冠心病心衰患者中医证型与心率变异性、脑钠素及心功能关系的研究

Correlational Study of Pattern/Syndrome Types of Chinese Medicine in the Patients with Coronary Heart Failure with Heart Rate Variability,Brain Natriuretic Peptide and Heart Function

目的探讨冠心病所致慢性心力衰竭(CHF)患者中医证型与心率变异性(HRV)、血脑钠素(BNP)及心脏超声指标(EF、FS、E/A)的关系,提供冠心病心力衰竭临床辨证参考指标。方法选择冠心病住院患者150例,按中医辨证分为心气阴虚证、心气阳虚证、气虚血瘀证、阳虚水泛证、心阳虚脱证五型,采用12导联同步HOLTER检测系统检查,测定HRV时域指标(24h MeanR-R、SDNN、SDANN、SDANNI、rMSDD、PNN50)、同时检测血脑钠素及超声心动图指标(EF、FS、E/A)。结果各中医证型组中,HRV从心气阴虚、心气阳虚、气虚血瘀、阳虚水泛、心阳虚脱呈依次降低趋势,组间比较,差异有统计学意义(P<0.05或P<0.01);阳虚水泛组、心阳虚脱组与心气阴虚、心气阳虚、气虚血瘀组比较,BNP有升高趋势、EF、FS、E/A有降低趋势,组间差异均有统计学意义(P<0.05)。结论心率变异性、脑钠素、心功能指标均可间接反应冠心病心力衰竭患者的患病程度及预后,可为中医辨证分型提供客观量化指标。

Objective To explore the correlation of the pattern/syndrome types of chronic heart failure（CHF）induced by coronary heart disease in Chinese medicine with heart rate variability（HRV）,blood natriuretic peptide（BNP）and echocardiographic indicators（EF,FS,E/A）so as to provide the reference indexes for the clinical pattern/syndrome differentiation of heart failure in coronary heart disease.Methods50 inpatients of coronary heart disease were selected and differentiated as five patterns/syndromes,namely deficiency of heart qi and yin,qi and yang deficiency of the heart,qi deficiency and blood stagnation,flooding due to yang deficiency and collapse of heart yang.12-lead synchronous HOLTER test system was adopted to determine HRV time domain indicators（24 h Mean R-R,SDNN,SDANN,SDANNI,rMSDD,PNN50）,BNP and echocardiographic indicators（EF,FS,E/A）.ResultsOf the pattern/syndrome groups in Chinese medicine,HRV was reduced in tendency among the groups of deficiency of heart qi and yin,qi and yang deficiency of the heart,qi deficiency and blood stagnation,flooding due to yang deficiency and collapse of heart yang in the sequence,indicating statistical significant differences in comparison（P0.05 or P0.01）.As compared with the groups of deficiency of heart qi and yin,qi and yang deficiency of the heart,qi deficiency and blood stagnation,in the groups of flooding due to yang deficiency and collapse of heart yang,BNP increased in tendency,EF,FS and E/A decreased in tendency,indicating statistical significant differences in comparison among groups（P0.05）.ConclusionHRV,BNP and heart function indicators all reflect indirectly the sickness extent and prognosis for the patients with heart failure in coronary heart disease and also can be the objective quantitative indicators for pattern/syndrome differentiation in Chinese medicine.