慢性心力衰竭病人舌下络脉变化与血常规指标的相关性分析

Relationship between Sublingual Collaterals Changes and Blood Components Content in Patients with Chronic Heart Failure

目的探讨不同程度慢性心力衰竭病人舌下络脉各种特征变化与血常规指标的相关性。方法选择54例不同纽约心脏病协会(NYHA)分级的慢性心力衰竭病人,采用天津中医药大学和天津大学联合研制的舌象采集仪器进行舌下络脉采集。运用中医舌象智能辅助诊断系统,对舌下络脉长度、宽度、迂曲程度和颜色深浅进行判断和等级分类,同时采集病人血常规各项检测指标。通过单因素ANOVA方差分析、Spearman等级相关分析方法筛选与舌下络脉各种特征变化程度有关联和呈线性趋势的血液成分指标,经多元有序Logistic回归分析探讨不同NYHA分级心力衰竭病人舌下络脉长度、宽度、迂曲程度和颜色深浅与筛选出的血液成分含量之间的关联,分析其相互影响作用,预测变化趋势。结果舌下络脉长度变化与血常规中平均血小板体积(MPV)、血小板分布宽度(PDW)、大型血小板百分比(P-LCR)水平呈正相关(P<0.05),随着NYHA分级增加而长度有增加趋势;宽度变化与血常规中平均血红蛋白浓度(MCHC)、血小板计数(PLT)、血小板压积(PCT)水平呈负相关(P<0.05),与MPV、PDW水平呈正相关(P<0.05),随着MCHC浓度升高其舌下络脉宽度有变细趋势;迂曲程度变化和血常规中PLT、PCT水平呈负相关(P<0.05);颜色变化和血常规中白细胞计数(WBC)、中性粒细胞计数(N)、PDW、P-LCR水平呈正相关(P<0.05),随着PDW水平增加络脉颜色有加深趋势。结论不同NYHA分级慢性心力衰竭病人舌下络脉特征变化与血常规中红细胞、血小板、白细胞等指标具有一定的关联性,尤其是与血小板活性成分关系较密切,观察舌下络脉可能是判断心力衰竭病人缺血缺氧和血液瘀滞状态的一种有效方法,对于心力衰竭病人预后判断也具有一定价值。

Objective To investigate the relationship between various characteristic changes of sublingual collateral and blood compo -nents content in patients with chronic heart failure （CHF）.Methods Fifty four patients with different levels of New York Heart Asso -ciation （NYHA） Functional Classification were selected.The sublingual collaterals were collected by the tongue image acquisition in -strument that developed by Tianjin University of Traditional Chinese Medicine and Tianjin University.The sublingual vein length,width,tortuous degree and color shade were judged and classified through Chinese medicine tongue intelligent assitant diagnosis system.The various blood routine test indexes were collected.One way ANOVA analysis of variance and Spearman rank correlation analysiswere used to screen blood components that correlated with various characteristics of sublingual collaterals and linear trend.Multivari-ate ordinal Logistic regression analysis was used to explore the correlation between the length,width,tortuosity degree,color depth ofsublingual collaterals and the screened blood component content in CHF patients with different levels of NYHA.The interaction effectswere analyzed.The trend of changes was predicted.Results The length change of sublingual collaterals was positively correlatedwith mean platelet volume （MPV）,platelet distribution width （PDW） and platelet large cell ratio （P LCR） levels in blood routine.Thelength increased with the increase of NYHA classification.The width change of sublingual collaterals was negatively correlated withmean corpuscular hemoglobin concentration （MCHC）,platelet counts （PLT）,and platelet crit （PCT） levels in the blood routine,and waspositively correlated with MPV and PDW levels.The width of sublingual collaterals decreased with increasing MCHC concentrations.There were negative correlations between tortuous degree changes and the levels of PLT and PCT in blood routine.Color changesand blood routine white cell count （WBC）,neutrophil count （N）,PDW,P LCR levels were positively correlated.The color of collateralshad a deepened trend with the increase of PDW content.Conclusion There are certain correlations between the tongue sublingualcollaterals changes and the content level of red blood cells,platelets,white blood cells and other indicators in blood routine,especiallywith the active ingredients of platelets in CHF patients with different NYHA classification.The observation of sublingual collaterals maybe an effective method to determine the status of ischemia,hypoxia and blood stasis in patients with heart failure,and it also has acertain value for the prognosis of patients with heart failure.