加载中医非药物治疗下慢性心力衰竭患者射血分数现况及影响因素分析

Influencing factors for ejection fraction in chronic heart failure patients undergoing non-pharmacological treatment of traditional Chinese medicine

关键词:  中医非药物治疗  慢性心力衰竭  左心室射血分数  影响因素

Key words:  traditional Chinese non-pharmacological treatment  chronic heart failure  left ventricular ejection fraction  influencing factors

摘要:

目的 探讨加载中医非药物治疗的慢性心力衰竭患者射血分数的现况以及影响因素。方法 收集2021年1月—2021年12月上海市浦东新区光明中医医院收治的285例慢性心力衰竭患者的临床资料。收集患者的性别、年龄、体重、心率、中医治疗情况、既往史、吸烟史、血常规及血生化指标、左心室射血分数等资料，分析慢性心力衰竭患者的左心室射血分数现况，运用单因素和多因素Logistic逐步向前回归分析射血分数降低的相关危险因素，通过受试者工作特征曲线(receiver operating characteristic, ROC)下的面积来对这些因素进行预测价值评估。结果 本研究加载中医非药物治疗包括针灸、手指点穴、穴位敷贴和耳穴压丸的慢性心力衰竭患者射血分数降低有44例，射血分数正常患者有241例；左心室射血分数降低与多因素有关，多因素Logistic逐步向前回归分析结果显示脑卒中(OR=2.776, 95%CI: 1.047.408）、尿素氮(OR=1.077, 95%CI: 1.0141.144)和中医证候积分(OR=1.094, 95%CI: 1.0231.17)是慢性心力衰竭患者左室射血分数降低的影响因素。脑卒中、尿素氮和中医证候积分预测慢性心力衰竭患者射血分数降低的ROC曲线下面积分别为0.546（95%CI: 0.4490.643）、0.656（95%CI: 0.5630.748）、0.617（95%CI: 0.5250.71）。结论 加载中医非药物治疗包括针灸、手指点穴、穴位敷贴和耳穴压丸的慢性心力衰竭患者射血分数降低的患者较少，为15.4%；Logistic回归结果分析显示是否有脑卒中、尿素氮水平以及中医证候积分不同均可以影响正常射血分数，应该受到关注并制定防控措施，但是脑卒中、尿素氮和中医证候积分对于慢性心力衰竭患者发生射血分数降低的预测效能不高，尚不能作为预测指标。

Abstract:

Objective To investigate influencing factors of ejection fraction in chronic heart failure(CHF) patients with non-pharmacological treatment of traditional Chinese medicine(TCM). Methods Clinical data of 285 patients with CHF admitted to Guangming TCM Hospital of Shanghai Pudong New Area from January 2021 to December 2021 were retrospectively analyzed. Sex, age, body weight, heart rate, non-pharmacological TCM treatment(acupuncture and moxibustion, finger point tapping, acupoint application and auricular point pressing pills), past history, smoking, blood routine and blood biochemical indexes, and left ventricular ejection fraction(LVEF) of patients were documented, and the risk factors related to the reduction of LVEF were analyzed by using univariate and multivariate logistic regression. The value of these factors in predicting reduction of election fraction predictive was assessed by receiver operating characteristic curve(ROC). Results There were 44 patients had decreased LVEF(15.4%) and 241 patients had normal LVEF. The results of stepwise forward logistic regression analysis showed that stroke(OR=2.776, 95%CI: 1.04-7.408), urea nitrogen(OR=1.077, 95%CI: 1.014-1.144), and TCM syndrome score(OR=1.094, 95%CI: 1.023-1.17) were the influencing factors for the decrease in LVEF in CHF patients. The area under the ROC curve(AUC) of stroke, urea nitrogen, and TCM syndrome score in predicting reduced LVEF in CHF patients was 0.546(95%CI: 0.449-0.643), 0.656(95%CI: 0.563-0.748), and 0.617(95%CI: 0.525-0.71), respectively. Conclusion The incidence of decreased LVEF in CHF patients with TCM non-pharmacological treatment is relatively low, which is related with the history of stroke, urea nitrogen level, and TCM syndrome scores. However, the predictive efficacy of above indicators for the occurrence of reduced ejection fraction is not high enough.