1、 临床研究 通讯作者:陈晨,硕士,副教授,研究方向:冠心病基础与临床。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、电重构特点分析孙盼1,朱征1,卿慧玲1,陈晨2,(1.湖北省中医院(湖北中医药大学附属医院、湖北省中医药研究院),湖北 武汉 430070;2.湖北中医药大学第一临床学院,湖北 武汉 430070)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
2、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(P0.05);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(P0.05);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(P0.05);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 CH
3、A2DS2-VASc 评分均高于其他两种证型(P0.05);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(P0.05);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(P0.05)。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
4、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。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 中图分类号:R 541.7+5 文献标志码:A 文章编号:1000-3649(2023)02-0067-05 Analysis on Characteristics of Anticoagulation Bleeding,Stroke Risk,Cardiac Structural Remo
5、deling and ElectricalRemodeling for Patients with Non-valvular Atrial Fibrillation of Different Traditional Chiense Medicine Syndromes/SUNPan,ZHU Zheng,QING Huiling,et al./1.Hubei Provincial Hospital of Traditional Chinese Medicine the Affiliated Hospitalof Hubei University of Traditional Chinese Me
6、dicine and Hubei Academy of Traditional Chinese Medicine(Wuhan Hubei 430070,China)Abstract:Objective:To explore the characteristics of anticoagulation bleeding,stroke risk,cardiac structural remodelingand electrical remodeling in patients with non-valvular atrial fibrillation of different TCM syndro
7、mes.Methods:102 patients withnon-valvular atrial fibrillation treated in the hospital were selected between November 2019 and November 2021.The coagulationfunction,bleeding risk(HAS-BLED)score,stroke risk(CHA2DS2-VASc)score and indicators of cardiac structural remode-ling and electrical remodeling w
8、ere compared among patients with non-valvular atrial fibrillation of different TCM syndromes.Re-sults:The patients with non-valvular atrial fibrillation were mainly manifested as Qi-Yin deficiency syndrome,Qi stagnation andblood stasis syndrome,phlegm-stasis internal obstruction syndrome,syndrome of
9、 fluid retention invading heart and heart-Yanghypoactivity syndrome,and the patients with Qi stagnation and blood stasis syndrome were mostly accompanied by hypertensionand the patients with syndrome of fluid retention invading heart were mostly complicated with coronary heart disease(P0.05).The pro
10、thrombin time(PT)and activated partial thromboplastin time(APTT)in patients with non-valvular atrial fibrillation ofQi stagnation and blood stasis syndrome and phlegm-stasis internal obstruction syndrome were shorter than those of the other threesyndromes,and the levels of serum fibrinogen(FIB)and D
11、-dimer(D-D)were higher than those of the other three syndromes762023 年第 41 卷第 2 期Vol.41,No.2,2023四 川 中 医Journal of Sichuan of Traditional Chinese Medicine(P0.05).The HAS-BLED score of patients with non-valvular atrial fibrillation of Qi stagnation and blood stasis syndrome orphlegm-stasis internal o
12、bstruction syndrome was higher than that of the other three syndromes(P0.05).The CHA2DS2-VAScscore of patients with non-valvular atrial fibrillation of Qi stagnation and blood stasis syndrome,phlegm-stasis internal obstructionsyndrome and syndrome of fluid retention invading heart was higher than th
13、at of the other two syndromes(P0.05).The left atrialdiameter(LAD)and left ventricular end-diastolic diameter(LVDd)of patients with Qi stagnation and blood stasis syndrome andsyndrome of fluid retention invading heart were higher than those of the other three syndromes while the left ventricular ejec
14、tionfraction(LVEF)was lower than that of the other three syndromes(P0.05).The PR interval and QRS time limit of patients withnon-valvular atrial fibrillation of Qi stagnation and blood stasis syndrome and syndrome of fluid retention invading heart were lon-ger than those of the other three syndromes
15、 while the atrial effective refractory period(AERP)was shorter than that of the otherthree syndromes(P65 岁、高血压、卒中史、出血史、异常 INR 值各 1 分,肝肾功能不全 2 分,使用药物或嗜酒各 1 分。总分3 分时提示出血风险高。卒中风险度:采用卒中风险(CHA2DS2-VASc)评分7进行脑卒中风险程度的评估,内容包括年龄 65-74 岁、高血压、糖尿病、左心室功能不全、合并血管疾病,女性各 1 分,年龄75 岁、卒中史各 2 分。总分2 分为高危,1 分为中危,0 分为低危。心脏
16、结构重构指标:采用彩色超声诊断仪(Philips,EPIQ5)测量所有患者左房内86四 川 中 医Journal of Sichuan of Traditional Chinese Medicine2023 年第 41 卷第 2 期Vol.41,No.2,2023径(LAD)、舒张末期左心室内径(LVDd),计算左室射血分数(LVEF)。心脏电重构指标:采用心电图仪测量所有患者 PR 间期、QRS 时限及基础有效不应期(AERP)。应用期前扫描刺激技术,设置刺激强度为 10 mA,脉宽 2 ms,S1S2之比为 8 1,基础间期为 400 ms,10 ms 递减,取 S2不诱发心房激动的最长 S1S2间期为 AERP。1.4统计学方法采用 SPSS22.0 软件处理数据,计量数据资料给予正态及方差齐性检验满足要求,用均数标准差(x-s)表达,多组比较采用单因素方差分析,组间行 t 检验,P0.05),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(P0.05),见表 1。表 1 不同中医证型的非瓣膜性房颤患者一般资料比较(n,x-s)分组n性别男女年龄(岁)体质指数(kg/m2
