阳虚与非阳虚型慢性心力衰竭与神经内分泌相关性研究

目的通过对阳虚与非阳虚型慢性心力衰竭与神经内分泌相关性研究,探讨阳气亏虚对慢性心力衰竭患者神经内分泌的影响,为慢性心力衰竭辨证施治提供客观依据。方法收集符合西医诊断标准的慢性心力衰竭患者55例,按照中医辨证标准分为阳虚组（29例）与非阳虚组（26例）,入院后检测血管紧张素Ⅰ（AngⅠ）、血管紧张素Ⅱ（AngⅡ）、醛固酮（ALD）、脑钠素（BNP）、甲状腺功能指标,分析阳虚型慢性心力衰竭与这些神经内分泌指标的相关性。结果阳虚组心功能明显比非阳虚组差（P〈0.05）;阳虚组患者EF值明显低于非阳虚组（P〈0.01）,BNP、游离甲状腺素（FT4）明显高于非阳虚组（P〈0.05）;AngⅠ、AngⅡ、醛固酮、血清游离三碘甲状腺原氨酸（FT3）、三碘甲状腺原氨酸（T3）、促甲状腺素（TSH）、甲状腺素（T4）两组间无统计学意义。在AngⅠ、AngⅡ、ALD、BNP、FT3、FT4、TSH、T3、T4中筛选出单因素有统计学意义的BNP、FT4进行回归分析,BNP与阳虚型慢性心力衰竭有明显相关性。结论在慢性心力衰竭的病程进展中存在BNP、FT4等神经内分泌的激活及损伤性作用,并且阳虚型心力衰竭较非阳虚型心力衰竭神经内分泌激活更加明显,损伤性作用更强。

The Relationship between the Neuroendocrine and Yang/Non-Yang Deficiency Syndrome in Chronic Heart Failure

Objective To observe the relationship between the neuroendocrine and yang/Non-Yang deficiency syndrome and non-yang deficiency syndrom in patients with chronic heart failure（CHF）,and to supply the objective gist for traditional Chinese medicine（TCM） treatment of CHF.Methods Referred to the standard diagnosis of CHF,traditional Chinese medicine＇s standard syndrome differentiation and the classification of functional capacity of the New York Heart Association（NYHA）,fifty-five patients with CHF were collected and divided into yang deficiency syndrome group（n=29） and non-yang deficiency syndrome group（n=26）.After admission,the levels of the angiotensin（Ang）Ⅰ,AngⅡ,aldosterone（ALD）,pro-brain natriuretic peptide（BNP）,FT3,FT4,TSH,T3,T4 were detected.Results Comparison of heart function：The levels of heart function was significant differences in yang deficiency syndrome group and non-yang deficiency syndrome group（P〈0.05）.The ejection fraction in yang deficiency syndrome group were lower than that in non-yang deficiency syndrome group（P〈0.01）.The levels of pro-BNP and FT4 in yang deficiency syndrome group were higher than that in non-yang deficiency syndrome group（P〈0.05）.There was no significant differences in the levels of AngⅠ,AngⅡ,ALD,FT3,T3,T4 and TSH between yang deficiency syndrome group and non-yang deficiency syndrome group.There was the correlation between BNP and yang deficiency syndrome by logistic analysis.Conclusion The neuroendocrine factor BNP and FT4 were activated and caused damage in patients with CHF.These neuroendocrine factors in yang deficiency syndrome group were more active than that in non-yang deficiency syndrome group.