痰瘀伏邪与冠心病心衰心功能分级、N端前脑钠素及心脏超声指标相关性研究

摘要

Objective:To study the relationship between TCM syndromes and cardiac functional grading,NT-proBNP and echocardiographic indexes of coronary heart disease-related heart failure by epidemiological investi gation,and to explore the pathogenic features of insidious pathogen of phlegm and blood stasis.Methods:The clinical data of 260 patients with coronary heart disease-related heart failure was collected by means of crosssectional study and the characteristics of TCM syndromes were summarized.The correlation between TCM syndromes and clinical conditions and physical and chemical indicators of coronary heart disease-related heart failure was analyzed by multivariate nonparametric test,chi-square test and analysis of variance.Results:The phlegm + blood stasis was the most common combination of coronary heart disease-related heart failure.There was a significant difference in the constitution ratio of different syndromes by cardiac functional grading (P ＜ 0.05).The phlegm + blood stasis was closely related to changes in cardiac functional grading.The NT-proBNP indexes in patients with different syndromes were significantly different (P＜ 0.05).The phlegm + blood stasis was closely related to changes in NT-proBNP.There was a significant difference in the internal constitution ratio of each echocardiography indicators related syndromes (all P＜0.05).The phlegm + blood stasis was closely related to the enlargement of left atrial and left ventricular and it was associated with systolic and diastolic dysfunction.Conclusion:TCM syndromes are closely related to cardiac functional grading,NT-proBNP and echocardiographic indexes in patients with coronary heart disease-related heart failure.The insidious pathogen of phlegm and blood stasis is the leading factor in the deterioration of coronary heart disease-related heart failure.%目的 利用流行病学调查方法研究冠心病心衰中医证候与心功能分级、N端前脑钠素(NT-proBNP)及心脏超声指标关系,探讨痰瘀伏邪的致病特点.方法 采用横断面调查方法收集260例冠心病心衰患者临床资料,总结中医证候特点,运用多因素非参数检验、X2检验、方差分析等医学统计方法,分析中医证候与冠心病心衰相关临床及理化指标的关系.结果 痰浊+血瘀是冠心病心衰中出现最多的内在组合形式.各证候在心功能级别分布上存在明显差异(P＜0.05),痰浊+血瘀与心功能变化密切相关.不同证候的NT-proBNP存在明显差异(P＜0.05),痰浊+血瘀与NT-proBNP变化相关.各心脏超声指标不同证候内部构成比存在明显差异(均P＜ 0.05),左房左室扩大及收缩、舒张功能减低与痰浊+血瘀相关.结论 冠心病心衰患者证候与心功能变化、NT-proBNP及心脏超声指标具有明显相关性,痰瘀伏邪是导致冠心病心衰病情恶化的重要因素.