慢性心力衰竭中医证型分层及中西医诊疗研究进展

Research Progress on TCM Syndrome Stratification and Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Chronic Heart Failure

摘要: 慢性心力衰竭是多种心血管疾病终末期临床综合征，以发病率高、再住院率高为主要特点，远期预后差，使其成为心血管领域的重大难题。现代西医“新四联”规范化治疗可抑制神经内分泌激活、延缓心室重构进程，但仍存在部分患者乏力、水肿等残余症状难以改善，个体治疗反应差异明显等现实局限。中医认为，心衰病机总属于本虚实证，在改善临床症状、提高生活质量方面具有独特的优势，以气虚、阴虚、阳虚为本，以血瘀、水饮、痰浊为标。目前围绕慢性心力衰竭中医证型分布、证型与客观实验室指标、预后关联、分证中西医干预已积累大量临床研究。本文梳理近年国内核心期刊公开文献，从西医病理认识、中医病机证型分布、证型客观化研究、中西医辨证干预、现存问题与展望展开综述，以期为慢性心力衰竭中西医结合临床与科研提供参考依据。

Abstract: Chronic heart failure (CHF) is a clinical syndrome at the end-stage of various cardiovascular diseases. Characterized by high morbidity and high readmission rates with poor long-term prognosis, it has become a major challenge in the field of cardiology. Standardized treatment with the modern Western medicine “four-pillar therapy” can inhibit neuroendocrine activation and delay the progression of ventricular remodeling. Nevertheless, practical limitations remain, including refractory residual symptoms such as fatigue and edema in some patients and marked individual variations in treatment response. From the perspective of traditional Chinese medicine (TCM), the pathogenesis of heart failure is generally defined as root deficiency and excess manifestation. TCM boasts unique advantages in relieving clinical symptoms and improving quality of life. Its root causes include qi deficiency, yin deficiency and yang deficiency, while blood stasis, fluid retention and phlegm turbidity represent the secondary manifestations. To date, abundant clinical studies have been conducted on the TCM syndrome distribution of CHF, correlations between TCM syndromes and objective laboratory indicators, the association of syndromes with prognosis, and syndrome-specific integrated Chinese and Western medicine interventions. By sorting out recent publicly available literature from domestic core journals, this paper reviews the Western pathological understanding, TCM pathogenesis and syndrome distribution, objective research on TCM syndromes, syndrome-differentiated integrated Chinese-Western medical interventions, existing problems and prospects, so as to provide references for clinical practice and scientific research of integrated traditional Chinese and Western medicine in the management of chronic heart failure.