【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。更多还原

【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.更多还原