2型糖尿病合并射血分数正常心力衰竭患者的超声指标与中医证型相关性研究

Clinical study on relationship between TCM syndrome and echocardiography parameters in T2DM combined with HFpEF

目的:通过分析2型糖尿病(T2DM)合并射血分数正常心力衰竭(心衰)(HFpEF)患者中医证型与超声心动图指标的相关性,探讨T2DM合并HFpEF各证型与心衰进展的相关性。方法:将150例T2DM合并HFpEF患者,根据中医证候、舌苔及脉象等分为阴虚热盛组、湿热困脾组、气阴两虚组、血瘀水停组、血瘀脉络组5组,对各组心脏结构、功能的超声指标及血浆B型钠尿肽(BNP)进行统计学分析。结果:T2DM合并HFpEF阴虚热盛证、湿热困脾证、气阴两虚证、血瘀水停证、血瘀脉络证的心功能量呈逐渐降低趋势;血瘀水停组、血瘀脉络组的超声指标左房容积指数、室间隔厚度、左室后壁厚度、二尖瓣环收缩期平均速度及血浆BNP与其他3组比较,差异均有统计学意义(均P<0.05),血瘀脉络组射血功能与其他4型比较差异有统计学意义(均P<0.05)。结论:血瘀水停组、血瘀脉络组左心形态及功能改变明显,血瘀脉络组可能是T2DM合并HFpEF发展晚期的证型,超声心动图指标有可能作为中医辨证分型的参考。

Objective:To explore the relationship between TCM syndrome differentiations and echocardiographic parameters in the patients of T2DM combined with HFpEF(heart failure with preserved left ventricular ejection fraction).Methods:150 cases of T2DM combined with HFpEF were selected,according to the patient’s syndromes,tongue and pulse devided into five TCM syndrome types:yin deficiency and heat syndrome,syndrome of dampness-heat blocking spleen,qi-yin deficiency syndrome,blood stasis swelling syndrome and blood stasis vein syndrome.The echocardiography indexes and BNP values for each type were statistically analyzed.Results:Their heart function showed a trend of gradual deterioration as the former sequence.The values of LAVI,IVS,LVPW,s’mean and BNP of patients with blood stasis swelling syndrome and blood stasis vein syndrome had significant differences compared with those of patients of other three syndrome(all P<0.05).The ejection function of blood stasis vein syndrome had significant differences comparison with the other four groups(P<0.05).Conclusion:With the aggravation of the imaginary,cardiac function progressively decreases in deficiency of Blood stasis syndrome group.The echocardiography can be used as objective and quantitative indexes of Syndrome differentiation of TCM.