射血分数保留的心力衰竭患者中医证型与游离脂肪酸和心型脂肪酸结合蛋白的相关性研究

Correlation Between Traditional Chinese Medical Syndromes and Free Fatty Acid,Heart Type Fatty Acid Binding Protein in Heart Failure with Preserved Ejection Fraction

目的:探讨射血分数保留的心力衰竭(HF-PEF)患者不同中医证型与血清中游离脂肪酸(FFA)及心型脂肪酸结合蛋白(H-FABP)含量的相关性。方法:选取2013年1月——2015年3月入住黑龙江中医药大学附属第一医院的140例HF-PEF患者,分为心血瘀阻证、水饮内停证、血瘀兼水停证和非血瘀水停证4组,选取30例健康体检者作为正常对照组。检测各组患者血清FFA、H-FABP含量,比较各组间二者的差异性,应用线性相关评价N末端B型利钠肽原(NT-proBNP)与FFA、H-FABP的相关性,并应用Logistic回归向前最大似然估计模式评价中医证型与FFA、HFABP的相关性。结果:HF-PEF患者NT-proBNP、FFA、H-FABP水平均高于正常组(P<0.01);NT-proBNP与FFA、H-FABP正相关(r=0.673,P<0.01;r=0.629,P<0.01),且FFA对NT-proBNP的影响大于H-FABP;FFA与心血瘀阻证负相关,H-FABP与心血瘀阻证、水饮内停证正相关,NT-proBNP与中医证型不相关。结论:FFA和H-FABP可能成为HF-PEF诊断的预测因子,同时亦可能是HF-PEF患者心血瘀阻证辨证分型的客观化指标。

Objective：To discuss the correlation between Traditional Chinese Medical （TCM） syndromes and free fatty acid （FFA） as well as heart type fatty acid binding protein （H -FABP） in heart failure preserved ejection fraction （HF -PEF）. Methods ： A total of 140 patients with HF - PEF were selected from The First Affiliated Hospital of Heilongjiang University of Chinese Medicine in January 2013 to March 2015 and divided into 4 groups： heart blood stasis syndrome, fluid retention syndrome, blood stasis and fluid retention syndrome, non blood stasis and fluid retention syndrome. Thirty cases of healthy physical examination were selected as the normal control group. We detected the contents of each patient＇s serum FFA and H - FABP and com- pared the differences of two groups. We evaluated the linear correlation of N terminal b - type natriuretic peptide （ NT - proBNP） and FFA as well as H - FABP and applied the logistic regression on maximum likelihood estimation model to evaluate the correlation of TCM syndromes and FFA as well as H - FABP. Results ： NT - proBNP, FFA and H -FABP levels of the patients with HF - PEF were higher than those of the normal group （P 〈 0. 01 ）. NT - proBNP and FFA as well as H - FABP were positively correlated （ r =0.673 ,P 〈0. 01 ;r =0.629 ,P 〈0. 01 ） and the influence of FFA levels in the NT - proBNP was greater than that in the H - FABP. FFA was negatively related to the syndrome of heart blood stasis and H - FABP positively related to the syndrome of heart blood stasis and the syndrome of fluid retention. The NT - proBNP was not associated with TCM syndromes types. Conclusion ： FFA and H - FABP may become the predictors of HF - PEF diagnosis and at the same time may be the objective indicators of heart blood stasis syndrome in patients with HF - PEF.