慢性心力衰竭患者中医证型与超声心动图的相关性研究

Correlation study of traditional Chinese medicine syndrome and echocardiography in patients with chronic heart failure

关键词:  慢性心力衰竭  辨证分型  超声心动图  相关性

Key words:  chromic heart failure  classification of syndrome  ultrasonic cardiogram  correlation

摘要:

[目的] 探讨慢性心力衰竭(CHF)患者中医证型与超声心动图的相关性。[方法] 选择符合标准的CHF患者62例,进行严格的中医辨证,分为气阴虚和气阳虚两组,分别进行主证计分和证候积分,采用改良二维超声心动图(2DE)改良Simpson法进行超声心动图检查,测量反映心脏结构指标、收缩功能指标和舒张功能指标,进一步分析比较上述指标在气阴虚与气阳虚两大证型组间的差异,并进行相关分析。[结果] 1)反映心脏结构指标左室收缩末内径(LVESD)、左室舒张末内径(LVEDD)、舒张末期左室后壁厚度(LVPW)气阳虚组>气阴虚组,气阴虚、气阳虚证候积分与LVPW呈显著正相关,且LVPW与证候积分的相关系数(r=0.141)大于心功能分级(r=0.016)。2)反映收缩功能指标左室射血分数(LVEF)气阴虚组明显高于气阳虚组,每搏量(SV)、心输出量(CO)、心脏指数(CI)及左室短轴分数(LVFS)均呈气阴虚组>气阳虚组趋势,而左室收缩末容积(LVESV)则呈气阳虚组>气阴虚组趋势;气阴虚、气阳虚证候积分与SV、CO、CI、LVEF呈显著负相关,LVEF与证候积分的相关系数(r=-0.514)大于心功能分级(r=-0.151)。3)反映舒张功能指标舒张末容积(EDV)、舒张早期血流峰值/舒张晚期血流峰值(E/A)值气阳虚组>气阴虚组;气阴虚、气阳虚证候积分与EDV呈显著负相关,与E/A值呈正相关,EDV与证候积分的相关系数(r=-0.229)大于心功能分级(r=-0.027)。[结论] 心脏超声指标与CHF中医证型存在一定相关性,证候积分可能是反映CHF患者LVPW、LVEF及EDV的敏感指标之一,证候积分越高者其LVPW越大、LVEF越低、EDV越小,心功能越差,舒张功能受损亦越严重。可为慢性心力衰竭气阴虚、气阳虚微观证辨证提供一定参考。

Abstract:

[Objective] To explore the correlation between traditional Chinese medicine(TCM) syndromes and echocardiography in patients with chronic heart failure. [Methods] The 62 patients with chronic heart failure were selected, proceeded the strict Chinese medicine syndrome differentiation, and the two major syndromes of Qi Yin deficiency and Yang deficiency syndrome. The 2DE modified Simpson method was used to measure the index of cardiac structure, systolic function and diastolic function. [Results] 1) The LVPW and LVESD in the cardiac structure index were significantly positively correlated with LVEDD and LVPW, and the correlation coefficient (r=0.141) of LVPW and syndrome score was higher than that of(r=0.016). 2) In the, LVEF, CO, CI, LVFS and SV were significantly higher than those in the Qi deficiency group, LVESV, r=-0.154, and SV, LVEF, CO, LVEF, r=-0.151 and CI were significantly negative. 3) The EDV, E/A, and EDV were significantly negatively correlated with E/A and EDV and the correlation coefficient (r=-0.229) of and syndrome score was higher than that of (r=-0.027). [Conclusion] There is a certain correlation between cardiac ultrasound index and CHF type of TCM syndromes, syndrome score may be one of the sensitive indicators of LVPW, LVEF and CHF, and the higher the EDV, the higher LVPW, LVEF, EDV, and the heart function is worse, diastolic function is more serious. The above results can provide a reference for chronic heart failure Qi Yin deficiency, Qi Yang deficiency syndrome differentiation.