应用心功能Tei指数与血浆BNP水平变化评价充血性心力衰竭中医辨证分型

目的通过研究充血性心衰竭（CHF）中医辩证分型与脑钠肽（BNP）及心功能Tei指数变化的关系。评价心功能Tel指数和血浆BNP在充血性心力衰竭中医辨证分型中的价值。方法将80例CHF患者分为4个证型组，测量各组患者的左室射血分数（LVEF）、舒张晚期血流峰值和二尖瓣121舒张早期之比（A／E）、E峰减速时间（EDT）、左室等容舒张时间（IVRT）等参数及Tel指数。测定各组血浆脑钠肽（BNP）浓度水平，并与对照组（25例）相同的测定指标进行比较分析。结果CHF兼水肿血瘀症、兼血瘀证、兼阴虚证患者血浆BNP明显高于对照组（P〈0．01）；CHF兼水肿血瘀症、兼血瘀证、兼阴虚证患者LVEF（％）均明显低于对照组（P〈0．01）；兼阴虚证组、兼血瘀证、兼水肿血瘀证组的A／E比值较对照组均明显增高（P〈0．01）。Tel指数依心气虚证、兼阴虚证、兼血淤证、兼水肿血淤证逐渐升高（P〈0.05）。结论BNP增高可能是CHF兼水肿血瘀证、兼血瘀证患者LVEF（％）下降的重要原因之一。BNP增高可能是CHF患者A／E比值逐步增高而导致左室舒张功能不全逐渐加重的重要原因之一。Tel指数结合BNP测定足综合反映CHF中医4分型心功能变化的可靠指标。

To Evaluate Congestive Heart Failure Syndrome Differentiation Types of TCM by BNP and Tei Index

Objective To study the relationship between the TCM(Traditional Chinese Medicine) Syndrome Differetiation-types of congestive heart failure(CHF) and BNP(B-type natriuretic peptide),as well as cardiac function parameters.Methods 80 patients with CHF were divided into 4 syndrom differentiation-type groups.The cardiac function parameters,including left ventricular ejection fraction(LVEF%),A/E peak ratio at mitrial orifice(A/E),E deceleration time(EDT),isovolumic relaxation time(IVRT),Tei index,and plasma BNP were determined and compared with those in 25 subjects in control group.Results In CHF patients of other three syndrome groups except for Xin-qi deficiency syndrome type,the level of plasma BNP was significantly higher than that in control group(P<0.05);the level of LVEF in the other three syndrome groups was significantly lower than that of control group(P<0.01).A/E value showed a higher level in patients of TCM type without Xin-qi deficiency group than that in the control(P<0.01).Tei index increased gradually with aggrevation of CHF patients following Xin-qi deficiency,Yin deficiency,Yin-deficiency and blood stasis,and edema and blood stasis.Conclusion The increasing of BNP may be one of the important reasons for lowering of LVEF in CHF patients with edema and blood stasis syndrome-type.The increasing of BNP may be one of the important reasons for gradual elevation of A/E and aggrevation of left ventricular diastolic dysfunction in CHF patients.The changes of Tei index and plasma BNP are credible parameters to reflect left ventricular systolic and diastolic function in syndrome differentiation types of TCM of patients with CHF.