Article(id=1322927592562623261, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926217711726961, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.08.001, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340116872, onlineDateStr=2026-10-30, pubDate=1754755200000, pubDateStr=2025-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340116872, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340116872, creator=13701087609, updateTime=1793340116872, updator=13701087609, issue=Issue{id=1322926217711726961, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='8', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1754755200000', pubDateStr='2025-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339789083, creator='13701087609', updateTime=1793340517761, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929274071679978, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926217711726961, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929274071679979, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926217711726961, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1, endPage=5, ext={EN=ArticleExt(id=1322927594517168926, articleId=1322927592562623261, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Paradigm Exploration onthe Full Cycle and All-round Prevention and Treatment of HFpEF based on the Preventive Thoughts of TCM, columnId=1256183423710970242, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=New Opinion of Ph.D. Supervisor, runingTitle=null, highlight=null, articleAbstract=

With the deep aging of the population,heart failure with preserved ejection fraction(HFpEF)has become the main type of heart failure currently and in the future.Due to limited treatment methods,it is crucial to move the front line of HFpEFprevention and treatment forward.This article proposes to explorethe paradigm of the full cycle and all-round prevention and treatment of HFpEF based on the preventive thoughts of TCM.According to the characteristics of the pathogenesis of HFpEF,proposes an innovative 7-stage division of the entire cycle:Diseasenot yet fully developed stage(healthy phase),diseaseis about to mature stage(pre-disease phase),disease stage(heart failure risk phase),disease progression phase(pre-heart failure phase),disease exacerbation phase(symptomatic heart failure phase),disease attack phase(acute heart failure phase),and disease end-stage(late heart failure phase).Proposes a 3-level and 7-stage prevention strategy for 7 stages,starting from the 0-level prevention of healthy populations,emphasizing the attention to the window period of disease transformation,and building a full cycle warning system to guide precise prevention and control.In view of the characteristics of China´s large population base,we advocate that the public health and medical service system should work together to build a full cycle dynamic health information database for the whole population,and implement closed-loop health management for the whole population,guide everyone to participate and transform passive health into active health,and encourage interdisciplinary collaboration to provide comprehensive prevention and control manage service system and empower prevention and control with digitalization.Aims to explore the whole population,full cycle,and all-round prevention and treatment paradigm of HFpEF under the guidance of the preventive thoughts of TCM,provides Chinese solutions and experiences for the prevention and control of chronic diseases including HFpEF,and promots the construction of a healthy China.

, authors=Guoju DONG1, 2, Luqi HUANG3, authorsList=Guoju DONG, Luqi HUANG, authorCompany=null, correspAuthors=Luqi HUANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322927595066622751, articleId=1322927592562623261, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=基于中医治未病思想对射血分数保留心衰全周期、全方位防治范式的探索, columnId=1256183426563096985, journalTitle=中华中医药学刊, columnName=博士导师新论, runingTitle=null, highlight=null, articleAbstract=

随着人口深度老龄化,射血分数保留心衰(heart failure with preserved ejection fraction,HFpEF)已成为目前及未来心衰的主要类型,因治疗方法有限,防治前线前移至关重要。针对目前HFpEF防治的现状与不足,提出基于中医治未病思想的HFpEF全周期、全方位防治范式的构建。根据HFpEF发病进程特点,创新性提出全周期7阶段划分:疾病未成期(健康期),疾病将成期(疾病前期),疾病期(心衰风险期),疾病进展期(心衰前期),疾病加重期(症状性心衰期),疾病发作期(急性心衰),疾病终末期(心衰晚期)。针对7个阶段提出3级7阶段预防策略,从健康人群的0级预防开始,强调关注疾病转化窗口期,构建全周期预警体系,以指导精准防治。针对中国人口基数大的特点,倡导公共卫生与医疗服务体系携手共建全民全周期动态健康信息库,对全人群实行健康闭环管理;引导全民参与,变被动健康为主动健康;鼓励多学科交叉合作提供综合防治管理服务体系,并借力数智化赋能防控。旨在探索中医治未病思想指导下的HFpEF全人群、全周期、全方位防治范式,为包括HFpEF在内的慢病防控提供中国方案和中国经验,推进健康中国建设。

, authors=董国菊1, 2, 黄璐琦3, authorsList=董国菊, 黄璐琦, authorCompany=null, correspAuthors=黄璐琦, authorNote=

