慢性心力衰竭中医证型与氨基末端B型脑钠肽原、肌钙蛋白I及左心功能参数相关性研究

A study on the correlation between TCM syndrome type of chronic heart failure and NT-proBNP,cTnI and left heart function parameters

目的:探讨慢性心力衰竭(Chronic Heart Failure,CHF)患者中医证型与血浆氨基末端B型脑钠肽原(N-terminal Probrain Natriuretic Peptide,NT-proBNP)、肌钙蛋白I(Cardiac Troponin I,cTnI)与左心功能参数[(左心室射血分数Left Ventricular Ejection Fraction,LVEF)、左心室舒张末期内径(Left Ventricular End Diastolic Diameter,LVEDD)、左心室质量指数(Left Ventricular Mass Index,LVMI)]的相关性,为CHF中医辨证分型提供客观依据。方法:按研究标准纳入150例CHF患者,进行中医辨证分型,同时选择100例正常体检者作为对照组。对150例CHF患者测定NT-proBNP、cTnI水平,采用心脏超声检测LVEDD和LVEF,并计算LVMI。考察CHF中医证型与血浆NT-proBNP、cTnI水平及LVEF、LVEDD、LVMI的相关性。结果:(1) NT-proBNP、cTnI水平比较:CHF组明显高于对照组(P <0.05);急性加重期高于稳定期,且急性加重期两组证型间差异具有统计学意义(P <0.05)。(2)左心功能参数比较:LVEF、LVEDD及LVMI在稳定期及急性加重期各证型间差异存在统计学意义(P <0.05),LVEDD、LVMI表现为阳虚水泛、瘀血阻络组>气虚血瘀水停组>气阳两虚血瘀组>气阴两虚血瘀组>气虚血瘀组;LVEF则依次递减,表现为气虚血瘀组>气阴两虚血瘀组>气阳两虚血瘀组>气虚血瘀水停组>阳虚水泛、瘀血阻络组。结论:NT-proBNP、cTnI及LVEF、LVEDD、LVMI可作为CHF中医辨证分型的客观量化指标,能够为CHF中医辨证分型提供参考。

Objective:To investigate the correlation between TCM syndrome type and plasma N-terminal B-type brain natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI)and left heart function parameters(LVEF,LVEDD,LVMI)in patients with chronic heart failure(CHF),so as to provide objective bases for TCM syndrome differentiation and classification of CHF.Methods:According to the study criteria,150 patients with CHF were included for TCM syndrome differentiation and classification,and 100 patients with normal physical examination were selected as the control group. The levels of NT-proBNP and cTnI were determined in 150 patients with chronic heart failure, LVEDD and LVEF were measured by echocardiography, and LVMI was calculated. The correlation between TCM syndromes of chronic heart failure and plasma levels of NT-proBNP, cTnI, LVEF, LVEDD and LVMI were investigated. Results: ① Comparison of NT-proBNP and cTnI levels: chronic heart failure group was significantly higher than the normal control group (P<0.05). Levels of NT-proBNP and cTnI in acute exacerbation stage of heart failure were higher than the stable stage of heart failure, and there was a statistical difference between the two groups in the acute exacerbation stage (P<0.05). ② Comparison of left heart function parameters: LVEF, LVEDD and LVMI showed statistical difference among the syndrome types in the stable stage of heart failure and the acute exacerbation stage (P<0.05). LVEDD and LVMI showed that Yang ( 阳) deficiency and water overflowing and blood stasis blocking collaterals group>Qi ( 气) deficiency, blood stasis and water retention group>Qi-yang ( 气阳) deficiency and blood stasis group>Qi-yin ( 气阴) deficiency and blood stasis group>Qi deficiency and blood stasis group;LVEF was decreased successively as follows: Qi deficiency and blood stasis group> Qi-yin deficiency and blood stasis group>Qi-yang deficiency and blood stasis group>Qi deficiency, blood stasis and water retention group>Yang deficiency and water overflowing and blood stasis blocking collaterals group. Conclusion: NT-proBNP, cTnI, LVEF, LVEDD, LVMI can be used as objective quantitative indicators of TCM syndrome differentiation and classification of chronic heart failure, and can provide reference for TCM syndrome differentiation of CHF.