慢性心力衰竭患者血清和肽素水平与中医分型的相关性研究

Study on the relationship between the serum Copeptin level and the syndrome differentiation of traditional Chinese medicine in patients with chronic heart failure

关键词:  慢性心力衰竭  中医分型  和肽素  相关性

Key words:  heart failure  differentiation of traditional Chinese medicine  copeptin  correlation

摘要:

[目的] 探讨心力衰竭（简称心衰）新型标志物和肽素（Copeptin）与中医辨证分型的关系。[方法] 采用前瞻性研究方法，连续采集冠心病、高血压病合并心功能不全的住院患者230例，参照Framingham心力衰竭诊断标准，分为心功能Ⅱ级82例，Ⅲ级76例，Ⅳ级72例，采集同期健康体检心功能正常者51例作为对照组。并参照《中药新药临床研究指导原则》与临床常见证型相结合，将心衰患者分为心气虚型42例，气阴两虚型64例，气虚痰瘀型77例，心肾阳虚型47例。所有入组患者于住院次日，正常组于体检日清晨空腹，肘静脉采血，检测氨基未端-脑钠肽前体（NT-proBNP）、Copeptin，以及左室射血分数。比较对照组与心衰组不同心功能分级血清NT-proBNP、Copeptin水平，采用简单线性相关分析Copeptin水平与NT-proBNP及美国纽约心脏协会心功能（NYHA）分级的相关性。比较各中医分型间血清NT-proBNP、Copeptin水平的变化。[结果] 心衰患者血清Copeptin水平的变化与NT-proBNP水平的变化相一致，随着心气虚证→气阴两虚证→气虚痰瘀证→心肾阳虚证的严重程度的增加而逐渐递增，Copeptin的水平在心肾阳虚组明显高于气虚痰瘀组、气阴两虚组及心气虚组[pmol/L：27.40（21.92，39.01）、18.80（16.23，21.94）、14.19（12.10，16.23）、8.93（7.35，11.75），P<0.05]。在心功能Ⅱ级患者中以心气虚型、气阴两虚型为主，在心功能Ⅲ级患者中以气虚痰瘀型为主，在心功能Ⅳ级患者中以心肾阳虚型为主。[结论] 血清NT-proBNP与Copeptin水平在慢性心力衰竭患者中随着中医分型的严重程度有一定的变化趋势，希望能够为中医分型提供辨证依据，从而提高辨证的准确性。

Abstract:

[Objective] To evaluate the correlation between Copeptin which is the model marker of heart failure and syndrome differentiation of traditional Chinese medicine. [Methods] A prospective study was performed. Patients were consecutively collected 230 patients with coronary heart disease and hypertension admitted to department of cardiology were divided into three groups: NYHA Ⅱ group (case 82), NYHA Ⅲ group (case 76), NYHA IV group (case 72), and control group (case 51) with normal heart function. Combined with Guiding Principle of Clinical Research on New Drugs of Traditional Chinese Medicine and the common syndromes, 230 patients were divided into Heart- Qi - deficiency group (case 42), Qi - Yin deficiency group (case 64), Qi deficiency with syndrome of intermingled phlegm and blood stasis group (case 77), heart-kidney Yang deficiency group (case 47). Limosis vein blood sample of each patient was drawn in the morning. Serum concentrations of NT-proBNP, Copeptin and Estimation of left ventricular systolic function were detected. The serum Copeptin concentration and the serum NT-proBNP concentration were compared among all the groups. The relativity among the levels of NT-proBNP, the levels of Copeptin and NYHA classification were confirmed with linear correlation. [Results] The change of serum Copeptin and NT-proBNP were consistent in patients with heart failure. The serum NT-proBNP and Copeptin levels went up according to Heart- Qi - deficiency, Qi - Yin deficiency, Qi deficiency with syndrome of intermingled phlegm and blood stasis group, heart-kidney Yang deficiency in order. The Copeptin values was the highest in the heart-kidney yang deficiency group compared with Heart-Qi-deficiency group, Qi-Yin deficiency group and Qi deficiency with syndrome of intermingled phlegm and blood stasis group(pmol/L: 27.40(21.92,39.01), 18.80(16.23,21.94), 14.19(12.10,16.23), 8.93(7.35,11.75), P<0.05. Heart-Qi deficiency and Qi-Yin deficiency were prevalent among patients of NYHA Ⅱ, Qi deficiency with syndrome of intermingled phlegm and blood stasis were prevalent among patients of NYHAⅢ, heart-kidney Yang deficiency was prevalent among inpatients of NYHA IV. [Conclusion] The levels of serum NT-proBNP and Copeptin in patients with chronic heart failure may vary according to the severity of syndrome differentiation. It can provide the basis for the syndrome differentiation of traditional Chinese medicine and improve the accuracy of the syndrome differentiation.