扩张型心肌病患者中医证素与抗心肌抗体的相关性

Traditional Chinese Medicine Syndrome Elements of Patients with Dilated Cardiomyopathy and Its Correlation with Anti-heart Antibodies

目的:分析无锡地区扩张型心肌病(dilated cardiomyopathy,DCM)患者中医证素的分布特点,观察血清中抗腺嘌呤核苷酸(ADP/ATP)转位酶(adenine nucleotide translocase,ANT),抗β1肾上腺素能受体(β1receptor),抗毒蕈碱2(muscarinic receptor 2,M2)受体、抗肌球蛋白重链(myosin heavy chain,MHC)4种自身抗心肌抗体的水平,探讨中医证素和抗心肌抗体两者间的关系,为DCM患者临床诊治提供客观的依据。方法:选取无锡地区2013年5月—2014年12月入住心内科的84例DCM患者,由专职中医师进行临床证候采集与中医证素的评估;随机抽取同期住院的61例非DCM引起的慢性心力衰竭患者作为心衰组,抽取47例健康体检者作为正常组。测定3组患者血清中ant-ANT,ant-β1,ant-M2,ant-MHC的水平。结果:DCM患者中医证素分布特点,84例DCM患者中医证素共出现158次,证素按出现频次高低依次为气虚57次(36.08%)>血瘀48次(30.38%)>阳虚27次(17.09%)>阴虚12次(7.59%)>水湿9次(5.70%)>痰浊5次(3.16%),其中虚性证素占60.76%,实性证素占39.24%。单证素24例,其中气虚(11例)<阳虚(13例);兼夹证素60例,其中气虚血瘀(26例)>气虚阴虚(12例)>阳虚血瘀(8例)>气虚血瘀水湿(5例)>阳虚血瘀水湿(4例)>气虚血瘀痰浊(3例)>阳虚血瘀痰浊(2例)。DCM患者与非DCM心力衰竭患者ant-ANT,ant-β1,ant-M2,ant-MHC的水平比较,DCM组抗心肌抗体ant-β1,antMHC,ant-ANT水平明显高于心衰组(P<0.05)。DCM患者中医证素与抗心肌抗体水平的关系,DCM患者中医单证素阳虚患者抗心肌抗体ant-β1,ant-ANT,ant-M2,ant-MHC水平均高于气虚患者(P<0.05),DCM患者中医兼夹证素间抗心肌抗体ant-β1,ant-ANT,ant-M2,ant-MHC值从高到低为阳虚血瘀>气虚血瘀>气虚阴虚。结论:DCM患者中医证素中,气虚所占比例最大,其次为实性证素血瘀,是本病最主要的病理因素之一。DCM患者中医证素与抗心肌抗体水平存在相关性,随着单证素从气虚到阳虚,兼夹证素从气虚阴虚,气虚血瘀到阳虚血瘀的演变,抗心肌抗体水平呈增高趋势。可指导临床应用相应的中西医结合方法治疗DCM。

Objective： To observe the distribution characteristics of traditional Chinese medicine （TCM） syndrome elements in patients with dilated cardiomyopathy （DCM） in Wuxi and its relationship with four anti-heart antibodies [ adenine nucleotide translocase, β1 receptor, muscarinic receptor 2 （M2 ）, myosin heavy chain （MHC） ]. Method： Totally 84 cases of hospitalized patients with DCM in Wuxi during May 2013 to December 2014 were selected and assessed for their TCM syndrome elements by a full-time TCM physician. A total of 61 patients with CHF （not caused by DCM ） were enrolled into the CHF group, and 47 people with physical examination were enrolled into normal group. Serum ant-β1, ant-MHC, ant-M2 and ant-ANT among three groups were detected. Result： The distribution characteristics of TCM syndrome elements in patients with DCM can be summarized as follows： the frequency of TCM syndrome elements in 84 DCM patients was 158, and the order was Qi deficiency （57 cases） 〉 blood stasis （48 cases） 〉 Yang deficiency （27 cases） 〉 Yin deficiency （12 cases） 〉 Dampness （9 cases） 〉 Phlegm （5 cases）. The asthenia syndrome elements accounted for 60.76%, and the demonstration syndrome elements accounted for 39.24%. The frequency of TCM syndrome elements in single syndrome element group was 24, and the order was Qi deficiency （11 cases） 〈 Yang deficiency （13 cases）. The frequency of TCM syndrome elements in folder syndrome element groups was 60, and the order was Qi deficiency and blood stasis （26 cases） 〉 Qi deficiency and Yin deficiency （ 12 cases） 〉 Yang deficiency and blood stasis （8 cases） 〉 Qi deficiency and blood stasis and Dampness （5 cases） 〉 Yang deficiency and blood stasis and Dampness （4 cases） 〉 Qi deficiency and blood stasis and Phlegm （3 cases） 〉 Yang deficiency and blood stasis and Phlegm （2 cases）. The concentrations of four anti-heart antibodies in the DCM group was higher than those of the CHF group （P 〈 0.05）. In the single syndrome element groups, the order for the concentrations of ant-β1, ant-ANT, ant-M2 and ant-MHC from high to low was Yang deficiency 〉 Qi deficiency, with significant differences （P 〈 0.05）. In the folder syndrome element group, the order for the concentrations of ant-β1, ant- ANT, ant-M2 and ant-MHC from high to low was Yin deficiency and blood Stasis 〉 Qi deficiency and blood stasis 〉 Qi deficiency and Yin deficiency. Conclusion ： All of the syndrome elements, Qi deficiency accounts for the largest proportion, which is followed by blood stasis, one of the most important pathological factors. There is correlation between the TCM syndrome elements and the level of anti-heart antibodies; With the changes from Qi deficiency to Yang deficiency and from Qi deficiency and Yin deficiency through Qi deficiency and blood stasis to Yin deficiency and blood stasis, the level of anti-heart antibodies increases.