背景:肺動脈高壓(Pulmonary Hypertension,PH)是以肺血管阻力進行性升高為特征,進而右心室肥厚擴張,甚至右心衰竭的一種肺血管病,發(fā)病率、致殘率及病死率較高。嚴重影響患者生活質(zhì)量及壽命。近年現(xiàn)代醫(yī)學(xué)對此病在診斷方面明確了病因及分類,治療上靶向藥的問世也提高了療效,但仍存在一些問題,如某些類型的肺動脈高壓治療療效欠佳,靶向藥價格昂貴,副作用大,預(yù)后不好等。臨床發(fā)現(xiàn),中醫(yī)藥在治療肺動脈高壓有一定療效,但近年研究缺乏大規(guī)模的臨床研究數(shù)據(jù)支持,且對于證候?qū)W研究證據(jù)不足。目的:探索肺動脈高壓病人中醫(yī)證候分布特點及與疾病預(yù)后指標的相關(guān)性,以明確肺動脈高壓優(yōu)勢證候及與疾病預(yù)后的相關(guān)性,為臨床辨證施治提供依據(jù)。方法:1.收集肺動脈高壓病人中醫(yī)臨床證候?qū)W資料,進行臨床辨證分析,初步探索肺動脈高壓證候特點及辨證分型。2.分析肺動脈高壓病人證型與預(yù)后指標如六分鐘步行距離、心功能分級、NT-proBNP的相關(guān)性。結(jié)果:1.在病性證素方面:32例肺動脈高壓病人的證候發(fā)生率依次是氣虛(100.00%)=血瘀(100.00%)水飲(50.00%)陽虛(40.62%)陰虛(40.62%)痰濁(15.62%)氣滯(18.75%)血虛(9.38%),進一步分別對動脈性肺動脈高壓和慢性血栓栓塞性肺動脈高壓兩類病人病性證素分布進行統(tǒng)計分析,發(fā)現(xiàn)兩類病人病性證素分布在統(tǒng)計學(xué)上無顯著差異,氣虛證、血瘀證是肺動脈高壓發(fā)生率最高的證候,約半數(shù)病人伴有水飲證,部分病人同時兼有陽虛、陰虛、痰濁、氣滯、血虛等。2.在病位證素方面:肺、脾、腎、心在肺動脈高壓發(fā)病中起重要作用。其中動脈性肺動脈高壓病位證素分布頻率依次是肺(100.00%)脾(58.33%)腎(41.67%)心(41.67%)肝(16.67%),慢性血栓栓塞性肺動脈高壓病位證素分布頻率依次是肺(100.00%)脾(60.00%)腎(55.00%)心(25.00%)肝(20.00%),兩類病人病位證素分布在統(tǒng)計學(xué)上有顯著差異,動脈性肺動脈高壓與慢性血栓栓塞性肺動脈高壓相比,肺所占比例相當(dāng),心在動脈性肺動脈高壓中所占比例較大,而脾、腎在慢性血栓栓塞性肺動脈高壓中所占比例較大。3.證型分布:可分為氣虛血瘀證(31.25%),陽虛血瘀水泛證(28.13%),陰虛血瘀水停證(21.88%),氣陰兩虛兼血瘀證(18.75%)4組。將動脈性肺動脈高壓和慢性血栓栓塞性肺動脈高壓兩類病人的四個證型進行統(tǒng)計分析,發(fā)現(xiàn)兩類病人的證型分布在統(tǒng)計學(xué)上無顯著差異。氣虛血瘀證是肺動脈高壓的主要證型。4.證型與NT-ProBNP、六分鐘步行距離、心功能分級的關(guān)系:分別對四組證型病人的NT-ProBNP、六分鐘步行距離、心功能分級進行統(tǒng)計分析,發(fā)現(xiàn),陰虛血瘀水停證的NT-ProBNP水平最高,其次是陽虛血瘀水泛證、氣虛血瘀證、氣陰兩虛兼血瘀證NT-ProBNP水平最低;氣陰兩虛兼血瘀證六分鐘步行距離最長,其次是氣虛血瘀證、陽虛血瘀水泛證,陰虛血瘀水停證六分鐘步行距離最短。四組證型的心功能分級差異無統(tǒng)計學(xué)意義。5.證型與NT-ProBNP和六分鐘步行距離的相關(guān)性邏輯回歸分析:將水飲證與NT-ProBNP和六分鐘步行距離做二元Logistic回歸分析,結(jié)果表明,NT-ProBNP與水飲證呈正相關(guān),六分鐘步行距離與水飲證呈負相關(guān)。結(jié)論:肺動脈高壓病人以氣虛血瘀證為基本病機,隨著疾病進展出現(xiàn)水飲證,根據(jù)陰陽偏盛偏衰的不同,可分為氣虛血瘀證、氣陰兩虛兼血瘀證、陽虛血瘀水泛證、陰虛血瘀水停證4個證型。其中水飲證與NT-ProBNP呈正相關(guān),和六分鐘步行距離呈負相關(guān),且在水飲證中,陰虛血瘀水停證的NT-ProBNP更大,六分鐘步行距離更短,提示病情可能更危重。
[Abstract]:Background: Pulmonary Hypertension (PH) is a kind of pulmonary vascular disease characterized by elevated pulmonary vascular resistance, and then right ventricular hypertrophy, even right heart failure, a kind of pulmonary vascular disease, the incidence, the rate of disability and the mortality are high. The quality of life and life of the patients are seriously affected. In recent years modern medicine has made clear the cause of the disease in the diagnosis of the disease. But there are still some problems, such as some types of pulmonary hypertension treatment is not good, the target drug is expensive, the side effect is large, the prognosis is not good. Clinical findings, Chinese medicine has a certain effect in the treatment of pulmonary hypertension, but in recent years there is a lack of large-scale clinical research data. Support, and lack of evidence for the study of syndrome. Objective: To explore the characteristics of the distribution of TCM syndromes and the correlation with the prognosis of the patients with pulmonary hypertension in order to clarify the correlation between the dominant syndromes of pulmonary hypertension and the prognosis of the disease, and to provide the basis for clinical syndrome differentiation. 1. Data, clinical syndrome differentiation and analysis, preliminary exploration of characteristics of pulmonary hypertension syndrome and syndrome differentiation.2. analysis of pulmonary hypertension patients' syndrome and prognostic indicators such as six minutes walking distance, cardiac function classification, NT-proBNP correlation. Results: 1. in the disease syndrome factor: 32 cases of pulmonary arteria hypertension patients in turn is Qi deficiency (100%) = blood stasis (100%) water (50%) Yang deficiency (40.62%) yin deficiency (40.62%) phlegm (15.62%) and Qi Stagnation (18.75%) blood deficiency (9.38%). The distribution of the syndromes of the two patients with arterial pulmonary hypertension and chronic thromboembolic pulmonary hypertension was analyzed, and there was no significant difference between the