Ma Sheng-Li, Hu Shan-You, Li Wu-Lin, You Da-Li, Jiang Ting-Ting, Wang Li, Wang Fei, Wu Xiao
Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Emergency Department, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China.
Evid Based Complement Alternat Med. 2022 Mar 21;2022:9329683. doi: 10.1155/2022/9329683. eCollection 2022.
Treatment based on syndrome differentiation under the traditional Chinese medicine (TCM) framework has been shown to be helpful in patients with coronary artery disease. We hypothesized that syndrome types could predict the risk of type 2 myocardial infarction (T2MI) caused by imbalance between myocardial oxygen supply and demand in critically ill patients with pulmonary disease.
This retrospective study included consecutive critically ill patients with pulmonary disease admitted to the ICU at Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences from January 1, 2017, to July 1, 2019. Diagnosis of T2MI was based on the fourth universal definition of myocardial infarction. Risk factors associated with T2MI were identified using multivariate regression analysis.
A total of 244 patients were included in the study: 78 who developed T2MI and the remaining 166 who did not develop T2MI during hospitalization. The incidence of phlegm syndrome and deficiency syndrome was 61.9% and 38.1%, respectively. In comparison with the patients with phlegm syndrome, the incidence of T2MI in patients with deficiency syndrome is significantly higher (40.9% vs. 26.5%, =0.019). In multivariate logistic regression, T2MI was independently associated with the baseline troponin level (OR 12.682, 95% CI 1.397∼115.121; =0.024), hemoglobin < 55 g/L (OR 12.76, 95% CI 2.359∼69.021; =0.003), mechanical ventilation (OR 2.244, 95% CI 1.029∼4.892; =0.042), and TCM deficiency syndrome (OR 2.214, 95% CI 1.032∼4.749; =0.041). After adjusting for confounding factors in Cox regression models, the hazard ratio (95% confidence interval) of qi deficiency syndrome groups was 1.183 (95% CI 1.053∼3.123, =0.032).
Patients with deficiency syndrome are at high risk of T2MI, especially those combined with qi deficiency syndrome.
在中医框架下基于辨证论治的治疗已被证明对冠心病患者有帮助。我们假设证型可以预测患有肺部疾病的重症患者因心肌供需失衡导致的2型心肌梗死（T2MI）风险。
这项回顾性研究纳入了2017年1月1日至2019年7月1日期间在上海健康医学院附属嘉定区中心医院重症监护病房连续收治的患有肺部疾病的重症患者。T2MI的诊断基于心肌梗死的第四个通用定义。使用多变量回归分析确定与T2MI相关的危险因素。
本研究共纳入244例患者：78例在住院期间发生了T2MI，其余166例未发生T2MI。痰证和虚证的发生率分别为61.9%和38.1%。与痰证患者相比，虚证患者中T2MI的发生率显著更高（40.9%对26.5%，P=0.019）。在多变量逻辑回归中，T2MI与基线肌钙蛋白水平独立相关（比值比12.682，95%置信区间1.397～115.121；P=0.024）、血红蛋白<55 g/L（比值比12.76，95%置信区间2.359～69.021；P=0.003）、机械通气（比值比2.244，95%置信区间1.029～4.892；P=0.042）以及中医虚证（比值比2.214，95%置信区间1.032～4.749；P=0.041）。在Cox回归模型中调整混杂因素后，气虚证组的风险比（95%置信区间）为1.183（95%置信区间1.053～3.123，P=0.032）。
虚证患者发生T2MI的风险较高，尤其是合并气虚证的患者。
