| Background:patients with left ventricular disease-associated pulmonary hypertension(PH-LHD)are the largest population of pulmonary hypertension at present.PH-LHD is now listed as the second largest category in the guidelines for the classification of pulmonary hypertension in Europe,the United States and China.The understanding of PH-LHD in traditional Chinese medicine has gradually deepened,and there have been corresponding studies on the etiology,pathogenesis and prognosis of the disease.Traditional Chinese medicine has shown certain therapeutic potential and advantages in controlling the development of diseases,improving the quality of life of patients,and improving the prognosis of patients.starting from the overall concept and syndrome differentiation and treatment of traditional Chinese medicine,To explore its mechanism,clinical characteristics,treatment and prognosis has become a hot research topic.There is an urgent need for new treatment methods,drugs and clinical research for PH-LHD,traditional Chinese medicine has shown a certain therapeutic potential and advantages.Objective:to collect the clinical syndromes of PH-LHD patients in order to understand the distribution of syndrome elements in PH-LHD and the correlation between the distribution of TCM syndromes and the severity of the disease,and to explore the appearance of TCM syndromes in PH-LHD.To clarify the dominant syndrome elements of PH-LHD and the types of syndrome elements related to the severity of the disease,and to provide the basis for the clinical dialectical treatment of traditional Chinese medicine.Methods:from June 2017 to December 2018,314 patients with PH-LHD were collected from the inpatient department of Dongzhimen Hospital of Beijing University of traditional Chinese Medicine,excluding incomplete data and patients’ refusal to cooperate.A total of 293 patients with PH-LHD were collected and sorted out,and 293 TCM syndrome questionnaires were completed.the frequency,factor,clustering and correlation of the database were studied by using Excel,SPSS21.0 and Stata8.3 statistical software.The distribution of syndrome elements in PH-LHD,the correlation between syndrome elements and cardiopulmonary function and the related indexes of disease severity were obtained,and the internal relationship between syndrome elements and syndrome elements was obtained.Thus,the common symptoms,signs,syndrome elements,possible combination forms of syndrome elements and syndrome elements related to the severity of the disease were obtained in PH-LHD.Results:among 293 effective cases,141(48%)were male and 152(52%)were female,the average age was 74.9 years old.coronary heart disease and hypertension were more common in the complicated diseases.Secondly,diabetes mellitus,hyperlipidemia,atrial fibrillation,cerebrovascular disease and valvular disease.Symptoms from high to low are chest tightness,dyspnea,shortness of breath,fatigue,cough,palpitations,chest pain,fainting.This study investigated eight common clinical syndrome factors in PH-LHD.According to the total occurrence frequency,the order of syndrome elements from high to low was as follows:blood stasis(224 times)>qi deficiency(183 times)>phlegm turbidity(110 times)>water drink(100 times)>yin deficiency(63 times)>yang deficiency(44 times)>qi stagnation(20 times)>blood deficiency(16 times).The four syndrome elements with the most frequent occurrence were blood stasis,qi deficiency,phlegm turbidity and water drink,in which the frequency of blood stasis and qi deficiency was significantly higher than that of other syndromes,which was also in accordance with the theory of qi and blood,which was an important theoretical basis for heart-related diseases.Phlegm turbid and water drink were also more pathological products in the development of PH-LHD,54 kinds of compound syndrome elements were analyzed and extracted.The order of occurrence frequency from high to low was as follows:Qi deficiency+blood stasis(52 times)>blood stasis+phlegm turbidity(41 times)>qi deficiency+blood stasis+ water drink(33 times)>qi deficiency+blood stasis+phlegm turbidity(14 times).Second)=Qi deficiency+Yin deficiency.(14 times)>Qi deficiency+Yin deficiency+blood stasis+ phlegm turbidity(9 times)=blood stasis+qi stagnation(9 times),Yang deficiency+water drink(8 cases),in which the composition ratio of the two syndrome elements was the largest.In the combination form of qi deficiency and blood stasis,the frequency of qi deficiency + blood stasis was the most,and the compound syndrome element with the highest frequency in the three syndrome elements was qi deficiency+blood stasis + water drink.Pulmonary hypertension was divided into mild(40～60mmHg),moderate(60～80mmHg)and severe(≥ 80mmHg).There were 222 patients with mild pulmonary hypertension,55 patients with moderate pulmonary hypertension and 16 patients with severe pulmonary hypertension.The frequency of syndrome elements in patients with mild pulmonary hypertension was blood stasis>qi deficiency>phlegm turbidity>water drink>yin deficiency>yang deficiency>qi stagnation>blood deficiency.The frequency of syndrome elements in patients with moderate pulmonary hypertension was blood stasis>qi deficiency=water drink>yang deficiency>yin deficiency = phlegm turbidity>blood deficiency.The frequency of syndrome elements in patients with severe pulmonary hypertension was blood stasis>phlegm turbidity>qi deficiency>water drink>yin deficiency>yang deficiency>qi stagnation>blood deficiency.The correlation analysis between PH-LHD TCM syndrome elements and NT-proBNP,LVEF(%)and pulmonary artery systolic pressure showed that water drink was related to the severity of the disease.There was a positive correlation between Shuiyin and NT-proBNP and pulmonary artery systolic pressure,but a negative correlation between water drink and LVEF(%),and there was a positive correlation between water drink and pulmonary artery systolic pressure,and a negative correlation between water drink and pulmonary artery systolic pressure(%).Through factor analysis,it can be concluded that the collection of qi deficiency,water drinking,blood stasis and phlegm turbidity can reflect the most important disease characteristics of PH-LHD patients.That is,qi deficiency,water drinking,blood stasis,phlegm turbid collection form is the most important combination of syndrome elements.Through data analysis,this paper further explains the TCM etiology and pathogenesis theory of "heart,lung and phlegm drink disease",that is,"heart,lung and phlegm drink disease",which is caused by the dysfunction of "qi,blood and water "and " qi deficiency and blood stasis,phlegm drink in phlegm",which is caused by the dysfunction of "qi,blood and water".Conclusion:Qi deficiency and blood stasis are the basic pathogenesis of PH-LHD patients,with the progression of the disease,phlegm turbidity and water drinking pathological products appear,in which water drinking syndrome is positively correlated with NT-proBNP and pulmonary artery systolic pressure,and negatively correlated with LVEF(%).It is suggested that water drinking is closely related to the severity of the disease.Qi deficiency,water drinking,blood stasis and phlegm turbid collection can reflect the most important disease characteristics of PH-LHD patients.qi deficiency and blood stasis are the basic pathological basis,phlegm turbidity is an important pathological product of the disease,and water drink is the final result of PH-LHD. |
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