董国菊(1975-),女,山东海阳人,主任医师,博士研究生导师,博士,博士后,研究方向:中西医结合心血管疾病基础与临床。

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黄璐琦(1968-),男,江西婺源人,院士,研究员,博士研究生导师,博士,研究方向:中药资源学与分子生药学。E-mail:。
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董国菊(1975-),女,山东海阳人,主任医师,博士研究生导师,博士,博士后,研究方向:中西医结合心血管疾病基础与临床。

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董国菊(1975-),女,山东海阳人,主任医师,博士研究生导师,博士,博士后,研究方向:中西医结合心血管疾病基础与临床。

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基于中医治未病思想对射血分数保留心衰全周期、全方位防治范式的探索
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董国菊 1, 2 , 黄璐琦 3
中华中医药学刊 | 博士导师新论 2025,43(8): 1-5
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中华中医药学刊 |博士导师新论 2025 , 43 (8) : 1 -5
基于中医治未病思想对射血分数保留心衰全周期、全方位防治范式的探索
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董国菊(1975-),女,山东海阳人,主任医师,博士研究生导师,博士,博士后,研究方向:中西医结合心血管疾病基础与临床。

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董国菊(1975-),女,山东海阳人,主任医师,博士研究生导师,博士,博士后,研究方向:中西医结合心血管疾病基础与临床。

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董国菊1, 2, 黄璐琦3
作者信息
  • 1.中国中医科学院西苑医院,北京 100091
  • 2.国家中医临床心血管病研究中心,北京 100091
  • 3.中国中医科学院,北京 100700
通讯作者:
黄璐琦(1968-),男,江西婺源人,院士,研究员,博士研究生导师,博士,研究方向:中药资源学与分子生药学。E-mail:。
作者简介:

董国菊(1975-),女,山东海阳人,主任医师,博士研究生导师,博士,博士后,研究方向:中西医结合心血管疾病基础与临床。

Paradigm Exploration onthe Full Cycle and All-round Prevention and Treatment of HFpEF based on the Preventive Thoughts of TCM
Guoju DONG1, 2, Luqi HUANG3
Affiliations
  • 1.Xiyuan Hospital,China Academy of Chinese Medical Science,Beijing 100091,China
  • 2.National Medical science,Beijing 100091,China
  • 3.China Academy of Chinese Medical Science,Beijing 100700,China
出版时间: 2025-08-10 doi: 10.13193/j.issn.1673-7717.2025.08.001
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随着人口深度老龄化,射血分数保留心衰(heart failure with preserved ejection fraction,HFpEF)已成为目前及未来心衰的主要类型,因治疗方法有限,防治前线前移至关重要。针对目前HFpEF防治的现状与不足,提出基于中医治未病思想的HFpEF全周期、全方位防治范式的构建。根据HFpEF发病进程特点,创新性提出全周期7阶段划分:疾病未成期(健康期),疾病将成期(疾病前期),疾病期(心衰风险期),疾病进展期(心衰前期),疾病加重期(症状性心衰期),疾病发作期(急性心衰),疾病终末期(心衰晚期)。针对7个阶段提出3级7阶段预防策略,从健康人群的0级预防开始,强调关注疾病转化窗口期,构建全周期预警体系,以指导精准防治。针对中国人口基数大的特点,倡导公共卫生与医疗服务体系携手共建全民全周期动态健康信息库,对全人群实行健康闭环管理;引导全民参与,变被动健康为主动健康;鼓励多学科交叉合作提供综合防治管理服务体系,并借力数智化赋能防控。旨在探索中医治未病思想指导下的HFpEF全人群、全周期、全方位防治范式,为包括HFpEF在内的慢病防控提供中国方案和中国经验,推进健康中国建设。

