心力衰竭中医辨证分型与心功能和脑钠肽的相关性观察

目的观察心力衰竭中医辨证分型与超声心动所测心功能和脑钠肽(brain natriuretic peptide,BNP)的相关性。方法选取2007年1月—2009年1月北京中医药大学东方医院心内科住院心力衰竭患者116例,辨证分为气阴两虚、气虚血瘀和阳虚水泛3个证型组,采用超声心动仪分别检测各组左心室收缩末期内径(left ventricular end-systolic diameter,LVEDs)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDd)、左心室射血分数(left ventricular ejection fraction,LVEF)和BNP。结果 LVEF值按气阴两虚→气虚血瘀→阳虚水泛顺序次第减低,而BNP次第升高,且气阴两虚、气虚血瘀和阳虚水泛比较,差异均有统计学意义(P0.01),中医辨证分型与LVEDs、LVEDd、LVEF和BNP均有相关性,其中与BNP和EF相关性(r=0.71,r=-0.34,P均0.05)最强。结论 BNP和EF可以反应心力衰竭的严重程度,也可以作为辅助心力衰竭辨证分型的一个有益的客观化量化指标。

Relationship of Chinese Medicine Syndrome Pattern with Heart Function and Brain Natriuretic Peptide in Patients with Heart Failure

Objective To observe the relationship of Chinese medicine（CM） syndrome pattern with heart function detected by ultrasonic cardiography and brain natriuretic peptide（BNP） level in patients with heart failure（HF）.Methods One hundred and sixteen inpatients of HF hospitalized in Dongfang Hospital from January, 2007 to January,2009 were assigned to three groups according to their CM syndrome pattern differentiated, the qi-yin deficiency group（QYD）,the qi-deficiency and blood-stasis group（QDBS） and the yang-deficiency with water overflowing group（YDWO）.Ultrasonic cardiographic（USCG） parameters,including left ventricular end-systolic diameter（LVEDs）,left ventricular end-diastolic diameter（LVEDd） and left ventricular ejection fraction （LVEF） were detected,and blood level of BNP was measured.Results LVEF was decreased while BNP was increased in patients with syndrome patterns in the order of QYD→QDBS→YDWO,and showed significant difference between groups（P0.01 ）;CM syndrome patterns was related with all the USCG parameters and BNP level,especially the BNP（r = 0.71,P0.05） and LVEF（r= -0.34,P0.05）.Conclusion LVEF and BNP can reflect the severity of heart failure,and they could be taken as the beneficial objective and quantitative indices for syndrome pattern differentiation.