缺血性心肌病患者中医证型、心功能、血清人可溶性生长刺激表达基因蛋白2水平的相关性

Study on Correlation between Traditional Chinese Medicine Syndromes,Cardiac Function and Human Serum sST2 Levels in Patients with Ischemic Cardiomyopathy

目的探讨缺血性心肌病患者血清人可溶性生长刺激表达基因蛋白2(sST2)水平与中医证型、心功能分级的关系。方法纳入缺血性心肌病患者116例(试验组),体检健康者26例(对照组)。将试验组患者辨证分为气虚血瘀证、痰瘀互结证、气阴两虚血瘀证、阳虚水泛血瘀证4种证型,心功能分级分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级,分别检测不同证型、不同心功能分级患者和对照组受试者血清sST2水平并进行比较。结果116例缺血性心肌病患者中气虚血瘀证11例,痰瘀互结证30例,气阴两虚血瘀证43例,阳虚水泛血瘀证32例;心功能Ⅱ级21例,心功能Ⅲ级55例,心功能Ⅳ级40例。试验组患者血清sST2水平为1790.25(1238.27,2168.96)pg/ml,显著高于对照组的733.32(592.23,854.60)pg/ml(P<0.01)。气虚血瘀证患者血清sST2水平低于气阴两虚血瘀证和阳虚水泛血瘀证患者(P<0.05);阳虚水泛血瘀证患者血清sST2水平高于痰瘀互结证及气阴两虚血瘀证患者(P<0.05);痰瘀互结证与气虚血瘀证患者血清sST2水平差异无统计学意义(P>0.05)。试验组各中医证型间心功能分级分布存在差异(χ^2=33.466,P<0.05)。心功能分级Ⅲ级、Ⅳ级者血清sST2水平高于心功能Ⅱ级者(P<0.05);心功能Ⅳ级者血清sST2水平高于心功能Ⅲ级者(P<0.05)。结论缺血性心肌病患者心功能越差血清sST2水平越高,且血清sST2水平随气虚血瘀→气阴两虚血瘀→阳虚水泛血瘀的演变而升高。

Objective To investigate the relationship between serum human soluble growth-stimulated expression gene 2(sST2)level,traditional Chinese medicine(TCM)syndrome type and cardiac function grading in patients with ischemic cardiomyopathy.Methods A total of 116 patients with ischemic cardiomyopathy(test group)and 26 healthy cases(control group)were selected.The syndromes of the test group were divided into 4 types:qi deficiency and blood stasis syndrome,intermingled phlegm and blood stasis syndrome,qi and yin deficiency and blood stasis syndrome,and water overflowing due to yang deficiency and blood stasis syndrome.The cardiac function was graded intoⅠ,Ⅱ,Ⅲ and Ⅳ level.The sST2 levels were measured and compared between patients with different syndrome types,different cardiac function grading patients and control subjects.Results Among 116 patients with ischemic cardiomyopathy,there were 11 qi deficiency and blood stasis syndrome,30 intermingled phlegm and blood stasis syndrome,43 qi and yin deficiency and blood stasis syndrome,32 water overflowing due to yang deficiency and blood stasis syndrome.For cardiac function,there were 21 cases of cardiac function grade Ⅱ,55 cases of grade Ⅲ and 40 cases of grade Ⅳ.The serum sST2 level of the test group was 1790.25(1238.27,2168.96)pg/ml,which was significantly higher than that of the control group of 733.32(592.23,854.60)pg/ml(P<0.01).The serum sST2 level of patients with qi deficiency and blood stasis syndrome was lower than that of patients with qi and yin deficiency blood stasis syndrome and water overflowing due to yang deficiency and blood stasis syndrome(P<0.05).The serum sST2 level of patients with water overflowing due to yang deficiency and blood stasis syndrome was higher than that of patients with intermingled phlegm and blood stasis syndrome and qi and yin deficiency and blood stasis syndrome(P<0.05);There was no significant difference in serum sST2 levels between patients with intermingled phlegm and blood stasis syndrome and patients with qi deficiency and blood stasis(P>0.05).There were differences in the distribution of cardiac function between the TCM syndrome types in the test group(χ^2=33.466,P<0.05).Serum sST2 level in patients with cardiac function grade Ⅲ and Ⅳ was higher than that in patients with cardiac function grade Ⅱ(P<0.05).Serum sST2 level in patients with cardiac function grade Ⅳ was higher than that in patients with cardiac function grade Ⅲ(P<0.05).Conclusion The worse the cardiac function of patients with ischemic cardiomyopathy is,the higher the serum sST2 level is,and the serum sST2 level increases with the evolution of type of qi deficiency and blood stasis to type of qi and yin deficiency and blood stasis and type of water overflowing due to yang deficiency.