射血分数保留心衰  /  治未病  /  全周期  /  全方位  /  防治范式

With the deep aging of the population,heart failure with preserved ejection fraction(HFpEF)has become the main type of heart failure currently and in the future.Due to limited treatment methods,it is crucial to move the front line of HFpEFprevention and treatment forward.This article proposes to explorethe paradigm of the full cycle and all-round prevention and treatment of HFpEF based on the preventive thoughts of TCM.According to the characteristics of the pathogenesis of HFpEF,proposes an innovative 7-stage division of the entire cycle:Diseasenot yet fully developed stage(healthy phase),diseaseis about to mature stage(pre-disease phase),disease stage(heart failure risk phase),disease progression phase(pre-heart failure phase),disease exacerbation phase(symptomatic heart failure phase),disease attack phase(acute heart failure phase),and disease end-stage(late heart failure phase).Proposes a 3-level and 7-stage prevention strategy for 7 stages,starting from the 0-level prevention of healthy populations,emphasizing the attention to the window period of disease transformation,and building a full cycle warning system to guide precise prevention and control.In view of the characteristics of China´s large population base,we advocate that the public health and medical service system should work together to build a full cycle dynamic health information database for the whole population,and implement closed-loop health management for the whole population,guide everyone to participate and transform passive health into active health,and encourage interdisciplinary collaboration to provide comprehensive prevention and control manage service system and empower prevention and control with digitalization.Aims to explore the whole population,full cycle,and all-round prevention and treatment paradigm of HFpEF under the guidance of the preventive thoughts of TCM,provides Chinese solutions and experiences for the prevention and control of chronic diseases including HFpEF,and promots the construction of a healthy China.

