心力衰竭患者脑钠肽与中医辨证分型相关性的临床研究

A Correlative Clinical Study on Brain Natriuretic Peptide of Heart Failure with Syndrome Differentiation of TCM

目的:观察充血性心力衰竭(CHF)患者脑钠肽(BNP)与中医辨证分型的关系。方法:以多普勒超声心动图及血浆 BNP检测与中医辨证分型对95例CHF患者进行宏观辨证与微观辨证研究,并与20例心功能正常的同期住院患者(对照组)相同指标比较。结果:CHF组BNP为(1363．33±1584．74)pg／mL,对照组BNP为(45．58±39．93)pg／mL,2组比较,差异有非常显著性意义(P<0．01),且CHF组随着心功能不全程度的加剧,其BNP含量也不断增高,与对照组比较,差异均有非常显著性意义(P <0．01)。BNP在CHF组中医不同证型间随着心气虚证→气阴两虚证→心阳虚证→阳虚水泛证的演变而逐步增高,各证型间差异有显著性或非常显著性意义(P<0．05,P<0．01)。CHF组中医不同证型LVEF(左室射血分数)与对照组比较,差异均有显著性意义(P<0．05),其中阳虚水泛证、心阳虚证LVEF较对照组及心气虚证、气阴两虚证降低更明显。CHF组中医不同证型均存在不同程度的左室重量指数增加,但室间隔厚度及左室后壁厚度除气阴两虚型外,与对照组比较,差异均无显著性意义(P>0．05)。而左室重量指数、室间隔厚度及左室后壁厚度以气阴两虚型增加最为明显,与其他各型比较,差异有显著性意义(P<0．05)。心阳虚型、阳虚水泛型LVDd(左室舒张末内径)较对照组增加,差异有显著性意义(P<0．05)。CHF组中医不同证型与BNP呈正相关(P<0．01),与LVEF呈负相关(P<0．05)。结论:BNP有可能作为中医不同辨证分型的指标之一。

Objective： To observe the relationship of brain natriuretic peptide （BNP） of congestive heart failure （CHF） with syndrome differentiation of TCM. Methods： 95 cases of CHF were studied by macroscopic and microcosmic syndrome differentiation with Doppler ultrasound echoeardiogram, determination of plasma BNP and syndrome differentiation of TCM, and compared with the same parameters of normal cardiac function in 20 cases. Results： In CHF group, the BNP was （1363.33 ± 1584.74） pg/mL, and （45.58±39.93） pg/mL in control group （P〈 0.01）, in CHF group, the degree of exacerbation of cardiac insufficiency followed with the content of BNP increase continuously in comparison with control group （P 〈 0.01）. In CHF group, the BNP was increased gradually from the order of heart - qi deficiency syndrome→deficiency of both qi and yin syndrome→heart - yang deficiency syndrome→ yang deficiency syndrome, the differences of various syndromes showed marked significance or very marked significance （ P 〈 0. 05, P 〈 0. 01）. In CHF group, the comparison of left ventricular ejection fraction （LVEF） of various syndromes with control group showed marked significance （ P 〈 0.05）, among them, the level of LVEF of yang- deficiency syndrome and heart-yang deficiency syndrome were markedly decreased than that of control group, heart - qi deficiency syndrome and deficiency of both qi and yin syndrome. In CHF group various syndromes existed different degree increase of left ventricle mass index （LVMI）, but the comparison of interventricle septal diameter （IVSD） and Left ventricle post wall diameter （LVPWD） with control group （except deficiency of both qi and yin syndrome） showed no marked significance （ P 〉 0.05）. The parameters of LVMI, IVSD and LVPWD were marked increase in deficiency of both qi and yin syndrome and yang - deficiency syndrome was increased than control group （ P 〈 0. 05）. In CHF group, various syndromes of BNP showed positive correlation （P 〈 0. 01） and negative correlation in LVEF （ P 〈 0. 05）. Conclusion： BNP may be one of the parameters in syndrome differentiation of TCM.