慢性心力衰竭中医证型与相关客观指标关系的对照研究

目的：分析慢性心力衰竭患者不同中医证型的客观指标规律,探讨BNP、CRP、LVEF作为CHF中医辨证分型客观指标的可行性。方法：选取符合慢性心力衰竭诊断标准的患者217例作为研究对象,另外选取正常体检者23例作为对照组。对217例患者进行中医辨证分型,同时抽取血液采用免疫荧光法测定BNP,免疫比浊法测定CRP,所有病例均进行心脏彩超检查测定LVEF,结果进行统计学分析。结果：CHF病人BNP水平明显高于对照组,BNP的水平随心力衰竭加重而上升,与NYHA心功能分级呈正相关（r=0.672,P=0.000〈0.05）;CHF病人LVEF明显低于对照组,LVEF随心力衰竭加重而降低,与NYHA心功能分级呈负相关（r=-0.527,P=0.000〈0.05）。BNP水平与中医证型间存在正相关性（r=0.819,P=0.000〈0.05）,BNP水平按心肺气虚→心气阴虚兼血瘀→气虚血瘀→心脾阳虚兼血瘀水停→心脾肾阳虚水泛兼血瘀逐级递增;心功能等级与中医证型间存在正相关性（r=0.407,P〈0.05）,按心肺气虚、心气阴虚兼血瘀→气虚血瘀→心脾阳虚兼血瘀水停→心脾肾阳虚水泛兼血瘀逐级递增;LVEF与中医证型间存在负相关性（r=-0.69,P=0.000〈0.05）,LVEF按照心肺气虚、心气阴虚兼血瘀→气虚血瘀、心脾阳虚兼血瘀水停→心脾肾阳虚水泛兼血瘀逐级递减。CHF病人CRP水平明显高于对照组,CRP水平与中医证型间存在正相关性（r=0.713,P=0.000〈0.05）,按心肺气虚、心气阴虚兼血瘀→气虚血瘀→心脾阳虚兼血瘀水停→心脾肾阳虚水泛兼血瘀逐级递增。心功能各分级之间CRP测值有显著性差异（P〈0.05）,且CRP随心衰程度加重而逐渐升。结论：慢性心力衰竭中医证型与BNP、CRP、LVEF具有相关性,BNP结合CRP水平、LVEF可为慢性心力衰竭的临床中医分型提供一个较为客观、量化的指标。

Control Study of Correlation of Objective Index in Chronic Heart Failure with Traditional Chinese Medicine Syndrome Types

Objective： To investigate the possibility of BNP, CRP, LVEF as biological markers for traditional Chinese medicine（TCM） syndrome types and to analyze relation between BNP, CRP, LVEF levels and TCM syndrome types in patients with chronic heart failure（CHF）. Methods： 217 patients with CHF were selected as research objects and then 3 healthy persons were as control objects. The clinical data of 217 patients with CHF was analyzed with TCM syndrome differentiation,and BNP and CRP levels were analyzed quantitatively with Immunofluorescence assay. All the patients were examined with cardiac color dopplar ultrasound and the result of LVEF determination was analyzed. Results： The BNP concentrations in patients with CHF were significantly higher than that in healthy controls. BNP concentrations were in- creased with CHF severity and were positively correlated with the NYHA classification system（ r = 0. 672, P = 0. 000 〈 0. 05）. The LVEF concentrations in patients with CHF were significantly lower than that in healthy controls. LVEF concentrations were reduced with CHF severity and were negatively correlated with the NYHA classification system （r = - 0. 527, P = 0. 000 〈 0. 05）. The BNP concentrations were positively correlated with TCM syndrome types（ r = 0. 819, P = 0. 000 〈 0. 05）. The NYHA classification system was positively correlated with TCM syndrome types （ r -- 0. 407＇i P 〈 0. 05）. The LVEF concentrations were negatively correlated with TCM syndrome types （ r = - 0. 69, P = 0. 000 〈 0.05 ） ~ The CRP in CHF group and control group had significant difference （ P 〈 0. 05）. The CRP concentrations were positive- ly correlated with TCM syndrome types（r = 0. 713, P = 0. 000 〈 0.05）. With CHF intensified and CRP gradually in- creased, CRP and NYHA cardiac function correlation classification and the grading test between heart CRP had signifi-cantly different values（ P 〈0. 05）. Conclusion： There was a relationship between BNP,CRP and LVEF levels and TCM syndrome types in patients with CHF. BNP,CRP and LVEF levels might be biological markers for TCM syndrome type determination in patients with CHF.