heart failure with preserved ejection fraction  /  preventive treatment of disease  /  full cycle  /  all-round  /  Prevention and control paradigm
董国菊, 黄璐琦. 基于中医治未病思想对射血分数保留心衰全周期、全方位防治范式的探索. 中华中医药学刊, 2025 , 43 (8) : 1 -5 . DOI: 10.13193/j.issn.1673-7717.2025.08.001
Guoju DONG, Luqi HUANG. Paradigm Exploration onthe Full Cycle and All-round Prevention and Treatment of HFpEF based on the Preventive Thoughts of TCM[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (8) : 1 -5 . DOI: 10.13193/j.issn.1673-7717.2025.08.001
射血分数保留心衰(heart failure with preserved ejection fraction,HFpEF)是目前心血管领域“最大的未被满足的医疗需求”[1],随着人口深度老龄化和各种慢病共病,HFpEF发病率不断攀升,但治疗方法有限,迫切需要防治前线前移[2]。葛均波院士在2024心血管健康大会致辞时指出,心血管疾病的防治工作面临严峻挑战,呼吁聚焦零级预防的创新理念,把防治前线前移到健康人群,探索全周期、全方位的心血管疾病管理新模式,为健康中国战略实施贡献智慧和力量。
治未病是中医的特色和优势,但中医以症状为主的诊断思维模式很难识别没有症状的HFpEF早期,不能有效识别和诊断,就无法早期防治[3],也就无法发挥中医药治未病的优势。笔者研究团队基于中医治未病思想一直致力于探寻HFpEF的早期防治策略,包括早期识别和诊断[4]、早期预警疾病进展[5]、早期干预以逆转心肌舒张功能障碍[6-7]等,随着对HFpEF研究的不断深入,意识到要从根本上解决规模化的防治压力和需求,需要探索新的管理模式。《“健康中国2030”规划纲要》(以下简称《纲要》)指出,推进健康中国建设,要坚持以人民健康为中心,以基层为重点,以预防为主,中西医并重,推动人人参与,推行健康生活方式,以减少疾病发生,实现全民健康。笔者团队受《纲要》的启发和引领,基于中医治未病思想提出将HFpEF防治前线前移、再前移,探索HFpEF全周期、全方位、变被动健康为主动健康的大健康管理模式[8],以期促进HFpEF管理的同时,为其他慢病的防控提供借鉴。
中医治未病思想源自《黄帝内经》“上工治未病,不治已病,此之谓也”。“治”,治理、管理之意,“未病”与“已病”相对应,指疾病未成。“治未病”指通过采取相应的措施,防止疾病的发生发展,其核心思想为未病先防,这不仅是中医在两千多年前的高瞻远瞩,也是当前实现《纲要》战略部署的重要举措。
“未病”的理论内涵在临床实践中逐渐得以丰富,疾病的发展是动态且延续的,每一个阶段相对于下一个阶段而言,都可以称之为“未病”,因此未病是相对而言的[9],可以包括:(1)疾病未成的健康期;(2)疾病将成的潜伏期;(3)疾病已成的稳定期;(4)疾病进展的加重期;(5)疾病初愈的康复期。相应地治未病的理论内涵也包含了“未病先防、已病防变、已变防渐、病盛防危、瘥后防复”5个方面。换言之,疾病发生发展过程中每一个节点相较于下一个节点都是治未病的体现。中医治未病理论的丰富和完善奠定了中医防治疾病的战略思想,能早则早,即使不早,也要积极“亡羊补牢”,及时止损。
西医的预防理念源于中医的“治未病”理念,一级预防相当于中医的未病先防,二级预防相当于已病防变,三级预防则相当于病盛防危。20世纪60年代末陆续有学者提出心血管疾病的一级预防理念[10-12],70年代逐步推出了高血压[13]、动脉粥样硬化[14]的一级预防内容。国内较早倡导心血管病一级预防的是陶寿淇教授[15],他在20世纪80年代就提出心血管病和其他非传染性疾病的防治是个涉及面广的复杂任务,呼吁政府支持、卫生和医务界主导、多部门和广大群众共同参与。
HFpEF是心血管疾病的终末战场,由于发病机制复杂,针对HFpEF的有效治疗十分有限[16],防治关口前移显得尤为重要。心力衰竭呈进行性、不可逆的发展进程,为强调防治前线前移,2001年美国心脏病学会(American College of Cardiology,ACC)及美国心脏协会(American Heart Association,AHA)首次提出将心力衰竭按病程进展分为A期(有心衰的易患危险因素,但无心脏结构/功能改变)、B期(有心脏结构/功能改变,但无临床症状)、C期(有心脏结构/功能改变,且有临床症状)、D期(经积极治疗后仍有症状)[17],这一分期一经提出便得到临床医生的广泛认可,为心衰的“未病先防”提供了依据。2022年AHA/ACC/HFSA心衰管理指南再次提出把A、B、C、D期重新命名为心衰风险期、心衰前期、心衰症状期和心衰晚期,旨在重申心衰早期防治的重要性[18]。
