中青年与老年急性心肌梗死患者中医证型特点及与脑钠素相关性分析

摘要

目的 探讨中青年与老年急性心肌梗死(AMI)患者中医辨证分型特点及脑钠素(BNP)的相关性.方法 按照完全随机化原则选择2011年1月-2012年2月在卫生部北京中日友好医院心内科住院的AMI患者147例,中青年组68例,老年组79例.中医辨证分为4个证型:即气虚血瘀证(气虚、阳虚证和气虚血瘀证)、气滞血瘀证、气虚痰瘀互阻证、气阴两虚血瘀证.采用干式快速荧光定量法检测BNP,统计分析探讨中青年及老年AMI中医证型分布特点及其与BNP的相关性,为中医辨证分型提供依据.结果 中青年组分型:气虚血瘀型(39.7％,27/68)＞气虚痰瘀互阻型(30.9％,21/68)＞气阴两虚血瘀型(16.2％,11/68)＞气滞血瘀型(13.2％,9/68)；老年组分型:气虚痰瘀互阻型(44.3％,35/79)＞气阴两虚血瘀型(25.3％,20/79)＞气虚血瘀型(22.8％,18/79)＞气滞血瘀型(7.6％,6/79)；两组中医证型构成比差异有统计学意义(P＜0.05).老年组各中医证型BNP高于中青年组BNP,差异有统计学意义(P＜0.01).中青年组BNP:气虚痰瘀互阻型＞气阴两虚血瘀型＞气虚血瘀型＞气滞血瘀型,中医各证型间比较气虚痰瘀互阻型与气滞血瘀型有差异(P＜0.05)；老年组BNP:气虚痰瘀互阻型＞气虚血瘀型＞气阴两虚血瘀型＞气滞血瘀型.结论 中青年组气虚血瘀证(39.7％)多见,老年组气虚痰瘀互阻证(44.3％)多见,考虑BNP升高可以作为气虚痰瘀互阻型AMI的微观指标之一.%Objective To investigate the relationship between plasma B - type natriuretic peptide ( BNP) and syndrome type of traditional Chinese medicine (TCM) in elderly and young patients with acute myocardial infarction (AMI). Methods One hundred fourty seven patients with AMI from in the cardiology department of China - Japan Friendship Hospital were randomly enrolled from January 2011 to February 2012, with 68 in young group and 79 in elderly group. The patients of the two groups were, basing on TCM syndrome, divided into 4 subgroups: Qi deficiency and blood stasis, Qi stagnation and blood stasis, Qi deficiency and phlegm stasis, Qi - Yin deficiency and blood stasis. BNP level was measured by rapid, point - of - care quantitative iramunofluorescent assay. The constituent ratios of TCM syndromes and the correlation with BNP in the two groups were analyzed. Results The constituent ratio of TCM syndromes in the young group was respectively 39. 7% (27/68) for Qi deficiency and blood stasis, 30. 9% (21/68) for Qi deficiency and phlegm stasis, 16. 2% ( 11/68) for Qi - Yin deficiency and blood stasis, and 13. 2% (9/68) for Qi stagnation and blood stasis. But the constituent ratio in the elderly group was 44. 3% (35/79) for Qi deficiency and phlegm stasis, 25. 3% (20/79) for Qi - Yin deficiency and blood stasis, and 22. 8% (18/79) for Qi deficiency and blood stasis, and 7. 6% (6/79) for Qi stagnation and blood stasis, The differences in the constituent ratio between young group and elderly group were statistically significant (P < 0. 05 ) . The plasma levels of BNP in the elderly subgroups were significantly higher than those in the young subgroups ( P < 0. 01). In the young group the plasma levels of BNP ranged in order of Qi deficiency and phlegm stasis > Qi - Yin deficiency and blood stasis > Qi deficiency and blood stasis > Qi stagnation and blood stasis, and among the subgroups there a significant difference between Qi deficiency and phlegm stasis subgroup and Qi stagnation and blood stasis group ( P < 0. 05 ). In the elderly group the plasma levels of BNP ranged in order of Qi deficiency and phlegm stasis > Qi deficiency and blood stasis > Qi - Yin deficiency and blood stasis > Qi stagnation and blood stasis but no significant difference was found among the subgroups (P > 0. 05 ) . Conclusion The Qi deficiency and blood stasis type was the most common in the young group (39. 7% ) , but the Qi deficiency and phlegm stasis type was the most common in the elderly group (44. 3% ). The elevation of BNP might be one of the microcosmic indexes for AMI of Qi deficiency and phlegm stasis.