Analysis Of Risk Factors For Diuretic Resistance In Chronic Heart Failure And Its Correlation With TCM Syndromes

Objective:Explore the related risk factors of chronic heart failure with diuretic resistance and their correlation with TCM syndromes,with a view to early screening of patients at high risk of diuretic resistance,and timely and effective intervention and treatment for them,as a TCM for such patients Differential treatment provides a more objective basis.Methods:Using a retrospective case study method,the time interval from January2018 to January 2021 was used to query the relevant case data of patients with chronic heart failure who were hospitalized in the Department of Cardiology,the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine during this period,to include And exclusion criteria are used to screen diuretic-effective patients and diuretic-resistant patients,and statistically analyze the general information of the two groups of patients and various laboratory indicators（Blood routine,liver function,kidney function,blood sugar,blood lipids,N-terminal pro-B-type natriuretic peptide（NT-pro BNP）,electrolytes）,inspection indicators（heart rate,blood pressure,echocardiogram）,and related conditions of TCM syndromes.Results:1.General information comparison:（1）.Demographic data comparison:There was no statistically significant difference between the two groups of patients in the distribution of gender,age,and BMI grade（P>0.05）.（2）.Comparison of general clinical data:the number of days of hospitalization,the reason for this admission,the average urine output in the three days before admission,the use of diuretics in the three days before admission,NYHA cardiac function classification,whether they have diabetes and lung infections There are statistically significant differences in the comparison（P<0.05）.Whether there is a history of smoking,drinking,hypertension,coronary heart disease,arrhythmia,stroke,peripheral artery disease,dyslipidemia,asthma,chronic obstructive pulmonary disease,thyroid There was no statistically significant difference in dysfunction（P>0.05）.2.Comparison of laboratory indicators:The two groups of patients are in hemoglobin（HGB）,hematocrit（HCT）,total protein（TP）,albumin（ALB）,blood creatinine（SCr）,blood urea nitrogen（BUN）,The differences in NT-pro BNP,Na⁺,Cl^-were statistically significant（P<0.05）,and the differences in alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,total bilirubin（TBIL）,uric acid（UA）,There was no significant difference in fasting blood glucose（FBG）,total cholesterol（TC）,triglycerides（TG）,high-density lipoprotein（HDL-C）,low-density lipoprotein（LDL-C）,K⁺,and Ca²⁺（P>0.05）.3.Comparison of inspection indicators:The two groups of patients had statistically significant differences in admission systolic blood pressure,limb edema at admission,and left ventricular ejection fraction（LVEF）（P<0.05）.In admission diastolic blood pressure,admission ECG heart rate,There was no significant difference in left atrium（LA）,left ventricular end diastolic diameter（LVDd）,and mean pulmonary artery pressure（MPA）（P>0.05）.4.Distribution of TCM syndrome types:The two groups of patients have statistically significant differences in the distribution of TCM syndrome types（P<0.05）.The distribution of syndrome types in the diuretic-effective group is as follows:heart and lung qi deficiency,blood stasis and water stop syndrome（A total of 57 cases,accounting for 37.50%）,deficiency of both qi and yin,heart and blood stasis syndrome（40 cases,accounting for 26.32%）,deficiency of Yang Qi,blood stasis and water stagnation syndrome（39 cases in total,accounting for 25.66%）Syndrome of deficiency of yin and yang,deficiency of kidney essence（16 cases in total,accounting for 10.53%）,the distribution of syndrome types in the diuretic resistance group from more to less followed by deficiency of yang and blood stasis and water cessation（46cases in total,accounting for 37.10%）,deficiency of both qi and yin,heart and blood stasis syndrome（33 cases,accounting for 26.61%）,cardiopulmonary qi deficiency,blood stasis and water cessation syndrome（27 cases in total,accounting for 21.77%）,deficiency of yin and yang,and insufficient kidney essence（18 cases in total,14.52%）.5.Correlation between the distribution of TCM syndrome types in the diuretic resistance group and related risk factors:The average urine output of patients with four different TCM syndrome types in the diuretic resistance group was statistically significant in the three days before admission（P<0.05）.There were no statistically significant differences in SCr,Cl^-,NT-pro BNP,admission systolic blood pressure,and diabetes mellitus（P>0.05）.Among them,there was a statistically significant difference in the average urine output three days before admission between patients with deficiency of yin and yang and deficiency of kidney essence and those with deficiency of both qi and yin,heart and blood stasis syndrome,heart and lung qi deficiency,and blood stasis and water stop syndrome group（adjusted P=0.047<0.05）,there was no statistically significant difference between the other groups.Conclusion:1.Whether it has diabetes,the average urine output three days before admission,admission systolic blood pressure,NT-pro BNP,Cl^-,SCr are independent influencing factors of diuretic resistance,which can significantly affect the occurrence of diuretic resistance.2.The pathological state of deficiency of yang and yin and yang in diuretic resistant patients is more common.3.The average urine output three days before admission is an influencing factor for the distribution of different TCM syndrome types in the diuretic resistance group.Compared with patients in the heart and lung qi deficiency,blood stasis and water stagnation syndrome,qi and yin deficiency,and heart blood stasis syndrome group,the deficiency of yin and yang,Patients in the kidney essence deficiency syndrome group are more likely to have poor early diuretic response.