目前,针对HFpEF前期的防治推荐仍属于空白,但已有相关研究表明有氧运动、沙库巴曲缬沙坦钠都能在一定程度上延缓HFpEF前期发展为HFpEF症状期[19-20]。笔者团队基于中医治未病思想,聚焦HFpEF前期防治[21],充分挖掘和发挥中医药的防治优势,开展了一系列基础和临床研究[22-23],为中医药早期防治HFpEF奠定了基础。2024年中国老年医学学会等联合发布了《心力衰竭早期筛查与一级预防中国专家共识》(以下简称《心衰一级预防共识》)[24],强调应改变“重治轻防”的状况,提出包括HFpEF在内的心衰早期筛查与早期预防方案,以有效减少心衰的发生,降低疾病负担。
《心衰一级预防共识》将心衰的防治关口前移到了心衰风险期,但HFpEF风险期包括高血压、冠心病、心房颤动、糖尿病、代谢综合征、肥胖、高脂血症、心脏瓣膜性疾病、心肌病、慢性肺病、心脏毒性药物使用史等众多危险因素,防治群体基数庞大,防治难度大[25]。一方面,HFpEF的病因涉及不同学科和专业,有的危险因素难以提前预防,如心肌病的患者,多与遗传学有关,无法提前规避;再如恶性肿瘤的化学治疗或者免疫治疗药物,容易引起心脏毒性导致HFpEF,但很难因药物的心脏毒性放弃原发病的治疗,只能在治疗过程中权衡利弊;另一方面,有些危险因素本身并非同一等级,如高血压和冠心病同为HFpEF的危险因素,但高血压又是冠心病的危险因素,不宜笼统归属于HFpEF一级预防。
全民健康是建设健康中国的根本目的,应将HFpEF防治关口再前移,立足全人群和全生命周期两个着力点,从健康人群开始,倡导零级预防,落实中医治未病理念在临床的应用和转化,改变目前“重治轻防”的防治现状。
理论上讲,HFpEF的一级预防主要是针对心衰风险期(A期)和心衰前期(B期)患者,因为这些患者尚未成为“真正的心衰”;HFpEF的二级预防则应该针对心衰症状期(C期)患者,预防病情进展,尤其要以减少急性心衰发作为主要目的;HFpEF的三级预防则应针对心衰晚期(D期)患者,以减少心血管事件,尤其以减少死亡为主。但目前HFpEF并没有规范的三级预防划分,《心衰一级预防共识》中一级预防内容包括3个方面:(1)对A期进行心衰危险因素的干预,以预防B期的发生;(2)对B期则同时进行心衰危险因素和器质性心脏病的干预,以预防C期发生;(3)对C、D期则遵循心衰指南进行规范治疗与管理,以降低患者的病死率和再住院率。这3个方面虽然都是中医“治未病”思想的体现,但不宜同列属于西医一级预防概念。
HFpEF可防、可控,但针对疾病进程中不同阶段的防控内容并不完全相同,不仅应规范一级、二级、三级预防内容,还应将预防分层再细化,从零级预防开始,聚焦全周期发病过程中每个关键节点,分阶段、分层次防治。
笔者团队基于中医治未病思想将HFpEF发病全周期划分为7个阶段,分别是:疾病未成期(健康期),疾病将成期(疾病前期),疾病期(心衰风险期),疾病进展期(心衰前期),疾病加重期(症状性心衰期),疾病发作期(急性心衰),疾病终末期(心衰晚期)。
以HFpEF最常见的病因高血压为例,全周期可以分为:健康期—高血压前期(收缩压在130~139 mm Hg和/或舒张压在80~89 mm Hg)—高血压(心衰风险期:收缩压≥140 mm Hg和/或舒张压在≥90 mm Hg)—心衰前期(患者有心脏结构/功能的改变,比如心房扩大或室间隔增厚或心脏舒张功能减退,但未出现临床心衰症状)—症状性心衰期(临床明确诊断为心衰)—心衰急性发作期—心衰晚期。7个阶段都是病情有质的变化和进展的阶段,也是临床应重点关注和干预的节点。
HFpEF的7个阶段是延续发展的,从临床防治角度每个阶段都应加强防治,尤其是疾病转化的关键窗口期。如高血压前期就是从健康期发展到高血压的关键窗口期,此期防治属于“一盎司的预防胜过一磅的治疗”[26],通过积极的生活方式干预或者联合中医药防治即可取得成效,临床投入少、获益多,是最佳干预节点[27];心衰前期是高血压向心衰转化的关键窗口期,是临床干预可行、可为的又一关键点[28],通过中西医结合治疗可以有效减缓或者阻止心衰的发生。HFpEF的7阶段分期细化使疾病进展中的关键防治节点得以凸显,为HFpEF全周期防治奠定了基础。
与HFpEF发病全周期7个阶段相对应,笔者团队基于中医治未病思想提出了HFpEF全周期3级7阶段预防策略,具体如下。
