冠心病及心肌梗死后心力衰竭病人血管内皮功能障碍与中医证型的相关性研究

Correlation between Vascular Endothelial Dysfunction and TCM Syndromes in Patients with Coronary Heart Disease and Heart Failure after Myocardial Infarction

目的 采用临床病例调查,分析冠心病及心肌梗死后心力衰竭病人血管内皮功能障碍与中医证型的相关性。方法 选取门诊及住院的80 例冠心病(心功能Ⅰ级)病人、63 例心肌梗死后心力衰竭(心功能Ⅱ级~Ⅳ级)病人,收集其年龄、性别、心率、血压、血流依赖性血管内皮舒张功能(FMD)、同型半胱氨酸(tHcy)、血脂、糖化血红蛋白(HbA1c)、超氧化物歧化酶(SOD)及中医辨证分型等资料,采用Spearman相关性分析FMD与SOD、高密度脂蛋白胆固醇(HDL-C)、年龄、低密度脂蛋白胆固醇(LDL-C)、tHcy、HbA1c 的相关性,并比较两组病人血管内皮功能障碍程度。结果 与冠心病(心功能Ⅰ级)病人相比较,心肌梗死后心衰(心功能Ⅱ级~Ⅳ级)病人FMD 值明显下降,差异有统计学意义(P <0.05);且随着心功能不全加重,FMD 值有进一步下降趋势;FMD 值与SOD、HDL-C 呈正相关,与年龄、LDL-C、tHcy、HbA1c 均呈负相关;比较中医证型分布发现,冠心病病人中痰瘀互阻型FMD 值明显降低(P <0.05);在心肌梗死后心衰病人中,心气下陷、瘀血阻滞型FMD 值明显降低(P <0.05)。结论 冠心病心肌梗死后心衰病人(心功能Ⅱ级~Ⅳ级)较冠心病(心功能Ⅰ级)病人血管内皮功能损伤的程度严重,且随着心功能不全加重血管内皮功能障碍进一步加重。对冠心病危险因素相关性研究发现:血管内皮功能程度与年龄、氧化应激、血脂、同型半胱氨酸、血糖水平等有关;中医证型分布研究发现冠心病病人中痰瘀互阻型血管内皮功能障碍较重。心肌梗死后心衰病人中心气下陷、瘀血阻滞型血管内皮功能障碍较重。

Objective To analyse the correlation between vascular endothelial dysfunction and traditional Chinese medicine(TCM)syndrome types in patients with coronary heart disease (CHD)and in which there were heart failure after myocardial infarction byclinical investigation.Methods We recruited 80 patients with CHD(heart function Ⅰ level),63 patients with heart failure after myocardialinfarction (heart function Ⅱ to Ⅳ level).The age,sex,heart rate,blood pressure,vascular endothelial dependent diastolicfunction (FMD),homocysteine (tHcy),blood lipid,glycated hemoglobin (HbA1c),superoxide dismutase (SOD)and TCM syndrometypes were analyzed by SPSS 20.0 statistical software.The vascular endothelial dysfunction was compared between two groups.ResultsCompared with patients with CHD(heart function Ⅰ level),FMD value decreased obviously in heart failure after myocardial infarction(heart function Ⅱ to Ⅳ level)patients,and there was significant statistical significance (P <0.05).With the cardiac insufficiency,FMD value had further downward trend.FMD value was positively correlated with SOD,HDL C,and negatively correlated with age,LDL C,tHcy,HbA1c.Comparison of TCM syndrome type distribution found in coronary heart disease group,phlegm and blood stasistransresistancetype FMD value decreased significantly (P <0.05).In patients with heart failure after myocardial infarction,FMD valuesignificantly decreased in patients with qi deficiency and blood stasis syndrome type(P <0.05).Conclusion The extent of the damage of vascular endothelial function in patients with heart failure after myocardial infarction (heart function Ⅱ to Ⅳ level)is the mostserious,and aggravates vascular endothelial dysfunction with cardiac insufficiency further.The study find that the endothelial functiondegree is correlated with risk factors of CHD and,for oxidative stress,age,blood lipids,homocysteine,blood glucose level and so on.TCM syndrome type distribution study shows that the endothelial dysfunction is heavier in patients with CHD and phlegm and bloodstasis transresistance type.In patients with heart failure after myocardial infarction,the endothelial dysfunction with qi deficiency andblood stasis syndrome type is more serious.