充血性心力衰竭中医辨证分型与心功能参数及甲状腺激素相关性的临床研究

目的观察充血性心力衰竭(CHF)中医辨证分型与甲状腺激素(T3、T4、TSH)、心房利钠多肽(ANP)、心功能参数左室射血分数(LVEF)、平均周缘纤维缩短速度(mVcf)、A峰／E峰(A／E)]的关系。方法将100例CHF患者分为4个证型组，检测各组心功能参数、ANP、甲状腺激素，并与对照组(23例)相同指标比较。结果CHF兼水肿血瘀证患者血浆ANP明显高于对照组(P<0．05)；T3较对照组、心气虚证组、兼阴虚证组与兼血瘀证组明显降低(P<0．0l，P<0．0l，P<0．05，P<0．01)；LVEF、mVcf较心气虚证、兼阴虚证、兼血瘀证组均明显降低(P均<0．01)；心气虚证组、兼阴虚证组与兼血瘀证组的T4水平较兼水肿血瘀证组均明显升高(P<0．05，P<0．01，P<0．01)；心气虚证组、兼阴虚证组、兼血瘀证与水肿血瘀证组的A／E比值较对照组均明显增高(P均<0．01)。T3与LVEF、T4均呈正相关(r=0．200，P<0．05；r=0．293，P<0．01)；与ANP呈负相关(r=-0．263，P<0．01)。T4与A／E呈负相关(r=-0．226，P<0．05)。结论T3、T4降低与ANP增高可能是CHF兼水肿血瘀证患者LVEF下降的重要原因之一。T4降低则可能为CHF4型中医分型患者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。

Study on Relationship among Thyroid Hormone Relativity and Syndrome Differentiation Types of TCM in Patients with Congestive Heart Failure

Objective To study the relationship between the TCM Syndrome Differentiation types of congestive heart failure (CHF) and thyroid hormones, including triiodothyronine (T 3), thyroxine (T 4) and thyroid stimulating hormone (TSH), and atrial natriuretic peptide (ANP), as well as cardiac function parameters, including left ventricular ejection fraction (LVEF), mean velocity of circumferentid fiber shortening (mVcf) and A peak/E peak (A/E). Methods One hundred patients with CHF were divided into 4 Syndrom Differentiation type groups, their cardiac function parameters, ANP and thyroid hormones were determined and compared with those in the 23 subjects in the control group. Results In CHF patients with edema and blood stasis Syndrome type, the level of plasma ANP was significantly higher than that in the control group (P<0.05); level of T 3 was significantly lower than that in the control group and in CHF patients of other three (Xin qi deficiency, Yin deficiency and blood stasis) Syndrome groups (P<0.01, P<0.01, P<0.05 and P<0.01); levels of LVEF and mVcf were significantly lower than those in the other three Syndrome groups (all P<0.01). Level of T 4 in other three Syndrome groups significantly increased than that in the edema and blood stasis Syndrome type. A/E value showed a higher level in patients of all TCM type than that in the control (P<0.01). Correlation analysis showed that T 3 was positively correlated with LVEF and T 4 (r=0.200, P<0.05, and r=0.293, P<0.01), and negatively correlated with ANP (r=-0.263, P<0.01); T 4 was negatively correlated with A/E (r=-0.226, P<0.05).Conclusion The lowering of T 3 and T 4 and increasing of ANP may be one of the important reasons for lowering of LVEF in CHF patients with edema and blood stasis Syndrome type. The decrease of T 4 may be one of the important reasons for elevation of A/E and aggravation of left ventricular diastolic dysfunction in CHF patients of all the 4 TCM Syndrome types.