0级预防:针对健康人群预防。美国预防临床服务指南工作组建议对18岁以上的健康成年人提供个性化咨询,包括运动咨询、饮食咨询、典型的行为干预方案等[29]。笔者团队结合中国现状,倡导推行全民健康的生活方式,针对不同年龄、不同生活环境、不同体质特点等多层次人群进行分类,有的放矢地推行健康可行的生活方式。同时对人群进行分类督导:有高血压、血脂异常等心血管疾病家族史的,建议30岁以上定期测血压、血脂、血糖等重要指标;40岁以上每年系统体检一次[30]。
0.5级预防:针对疾病将成期的人群防治,如高血压前期患者、空腹血糖受损(空腹血糖在6.1~6.9 mmol/L)或者糖耐量异常患者(餐后2 h血糖在7.8~11.1 mmol/L)[31]、血脂边缘升高患者(低密度脂蛋白3.4~4.0 mmol/L,或者甘油三酯1.7~2.2 mmol/L)[32]等。该期是疾病转化的关键窗口期,也是中医药大有可为的干预节点。防治策略应以生活方式干预为主,辅以个性化饮食计划、运动计划,配合中医特色治疗技术服务包,比如穴位按摩、代茶饮、代餐中药包等,通过积极的防治干预,将疾病“扼杀”在摇篮之中。
1级预防:针对疾病已成的人群防治,如高血压、糖尿病、高脂血症、冠心病等HFpEF的危险因素人群,此期生活方式干预仍然是基石,同时需要根据各个疾病的指南推荐,进行规范化的中西医结合治疗,定期监测指标,防止或者延缓并发症的发生。
1.5级预防:针对HFpEF前期人群防治。该期患者虽然无临床心衰症状,但已经出现了心脏结构和/或功能的改变,是HFpEF疾病转化的又一关键窗口期。此期尚未形成真正的心衰,在积极1级预防基础上,针对性应用改善、逆转心脏舒张功能的中西药物尤为关键。
2级预防:针对HFpEF患者防治。该期是有心衰症状且明确诊断为HFpEF的患者,积极治疗可以长期稳定病情,减少急性发作和疾病进展。目前此期指南推荐钠-葡萄糖共转运蛋白2抑制剂,但不能覆盖所有类型的HFpEF,需积极研发新的治疗策略。
2.5级预防:针对急性HFpEF患者防治。心衰急性发作是打破病情稳定的转折点,是疾病转化的又一关键窗口期。心衰急性发作期旨在快速缓解患者症状,后续往往需要在原有治疗基础上进一步强化中西医药物治疗,以减少急性心衰再发作、减少再住院次数。
3级预防:针对晚期HFpEF患者防治。该期患者病情严重且反复加重,预后差,治疗方法有限,临床以对症治疗为主,以提高生活质量、延长生存时间为目的。中医药的特色治疗,如膏摩、足浴、穴位贴敷、温灸刮痧等在提高患者生活质量、减少利尿剂抵抗等方面有一定疗效[33-35],配合中药益气温阳活血利水[36],能在一定程度上延长患者生存期。
HFpEF的发生发展受多重因素影响,包括危险因素控制、个体体质差异、治疗方案选择、疾病演变过程中的证候变化以及多系统功能失调等。系统分析、关联外在宏观的中医表征和内在微观的蛋白、代谢组学变化,聚焦疾病转化的关键窗口期,实现“未病”向“已病”转化的早期预警是中医治未病亟需解决的重大科学问题。
目前医疗模式更多关注HFpEF患者的临床防治,忽视了HFpEF发病进程中的早期预警。笔者团队倡导构建全人群健康信息数据库和全人群生物数据库,全面收集与分析数据,多学科交叉合作,构建基于机器学习的复杂数学模型,明确不同模态数据在HFpEF疾病分层、早期预警及精准治疗中的作用和贡献,构建HFpEF全生命周期的中西医协同预警体系,推动HFpEF的精准预警、精准防治。
治未病的根本在于从“以疾病为中心”转向“以健康为中心”,这需要公共卫生与医疗服务体系的协同融合[37-38],建立全民电子健康档案是加强二者融合的具体举措[39]。记录全人群从出生信息到疫苗接种信息,从学校体检到工作单位体检,对于没有体检信息的居民进行年龄分层,定期推送就近免费体检机会,避免因长期信息空缺成为“死档案”[40],任何时候因病就诊记录(包括医院、检查结果、诊断、用药等)通过系统自动上传,根据年龄定期更新个人家族史、居住地、生活习惯、工作性质等。
公共卫生与医疗服务体系携手共建全民全周期动态健康信息库,对全人群实行健康闭环管理,通过设置预警指标值(体质量、血压、血脂、吸烟史、摄盐量等)和家族史预警信息,精准抓取重点防控人群。公共卫生体系从人群出生信息开始采集、构建数据库,持续维护与更新,通过设立用户终端,及时推送各种信息,尤其是预警信息。包括体检中心、社区、医院在内的医疗服务体系,形成联动管理机制,为高危预警人群推送预约就诊信息、转诊建议、就诊记录、个体化防治方案等,合力联防联控。
《纲要》指出建设健康中国的战略主题是“共建共享、全民健康”,共建共享需要统筹社会、行业和个人三个层面。具体而言,坚持政府主导与调动社会、个人的积极性相结合,推动人人参与、人人尽力、人人享有。
现有HFpEF管理模式主要以医院为中心,患者大多在心衰C期和D期才就医诊治,错失早期防治时机。要强化个人健康主体责任,提高全民健康素养,变被动健康为主动健康,通过以科普形式的专业技术手册编制、动画形式的线上宣教平台、图文并茂形式的宣传画张贴、线下现场进行HFpEF全周期防治培训、定期义诊和科普讲座、扫描二维码、关注微信小程序等多种形式和方法,引导形成自主自律、符合自身特点的健康生活方式,有效控制影响健康的生活行为因素,形成热爱健康、追求健康、促进健康的社会氛围。
