老年阵发性房颤中医证型的客观化研究

摘要

Objective To investigate the relationship between the traditional Chinese medicine(TCM)syndrome differentiation and pa-rameters of thrombelastogram,serum lipid,N terminal pro brain natriuretic peptide (NT proBNP),left atrial dimension in senile patients with paroxysmal atrial fibril ation (PAF).Methods One hundred and sixty senile patients with PAF and the syndrome of phlegm heat blocking internal y(PHBI,40 patients),blood stasis due to qi deficiency (BSQD,40 patients),timidity due to deficiency of heart qi(TDHQ,40 patients)and deficiency of Qi and Yin(DQY,40 patients)were chosen.Meanwhile,40 healthy individuals were selected as the control group(CG).Parameters of thrombelastogram,serum lipid,NT proBNP,the left atrial dimension were tested. Results The levels of triglyceride (TG),low density lipoprotein cholesterol (LDL C)in PHBI group were higher than that in control group,BSQD group,TDHQ group and DQY group(P<0.01 or P<0.05).The value of R and K of TEG in BSQD group were de-creased,but Angle and MA were increased compared with the control group,PHBI,TDHQ and DQY(P<0.01 or P<0.05).The lev-els of NT proBNP in PHBI group,BSQD group,TDHQ group and DQY group were higher than that in control group.There was sta-tistical difference between PHBI and the other syndrome groups(P<0.01).The dimension of the left atrial in DQY group and BSQD group were more than that in control group,and the left atrial dimension in DQY group were wore than BSQD group and TDHQ group (P<0.01).R,K,Angle,MA,TG and NT proBNP were selected by stepwise discriminant analysis.The predictive accuracy of classifi-cation function by originaI grouped was 94.6%.Conclusion Parameters of thrombelastogram,serum lipid,NT proBNP,the left atrial dimension were different among the TCM syndromes in senile patients with PAF.The values of R,Angle,G,TC and NT proBNP were related to discrimination the TCM syndrome in senile patients with PAF.%目的：探讨老年阵发性房颤中医辨证分型与血栓弹力图、血脂、N 末端脑利钠肽原(N terminal pro brain natriuretic peptide,NT proBNP)、左房内径的关系。方法选取老年阵发性房颤病人痰热内扰型、气虚血瘀型、心虚胆怯型、气阴两虚型的病例各40例,并以同期健康体检者40名为对照组,分别检测血栓弹力图指标 R值、K值、Angle、MA、血脂、NT proBNP及左房内径。结果痰热内扰型三酰甘油(TG)、低密度脂蛋白(LDL C)高于对照组及其他三型(P<0.05或P<0.01)。气虚血瘀型 R、K值低于对照组及其他三型,而 Angle、MA高于对照组及其他三型(P<0.05或P<0.01)。4种证型 NT proBNP均高于对照组,气阴两虚与其他证型间有统计学意义(P<0.01)。气阴两虚型、气虚血瘀型左房内径大于对照组,且气阴两虚型大于痰热内扰型及心虚胆怯型(P<0.01)。采用逐步判别分析时 R值、K值、Angle、MA、三酰甘油、NT proBNP被保留,判别方程总回代符合率为94.6%。结论血栓弹力图参数、血脂、NT proBNP、左房内径在老年阵发性房颤各证型间存在差异,R值、K值、Angle、MA、TG、NT proB-NP有助于判别老年阵发性房颤的中医辨证分型。