心力衰竭患者中医辨证分型与血浆cTnⅠ水平、甲状腺功能的相关性研究

Correlation between Syndrome Differentiation and Typing,Plasma cTnⅠLevel and Thyroid Function in Heart Failure Patients

目的:探究心力衰竭患者中医辨证分型与血浆肌钙蛋白I(cardiac troponinⅠ,cTnⅠ)水平、甲状腺功能指标的相关性。方法:选取心力衰竭患者96例,按照中医证型的不同分为4个证型组,选取同一时期心功能正常者24例作为对照组,比较各组的cTnⅠ水平和甲状腺功能指标水平,采用Spearman相关分析探讨心力衰竭患者甲状腺功能和cTnⅠ与中医辨证分型的关系。结果:按照血清总甲状腺素(thyroxine,T4)和血清总三碘甲状腺原氨酸(triiodothyronine,T3)的降低顺序,依次为对照组>心肺气虚证组>气阴两虚证组>气虚血瘀证组>阳虚水泛证组(P<0.05),按照cTnⅠ水平的升高顺序,依次为对照组<心肺气虚证组<气阴两虚证组<气虚血瘀证组<阳虚水泛证组(P<0.05)。经Spearman相关分析,心肺气虚证、气阴两虚证、气虚血瘀证、阳虚水泛证与cTnⅠ均呈正相关(r=0.814、0.816、0.807、0.820,P<0.01);与T3均呈负相关(r=-0.367、-0.367、-0.372、-0.308,P<0.05),与T4均呈显著负相关(r=-0.332、-0.364、-0.345、-0.336,P<0.05);96例心力衰竭患者cTnⅠ与T3、T4呈显著负相关(P<0.05)。结论:随着心力衰竭患者病情的进展,即心肺气虚证→气阴两虚证→气虚血瘀证→阳虚水泛证,T4、T3水平逐渐降低,cTnⅠ水平逐渐升高。T3、T4、cTnⅠ表达水平对心力衰竭患者的中医辨证分型具有一定参考价值。

Objective:To investigate the correlation between syndrome differentiation and typing,plasma cTnⅠlevel and thyroid function indexes in heart failure patients.Methods:Ninety-six patients with heart failure were selected and divided into four groups according to TCM patterns,and 24 patients with normal cardiac function in the same period were selected as the control group,to compare the levels of cTnⅠand thyroid function indexes in each group,and Spearman correlation analysis was used to explore the relationship between thyroid function,cTnⅠlevel and syndrome differentiation and typing in heart failure patients.Results:According to the decreasing order of serum total thyroxine(T4)and serum total triiodothyronine(T3),the groups ranked in the order:the control group>heart and lung Qi deficiency syndrome group>Qi and Yin deficiency syndrome group>Qi deficiency and blood stasis syndrome group>Yang deficiency and water flooding syndrome group(P<0.05),they ranked in the order of increasing cTnⅠlevel:the control group<heart and lung Qi deficiency syndrome group<Qi and Yin deficiency syndrome group<Qi deficiency and blood stasis syndrome group<Yang deficiency and water flooding syndrome group(P<0.05).Through Spearman's correlation analysis,cardiopulmonary Qi deficiency syndrome,Qi and Yin deficiency syndrome,Qi deficiency and blood stasis syndrome,and Yang deficiency and water flooding syndrome were positively correlated with cTnⅠ(r=0.814,0.816,0.807,0.820,P<0.01),negatively correlated with T3(r=-0.367,-0.367,-0.372,-0.308,P<0.05),and significantly negatively correlated with T4(r=-0.332,-0.364,-0.345,-0.336,P<0.05);cTnⅠwas significantly negatively correlated with T3 and T4 in 96 patients with heart failure(P<0.05).Conclusion:With the progression of heart failure patients'conditions,i.e.cardiopulmonary Qi deficiency syndrome→Qi and Yin deficiency syndrome→Qi deficiency and blood stasis syndrome→Yang deficiency and water flooding syndrome,the levels of T4 and T3 were gradually decreased,and the level of cTnⅠwas gradually increased.The expressions of T3,T4,and cTnⅠare of reference value for TCM diagnosis and typing of heart failure patients.