two types of patients with the distribution of the syndromes in the two patients. Qi deficiency syndrome, blood stasis syndrome is the highest incidence of pulmonary arterial hypertension, about half of the patients have water drinking syndrome. Some patients also have Yang deficiency, yin deficiency, phlegm, qi stagnation, blood deficiency and other.2. in the disease position syndrome: lung, spleen, kidney, heart play an important role in the pathogenesis of pulmonary artery hypertension. The pulmonary (100%) spleen (58.33%) kidney (41.67%) heart (41.67%) liver (16.67%), the frequency of the chronic thromboembolic pulmonary hypertension syndrome distribution frequency is the lung (100%) spleen (60%) kidney (55%) heart (20%) (20%), and the distribution of the syndrome factors of the two patients is statistically significant, the arterial hypertension and the chronic thromboembolic lung. The proportion of the pulmonary hypertension is comparable, the proportion of the heart in the arterial hypertension is larger, and the proportion of the spleen and the kidney in the chronic thromboembolic pulmonary hypertension is.3., which can be divided into Qi deficiency and blood stasis syndrome (31.25%), Yang deficiency and blood stasis water syndrome (28.13%), yin deficiency and blood stasis water stop (21.88%), Qi Yin deficiency and blood stasis syndrome (18) .75%) 4 groups. Statistical analysis was made on the four types of two types of patients with arterial pulmonary hypertension and chronic thromboembolic pulmonary hypertension. There was no significant difference between the two types of patients' syndrome distribution. Qi deficiency and blood stasis syndrome was the main syndrome type of pulmonary hypertension and NT-ProBNP, six minutes walking distance, and the classification of cardiac function. NT-ProBNP, six minutes walking distance and the classification of cardiac function of four groups of patients were statistically analyzed. It was found that the level of NT-ProBNP was the highest in Yin deficiency and blood stasis water, followed by Yang deficiency and blood stasis water syndrome, Qi deficiency and blood stasis syndrome, and the lowest NT-ProBNP level of Qi Yin deficiency and blood stasis syndrome, and the longest walking distance of Qi Yin deficiency and blood stasis syndrome for six minutes. The second is Qi deficiency and blood stasis syndrome, Yang deficiency and blood stasis water flooding syndrome, and the shortest walking distance of yin deficiency and blood stasis water stop for six minutes. There is no statistically significant correlation between the four groups of syndrome types of cardiac function classification difference between.5. syndrome and NT-ProBNP and six minutes walking distance: the water drink syndrome and NT-ProBNP and the six minute walking distance are two yuan Logistic regression The results showed that NT-ProBNP was positively related to water drinking syndrome, and the walking distance of six minutes was negatively correlated with water drinking syndrome. Conclusion: the basic pathogenesis is Qi deficiency and blood stasis syndrome in patients with pulmonary hypertension. With the development of deficiency of yin and Yang, the syndrome of qi deficiency and blood stasis can be divided into Qi deficiency and blood stasis syndrome, Qi Yin deficiency and blood stasis syndrome, Yang deficiency and blood stasis water flooding. Syndrome, yin deficiency and blood stasis water stop 4 syndrome types, of which water drinking syndrome is positively related to NT-ProBNP, and six minutes walking distance is negative correlation, and in water drinking syndrome, the NT-ProBNP of yin deficiency and blood stasis water stop syndrome is greater, six minutes walk distance is shorter, suggesting that the condition may be more critical.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259

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