HFpEF病因复杂,涉及心脏及心脏以外多系统疾病,是一个需要多学科合作防治的临床综合征。在早期预防管理上,需经过专门培训的专业人士,包括医生、护士、运动专家、营养学家、注册营养师、物理治疗师、心理学家等集体参与协作防治,充分考虑患者的活动能力、生活环境、健康状况等,提供个体化的量身定制防治方案[29]。在诊疗方案制定上,需要中医师和西医师的优势互补,需要心血管、呼吸、内分泌、肿瘤等不同专业的临床医师协同合作,需要分子生物学、人工AI、基础医学等多学科共同参与,构建基于机器学习的中西医协同预警模型,精准指导危险分层,提供多元化防控方案。
多元化的防控需将人群根据病情(7阶段划分)分层,再结合基础疾病、年龄、饮食习惯、工作性质、生活环境、个人偏好等信息进行亚组分类,针对每一层级、每一亚组形成并推送一组综合防控方案,每组防控方案包含多个服务包,包括必选服务包和个性化自选服务包,服务包方案由临床医师、营养师、运动专家、心理学家等多学科专家协作制定。如老年衰弱人群的营养管理服务包,焦虑人群的情绪管理服务包,心衰康复期的运动管理服务包、心衰晚期的容量管理服务包等。多学科协作可以覆盖HFpEF不同病因的预防,形成基于机器学习的诊断与鉴别诊断模型,整合资源,形成中西医结合的、预防与治疗结合的、运动与饮食结合的、身体健康与心理健康结合的综合防治方案。
治未病是中医防治疾病的独特优势,是实现《纲要》提出的健康中国的具体举措。将治未病理念应用于临床,实现从理论到实践的转化与落地,实现全人群、全周期、全方位防控管理模式,对于慢病防治具有重要意义。
笔者团队以目前心血管领域最为棘手的HFpEF为研究切入点,针对目前防治的现状与不足,基于中医治未病思想探讨HFpEF全周期、全方位防治范式的构建。根据HFpEF发病进程特点,创新性提出全周期7阶段划分,并针对7个阶段提出3级7阶段预防策略,从健康人群的0级预防开始,强调关注疾病转化窗口期,构建全周期预警体系,以指导精准防治。针对中国庞大的基础人群,借力数智化赋能防控,公共卫生与医疗服务体系联手打造闭环管理平台,构建全人群、全周期健康数据信息,多学科交叉合作提供防治管理服务体系,推动人人参与、共建共享、全民健康。
当然,这一范式的形成并非一日之功。首先需要政府层面的政策引导和落实,立足全人群、全周期、全方位管理,立足健康中国的宏伟目标,高屋建瓴,统一部署;需要公共卫生系统和医疗服务体系携手防治“一盘棋”;需要不遗余力加大宣传,将主动健康理念深植人心,尤其要从青少年开始抓起,实现真正的早防;需要与时俱进,多学科交叉合作,共同打造数智化、多元化、联防联控的HFpEF管理平台。
随着人口不断老龄化,HFpEF已成为目前及未来心衰的主要类型。HFpEF防治工作既是挑战,也是机遇,以中国特色的中西医结合防治方案为主体,构建大健康理念指导下的HFpEF全人群、全周期、全方位防治范式,为包括HFpEF在内的慢病防控提供中国方案和中国经验,推进健康中国建设。
  • 国家自然科学基金面上项目(82074423)
  • 中国中医科学院科技创新工程医理交叉课题(CI2023C010YL)
  • 中国中医科学院科技创新重大攻关项目(CI2021A00903)
  • 中国中医科学院西苑医院能力提升项目(XYZX0201-02)
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2025年第43卷第8期
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doi: 10.13193/j.issn.1673-7717.2025.08.001
  • 首发时间:2026-10-30
  • 出版时间:2025-08-10
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国家自然科学基金面上项目(82074423)
中国中医科学院科技创新工程医理交叉课题(CI2023C010YL)
中国中医科学院科技创新重大攻关项目(CI2021A00903)
中国中医科学院西苑医院能力提升项目(XYZX0201-02)
作者信息
    1.中国中医科学院西苑医院,北京 100091
    2.国家中医临床心血管病研究中心,北京 100091
    3.中国中医科学院,北京 100700

通讯作者:

黄璐琦(1968-),男,江西婺源人,院士,研究员,博士研究生导师,博士,研究方向:中药资源学与分子生药学。E-mail:。
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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