慢性心力衰竭中医证候特征与客观化研究

Study on the TCM Syndromes Characteristics and Objective Research of Chronic Heart Failure

目的:分析慢性心力衰竭(chronic heart failure,CHF)患者中医征候特征,探讨不同中医证候CHF患者脑钠肽(brain natriuretic peptide,BNP)和心功能指标[左室射血分数(Left Ventricular Ejection Fractions,LVEF)]之间的变化规律,研究CHF患者BNP与LVEF之间的关系。方法:本研究采用前瞻性的研究方式,收集安徽中医药大学第一附属医院2013年4月—2014年2月慢性心力衰竭患者的一般资料,原发病史,中医证候特征与相关化验及检查结果等资料。应用SPSS17.0统计软件进行统计分析。结果:CHF住院患者以高龄患者居多,慢性心力衰竭患者中,原发病以冠状动脉粥样硬化性心脏病所占的比例最大,临床证候分布复杂,本研究出现12种证候,≥5例的中医证候,分别为气虚血瘀证17例,气阴两虚夹瘀证16例,气阴两虚证9例,痰浊闭阻证9例,心肾阳虚证7例,痰瘀互结证6例,阳虚水泛证5例。CHF住院患者血浆BNP水平在各证候间差异无统计学意义(χ2=12.298,P=0.056)。经方差分析,CHF住院患者LVEF在各证候间差异有统计学意义(P=0.01),再用LSD检验(α=0.05)进行证候间的两两比较,结果显示:痰浊闭阻证与气虚血瘀证比较,差异有统计学意义(P=0.013)。痰浊闭阻证与气阴两虚夹瘀证比较,差异有统计学意义(P=0.002)。心肾阳虚与气虚血瘀证比较,差异有统计学意义(P=0.018)。心肾阳虚与气阴两虚夹瘀证比较,差异有统计学意义(P=0.003)。其余证候比较,差异无统计学意义(P>0.05)。经Spearman相关分析,BNP与LVEF之间存在负相关,相关系数为-0.545。结论:慢性心力衰竭住院患者具有高龄、原发病以冠状动脉粥样硬化性心脏病居多、临床证候分布复杂化的特点;LVEF可作为中医辨证的参考,中医证候与BNP未显出相关性。BNP与LVEF之间存在负相关,BNP与LVEF可作为病情程度的参考指标。

Objective： Analysis TCM syndrome characteristics of chronic heart failure（ CHF） in patients,discuss the change rule between brain natriuretic peptide（ BNP） and cardiac function index（ LVEF） for the CHF patients with different TCM syndrome,and study the relationship between the BNP and LVEF value of CHF patients. Methods： This study adopts the prospective study method,collect the general information,a primary history,characteristics and diagnosis of TCM syndrome,and relevant tests and examination results of patients with CHF during hospitalization in first affiliated hospital of Anhui medical university in April 2013-February 2014. SPSS 17. 0statistical software was used for statistical analysis. Results： The old age patients are the majority in hospitalized patients. In patients,the proportion of the primary disease is the largest to coronary heart disease,the distribution in clinical syndrome is complicated,this study include 12 types of TCM syndrome,the TCM syndrome with types of cases number of 5 or more are Qi deficiency and blood stasis of 17 cases,deficiency of Qi and Yin folder stasis of 16 cases,deficiency of Qi and Yin of 9 cases,phlegm turbidity closed resistance of 9 cases,heart kidney Yang deficiency of 7 cases,phlegm and blood stasis of 6 cases,Yang deficiency and water flood of 5 cases,Plasma BNP levels have no statistically significant difference in hospitalized patients with CHF between the different syndrome types（ χ2=12. 298,P = 0. 056）. Via analysis of variance,left ventricular ejection fraction LVEF values in the patients has statistically significant（ P = 0. 01）,then by the LSD test（ α = 0. 05）,to conduct comparison between syndromes,the result shows that： phlegm turbidity closed resistance compared with Qi deficiency blood stasis,P = 0. 013,the difference was statistically significant,phlegm turbidity closed resistance compared with deficiency of Qi and Yin clip stasis,P = 0. 002,the difference was statistically significant,heart kidney Yang deficiency compared with Qi deficiency and blood stasis syndrome,P = 0. 018,the difference was statistically significant. Heart kidney Yang deficiency compared with deficiency of Qi and Yin clip stasis,P = 0. 003,the difference was statistically significant. No more than the difference between the syndromes. Use Spearman correlation analysis method,the presence of a negative correlation between BNP and LVEF that correlation coefficient is 0. 545. Conclusion： Patients with chronic heart failure hospitalization with older age,primary disease with coronary heart disease in the majority,the characteristics of the complicated clinical syndrome type distribution. LVEF value can be used as the reference of TCM syndrome differentiation. TCM syndrome type and BNP did not show correlation. There is negative correlation between the BNP and LVEF,the BNP and LVEF value can be used as reference condition level.