脑钠肽或脑钠肽前体、肌钙蛋白与胸痹心痛中医证型相关性的研究

摘要

目的:探讨脑钠肽前体(NT-proBNP)水平和肌钙蛋白(cTnI)与胸痹心痛不同中医证型之间的内在联系,为胸痹心痛患者进行针对性的中医辨证治疗提供客观依据.方法:将1 157例冠状动脉造影检查患者,胸痹心痛中医辨证分为心气不足、心阳不振、心阴不足、痰浊闭塞、心血瘀阻、阴寒凝结、气滞胸痛和胸痹心痛的变证真心痛证型:痰瘀交阻、气阴两虚、阳虚欲脱共10个证型,1个对照组;并设立冠心病组、动脉粥样硬化组、正常组,搜集正常组,冠状动脉粥样硬化组和各个中医证型NT-proBNP、cTnI 的数据分析他们之间的相关性.由ROC曲线确定NT-proBNP水平从而诊断(辨证)心阳不振证型.结果:NT-proBNP冠心病组、冠状动脉粥样硬化组高于正常组(P ＜0.001),冠心病组高于冠状动脉粥样硬化组(P＜0.001),冠心病组NT-proBNP、cTnI低于急性心梗组,有显著性差异(P ＜0.001);NT-proBNP:心阳不振＞阳虚欲脱＞气阴两虚＞痰瘀交阻＞心气不足、心血瘀阻＞痰浊闭塞、寒凝气滞＞气滞胸痛、心阴不足＞对照组.心阳不振与心气不足、心阴不足、痰浊闭塞、寒凝气滞、心血瘀阻、气滞胸痛、痰瘀交阻、气阴两虚、对照组比较,P ＜0.001;与阳虚欲脱比较,P＞0.05;ROC曲线AUC面积为0.874(P ＜0.001),有统计学意义,说明NT-proBNP对心阳不振的辨证(诊断)有意义.cTnI冠心病组高于正常组(P＜0.001),冠状动脉粥样硬化组与正常组比较,P＞0.05.cTnI真心痛的证型值(痰瘀交阻、气阴两虚、阳虚欲脱)最高分别与心阳不振、心气不足、心阴不足、痰浊闭塞、寒凝气滞、心血瘀阻、气滞胸痛、痰瘀交阻、气阴两虚、对照组比较,P ＜0.001.结论:NT-proBNP可以作为心阳不振辨证的客观指标,最佳临界值是NT-proBNP为563,约登指数为(Youden index)0.588.cTnI可以作为辨证真心痛证型的客观指标.%Objective:To investigate the correlation of N-terminal pro-brain natriuretic peptide NT-proBNP) and troponin (cTnI) with different traditional Chinese medicine (TCM) syndrome types of chest stuffiness and pain,so as to provide the objective basis for dialectical TCM treatment in patients with chest stuffiness and pain.Methods:This study included 1,157 cases of patients examined by coronary artery angiography.TCM syndrome types were deficiency of heart-Qi,devitalization of heart Yang,deficiency of heart Yin,phlegm muddy and out-of-the-way,cariac blood stasis,cold inducing stagnation,Qi stagnation and chest pain,as well as angina pectoris types of chest stuffiness and pain:phlegm-blood-stagnancy-type,deficiency of both Qi and Yin as well as deficiency of Yang (10 types of syndrome totally),and the control group (n =1);furthermore,coronary heart disease group,atherosclerosis group and control group were also set up to illustrate the correlation and relationship between NT-proBNP and cTnI among the above three groups with different TCM syndrome types.ROC curve was applied to determine the concentration of NT-proBNP in the diagnosis (differentiation) of devitalization of heart Yang.Results:NT-proBNP levels were both higher in the coronary heart disease group and atherosclerosis group than those in the control group (P ＜ 0.001),and such level was higher in the coronary heart disease group than that in the atherosclerosis group (P ＜ 0.001),whereas NT-proBNP and cTnI in the coronary heart disease group were lower compared with those in the acute infarct group,with a significantly statistical difference (P ＜ 0.001);the trend of NT-proBNP levels in different TCM syndrome types were:devitalization of heart Yang ＞ deficiency of Yang ＞ deficiency of both Qi and Yin ＞ phlegm-blood-stagnancy-type ＞ deficiency of heart-Qi,caffac blood stasis ＞ phlegm muddy and out-of-the-way,cold obstruction causing Qi stagnation ＞ Qi stagnation and chest pain,deficiency of heart-Yin ＞ control group.Furthermore,there was statistical differences with respect to the comparison of devitalization of heart Yang with deficiency of heart-Qi,deficiency of heart-Yin,phlegm muddy and out-of -the-way,cold obstruction causing Qi stagnation,cariac blood stasis,Qi stagnation and chest pain,phlegm -blood-stagnancy-type,deficiency of both Qi and Yin and the control group (P ＜ 0.001);whereas no statistical difference was found comparing with deficiency of Yang (P ＞ 0.05).The AUC area under the ROC curve was 0.874,with a statistical difference (P ＜ 0.001),showing that NT-proBNP might have a differentiation (diagnosis) role in devitalization of heart Yang.cTnI level in the coronary heart disease group was higher than that in the control group (P ＜0.001),while there was no statistical difference in the comparison between the atherosclerosis group and the control group (P ＞ 0.05).The highest level of cTnI in angina pectoffs types of chest stuffiness and pain (phlegm-blood-stagnancy-type,deficiency of both Qi and Yin as well as deficiency of Yang) had statistical differences when compared with that in groups with other types,including deficiency of heart-Qi,devitalization of heart Yang,deficiency of heart-Yin,phlegm muddy and out-of-the-way,cariac blood stasis,cold inducing stagnation,Qi stagnation and chest pain,phlegm blood-stagnancy-type,deficiency of both Qi and that in the control group (P ＜ 0.001).Conclusion:NT-proBNP can be considered as an objective indicator in the differentiation of devitalization of heart Yang.the best cut-off value of NT-proBNP was 563 and corresponding Youden index was O.588.cTnI can be used as the objective index to differentiate angina pectoffs types of chest stuffiness and pain.