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充血性心力衰竭中医辨证分型与左心室功能不全及甲状腺素相关性的临床研究
Clinical Study on Relationship among thyroid hormone, left ventricular dysfunction and Syndrome Differentiation Type of TCM in patients with congestive heart failure
【作者】 周杰; 高晓玲; 张宝州; 黄仕君; 王兰娣; 盛丽; 史东静; 阎晓霞; 杨阿妮; 黄腾辉; 裴玉琴; 陈进凡; 程烜;
【Author】 ZhouJie, Gao Xiao-ling, Zhang Bao-zhou, et al.
【机构】 甘肃省中医院胸内科;
【摘要】 目的:评价充血性心力衰竭(CHF)不同中医辨证分型与甲状腺激素,心钠素(ANP),左心室收缩功能不全(left ventricular systolic dysfunction,LVSD),左心室舒张功能不全(left ventricular diastolic dysfunction,LVDD)之间的关系。方法:以彩色多普勒血流成像仪,血浆心房利钠肽(ANP),甲状腺激素对100例CHF患者进行检测,并与23例健康人相同指标比较。结果:CHF组不同中医辨证只有兼水肿血瘀证患者血浆ANP水平明显高于健康组(P=0.015)。兼水肿血瘀证组的T3水平较健康组、心气虚证组、兼阴虚证组与兼血瘀证组均明显降低(P=0.009,P=0.006,P=0.032,P=0.006)。与健康组比较,心气虚证组、兼阴虚证组与兼血瘀证组的T4水平均明显升高(P=0.028,P=0.007,P=0.004);与兼水肿血瘀证组比较,心气虚证组、兼阴虚证组与兼血瘀证组的T4水平均明显升高(P=0.017,P=0.005,P=0.003)。兼水肿血瘀证组的LVEF,mVcf较心气虚证组、兼阴虚证组、兼血瘀证组均明显降低(P均=0.000);与健康组比较,A/E比值较心气虚证组、兼阴虚证组、兼血瘀证与水肿血瘀证组均明显降低(P=0.003,P=0.000,P=0.000,P=0.000);与水肿血瘀证组比较,A/E比值较兼血瘀证组、兼阴虚证组、心气虚证组与健康组明显增高(P=0.003,P=0.000,P=0.000,P=0.000),依次为兼水肿血瘀证组>兼血瘀证组>兼阴虚证组>心气虚证组>健康人组。T3与LVEF,T4均呈显著正相关(r=0.200,P=0.046,r=0.293,P=0.003);与ANP呈高度负相关(r=-0.263,P=0.008)。T4与A/E呈显著负相关(r=-0.226,P=0.024)。结论:T3,T4水平的降低与ANP水平的增高可能为CHF四型中医分型中兼水肿血瘀证患者LVEF下降的重要原因之一。T4水平的降低则可能为CHF四型中医分型患者A/E比值逐步增高而导致LVDD逐渐加重的重要原因之一。
【Abstract】 Objective: To study the relationship among syndrome differentiation types of TCM, left ventricular dysfunction and thyroid hormone in patients with congestive heart failure. Methods: Doppler echocardiogram, thyroid hormone and Atrial natriuretic peptide (ANP) were used to observe 100 patients with CHF clinically, compared with 23 peoples those in healthy control subjects. Results: The level ANP in the Oedema and Blood Stasis Syndrome group (OBSS) was obviously higher than that in the control group (P=0.015). The level of T3 in the OBSS was obviously lower than that in the control group, the Heart-Qi Deficiency Syndrome (HQDS) the Yin Deficiency Syndrome (YDS) and the Blood Stasis Syndrome (BSS) (P=0.009, P=0.006, P= 0.032, P=0.006, respectively). Compared with the control group, The levels of T4 in the HQDS, the YDS and the BSS were obviously higher (P = 0.028, P = 0.007, P = 0.004); Compared with the OBSS, the levels of T4 in the HQDS, the YDS and the BSS were obviously higher (P = 0.017, P = 0.005, P = 0.003). The levels of LVEF, mVcf in the OBSS was obviously lower than that in the control group, the HQDS, the YDS and the BSS (P = 0.000, all); The radio of A/E in the control group was obviously lower than that in the HQDS, the YDS, the BSS and the OBSS (P = 0.003, P = 0.000, P = 0.000, P = 0.000, respectively); the radio of A/E in the OBSS was obviously higher than that in the BSS, the YDS, the HQDS and the control group (P = 0.003, P = 0.000, P = 0.000, P = 0.000, respectively). There were significant positive correlation between T3 and LVEF, T4 (r = 0.200, P = 0.046, r = 0.293, P = 0.003); there was a significant negative correlation between T3 and ANP (r = -0.263, P = 0.008). There was a significant negative correlation between T, and A/E (r = -0.226, P= 0.024). Conclusion: This study shows that reduced T3, T, and elevated ANP may be one of the most important reasons for LVEF lowing in the OBSS; reduced T4, with progression of LVDD, may be one of the most important reasons for the elevated gradually A/E.
【Key words】 Heart failure,congestive; Left ventricular dysfunction,; Syndrome differentiation type of TCM; thyroid, hormone; correlation;
- 【会议录名称】 第四次全国中西医结合养生学与康复医学学术研讨会论文集
- 【会议名称】第四次全国中西医结合养生学与康复医学学术研讨会
- 【会议时间】2004-08
- 【会议地点】中国广西北海
- 【分类号】R259
- 【主办单位】中国中西医结合学会养生学与康复医学专业委员会