| Objective:By collecting clinical case data of patients with rheumatic heart disease,this study further understood the distribution characteristics of TCM syndrome differentiation and classification of patients with rheumatic heart disease.Meanwhile,relevant clinical examination indicators of patients were collected to analyze the differences among clinical indicators of different TCM syndrome differentiation and classification,so as to provide evidence for TCM clinical diagnosis and treatment of rheumatic heart disease.So as to provide a certain theoretical basis for the standardized diagnosis and treatment of TCM.Methods:A total of 228 patients admitted to the inpatient Department of Cardiac Macrovascular Surgery,Yan ’an Hospital,Kunming City from October 2021 to February 2023 who were diagnosed with rheumatic heart disease by color Doppler ultrasound were randomly collected.General data,four diagnostic data,cardiac function indexes,examination indexes and related laboratory indexes of the patients were collected,and syndrome differentiation was performed for the patients.And explore the correlation between TCM dialectical classification and the above clinical indicators.Research results:1.Among 228 patients with rheumatic heart disease,84 cases(36.8%)had syndrome of blood blood stasis.76 cases of deficiency of heart and spleen,accounting for 33.3%;There were 42 cases with insufficient Qi and Yin syndrome,accounting for 18.4%;There were 26 cases(11.4%)with heart-kidney Yang deficiency syndrome.2.Most patients in this study are between 50 and 60 years old.The incidence rate of female was higher than that of male,with 56 male cases(24.6%)and 172 female cases(75.4%).3.There is a correlation between cardiac function classification and different TCM syndrome in patients with rheumatic heart disease.Chi-square value was 14.439,df=6,P=0.025,P<0.05.The results of this study showed that there were 104 patients with grade Ⅱ heart function,accounting for 45.6%.The distribution was as follows:syndrome of deficiency of heart and spleen(40.4%)>syndrome of blood blood stasis(34.6%)>syndrome of deficiency of Qi and Yin(21.2%)>syndrome of deficiency of heart and kidney Yang(3.8%);There were 64 patients with grade Ⅲ cardiac function,accounting for 28.1%.The distribution was as follows:syndrome of blood blood stasis>syndrome of deficiency of heart and spleen(43.8%)>syndrome of deficiency of heart and spleen(28.1%)>syndrome of deficiency of qi and Yin(21.9%)>syndrome of deficiency of heart and kidney Yang(6.3%).Sixty patients with grade Ⅳ cardiac function,accounting for 26.3%.The distribution was as follows:syndrome of blood blood stasis(33.3%)>syndrome of deficiency of heart-kidney Yang(30.0%)>syndrome of deficiency of both heart and spleen(26.7%)syndrome of deficiency of Qi and Yin(10.0%),with differences among groups(P<0.05).With the gradual increase of patients’ cardiac function grade,TCM syndrome types also changed correspondingly.4.There was correlation between the plasma BNP value and different TCM syndrome differentiation types in patients with rheumatic heart disease.The plasma BNP value of each syndrome type decreased gradually with the syndrome of heart-kidney Yang deficiency,the syndrome of blood-blood stasis,the syndrome of heart-spleen deficiency and the syndrome of deficiency of Qi and Yin,and there were significant differences between the syndrome of blood-blood stasis,the syndrome of heart-spleen deficiency and the syndrome of deficiency of qi and Yin respectively(P<0.01).The plasma BNP value was positively correlated with cardiac function grade(P<0.01).5.In the data of 228 patients with rheumatic heart disease,the first LVEF value after admission was correlated with different TCM syndrome differentiation types,which gradually increased with heart-kidney Yang deficiency syndrome,blood-blood stasis syndrome,heart-spleen deficiency syndrome and deficiency of Qi and Yin syndrome;There were significant differences between the syndrome of blood blood stasis,deficiency of heart and spleen,deficiency of Qi and Yin and the syndrome of deficiency of heart and kidney and Yang(P<0.001).There was a negative correlation between the first LVEF value and cardiac function grade after admission(P<0.01).6.The six-minute walking test referred to the clinical standard of the six-minute walking test and applied the Chinese expert consensus classification.Among them,20 patients with severe classification of central blood stasis syndrome accounted for 33.3%,14 patients with heart and spleen deficiency syndrome accounted for 23.3%,6 patients with qi and yin deficiency syndrome accounted for 10.0%,20 patients with heart and kidney yang deficiency syndrome accounted for 33.3%,22 patients with moderate classification of central blood stasis syndrome accounted for 40.7%,14 patients with heart and spleen deficiency syndrome accounted for 25.9%,14 patients with qi and yin deficiency syndrome accounted for 25.9%,and 4 patients with heart and kidney yang deficiency syndrome accounted for 7.4%.Mild classification center blood stasis syndrome 42 people accounted for 36.8%,heart and spleen deficiency syndrome 48 people accounted for 42.1%,qi and yin deficiency syndrome 22 people accounted for 19.3%,heart and kidney yang deficiency syndrome 2 people accounted for 1.8%,different TCM syndrome differentiation and six minutes walking test value correlation;there were significant differences between heart blood stasis syndrome,heart and spleen deficiency syndrome,qi and yin deficiency syndrome and heart and kidney yang deficiency syndrome(P<0.001).7.The distribution of clinical indicators of SCr,ESR,LDH and HBDH of different TCM syndrome differentiation types in patients was correlated,among which,the SCr level of blood blood stasis syndrome was higher than that of the other three groups,while the ESR,LDH and HBDH level of patients with deficiency of Qi and Yin syndrome was lower than that of the other three groups,the difference was statistically significant(P<0.001).Conclusions:1.Among the patients with rheumatic heart disease investigated in this study,syndrome differentiation of TCM is the syndrome of blood blood stasis,and the syndrome of heart-kidney Yang deficiency has reached the terminal stage of the development of rheumatic heart disease.Different TCM dialectical syndromes reflect different physiological stages of the disease.2.There is a correlation between different TCM dialectical classifications of rheumatic heart disease and cardiac function grading.With the increase of the cardiac function grade of patients,the TCM syndrome types also changed,and gradually progressed in the order of deficiency of Qi and Yin,deficiency of heart and spleen,blockage of blood and blood stasis to deficiency of heart and kidney Yang.3.With the change of TCM syndrome differentiation in patients with rheumatic heart disease,the cardiac function grade and plasma BNP value were increased accordingly,while the first LVEF value and the six-minute walking test value were decreased accordingly after admission,which provided certain reference value for TCM syndrome differentiation and classification of rheumatic heart disease.4.indicators ESR,LDH,HBDH levels can provide a certain drug reference for rheumatic heart disease changes. |
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