Exploratory study on characteristics of potential subgroups in patients with chronic heart failure of qi deficiency and blood stasis syndrome

YANG Shuai; LING Yiyue; JIA Zhishan; LI Xiaoqian; HE Jiancheng; YAO Lei; CAO Xuebin

doi:10.16305/j.1007-1334.2024.z20240703003

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Exploratory study on characteristics of potential subgroups in patients with chronic heart failure of qi deficiency and blood stasis syndrome

更新时间：2024-11-07

- Exploratory study on characteristics of potential subgroups in patients with chronic heart failure of qi deficiency and blood stasis syndrome
- Shanghai Journal of Traditional Chinese Medicine Vol. 58, Issue 11, Pages: 21-27(2024)
- 作者机构：
  
  1.上海中医药大学（上海 201203）
  2.上海中医药大学附属岳阳中西医结合医院（上海 200437）
  3.陆军第八十二集团军医院（河北保定 071000）
- 作者简介：
- 基金信息：
- DOI：10.16305/j.1007-1334.2024.z20240703003
  CLC：
- Published：10 November 2024，
  
  Received：03 July 2024，
- 稿件说明：
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杨帅,凌艺月,贾志山,等.慢性心力衰竭气虚血瘀证潜在亚组人群特征探索研究[J].上海中医药杂志,2024,58(11):21-27.

YANG Shuai,LING Yiyue,JIA Zhishan,et al.Exploratory study on characteristics of potential subgroups in patients with chronic heart failure of qi deficiency and blood stasis syndrome[J].Shanghai Journal of Traditional Chinese Medicine,2024,58(11):21-27.
杨帅,凌艺月,贾志山,等.慢性心力衰竭气虚血瘀证潜在亚组人群特征探索研究[J].上海中医药杂志,2024,58(11):21-27. DOI： 10.16305/j.1007-1334.2024.z20240703003.

YANG Shuai,LING Yiyue,JIA Zhishan,et al.Exploratory study on characteristics of potential subgroups in patients with chronic heart failure of qi deficiency and blood stasis syndrome[J].Shanghai Journal of Traditional Chinese Medicine,2024,58(11):21-27. DOI： 10.16305/j.1007-1334.2024.z20240703003.

摘要

目的

探索慢性心力衰竭（CHF）气虚血瘀证潜在亚组人群，为心力衰竭的中医精准辨治提供客观依据。

方法

收集126例CHF气虚血瘀证患者的19种症状/体征指标和21种生化指标，利用R和Python软件进行K-mediods聚类算法分析，以轮廓系数确定最佳的聚类数目。组间比较，连续变量采用Kruskal-Wallis检验，分类变量采用Pearson's chi-squared检验或者Fisher's exact检验。

结果

CHF气虚血瘀证患者被聚类为3组，组间比较发现，气喘、不寐、颈脉怒张、纳差、畏寒5个症状/体征以及NYHA分级、氨基末端脑钠肽前体（NT-proBNP）、红细胞比容、尿素氮4个临床指标差异具有统计学意义（

0.05）。第1组人群整体各症状/体征发生频率和临床指标严重程度相对较低；第2组人群以颈脉怒张发生频率较其他组高为特征，且促甲状腺激素、总胆固醇及低密度脂蛋白有偏高趋势，血小板有偏低的趋势；第3组人群以畏寒、纳差、不寐的发生率较其他组显著升高为特征，伴随尿素氮增高、红细胞比容降低。

结论

CHF气虚血瘀证潜在3种亚型，分别是气虚血瘀证本证型、气虚血瘀兼痰浊型、气虚血瘀兼阳虚型。

Abstract

Objective

To explore potential subgroups among patients with chronic heart failure （CHF） of qi deficiency and blood stasis syndrome， providing an objective basis for precise traditional Chinese medicine （TCM） diagnosis and treatment of heart failure.

Methods

Nineteen symptoms/signs and 21 biochemical indicators were collected from 126 patients with CHF of qi deficiency and blood stasis syndrome. The K-medoids clustering algorithm was applied using R and Python software， and the optimal number of clusters was determined via the silhouette coefficient. For intergroup comparisons， continuous variables were analyzed using the Kruskal-Wallis test， and categorical variables were analyzed using Pearson's chi-squared test or Fisher's exact test.

Results

Patients with CHF of qi deficiency and blood stasis syndrome were clustered into three groups. Intergroup comparisons revealed that five symptoms/signs （shortness of breath， insomnia， jugular vein distention， poor appetite， and aversion to cold） and four clinical indicators （NYHA classification， NT-proBNP， hematocrit， and blood urea nitrogen） showed

statistical significance （

0.05）. Group 1 had relatively lower frequencies of symptoms/signs and less severe clinical indicators. Group 2 was characterized by a higher frequency of jugular vein distention compared to other groups， with tendencies toward elevated thyroid-stimulating hormone， total cholesterol， low-density lipoprotein， and decreased platelet counts. Group 3 exhibited significantly higher incidences of aversion to cold， poor appetite， and insomnia， accompanied by increased blood urea nitrogen and decreased hematocrit.

Conclusion

Three potential subtypes of qi deficiency and blood stasis syndrome in CHF patients have been identified： pure qi deficiency and blood stasis syndrome type， qi deficiency and blood stasis combined with phlegm-dampness type， and qi deficiency and blood stasis combined with yang deficiency type.

关键词

慢性心力衰竭气虚血瘀证痰浊阳虚聚类算法数据挖掘辨证论治

Keywords

chronic heart failureqi deficiency and blood stasis syndromephlegm-dampnessyang deficiencyclustering algorithmdata miningsyndrome differentiation and treatment

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