Research On Relationship Between Syndrome Differentiation Type Of TCM, NT-proBNP And Heart Function Index In Elderly Patients With Chronic Heart Failure

Objective:1.To study the rule of changes between syndrome differentiation type of TCM and heart function index(NT-proBNP,CO,CI,LVEF) in elderly patients with chronic heart failure(CHF),seeking the objective quantitative basis for the chinese medicine syndromes type.2.To research the relationship between NYHA cardiac classification type and plasma N-terminal pro-brain natriuretic peptid(NT-proBNP), Cardiac output(CO), Cardiac index(CI), Left ventricular ejection fraction(LVEF) in elderly patients with chronic heart failure(CHF).Methods:119cases who caught chronic heart failure were selected in Tianjin Medical University Second Hospital of Cadre Health Care from January2011to November2012.After collecting the cases symptoms, signs and laboratory test results, and the establishment of a database for data management. All the cases were divided into four groups which include syndrome of Qi deficiency of cardiopulmonary, syndrome of Qi and Yin deficiency,syndrome of Qi deficiency and Xue stasis and syndrome of yang deficiency with water flood.At the same time,the cases were conducted NYHA functional class and detected plasma NT-proBNP, hemodynamic parameters (CO, CI, LVEF).The data collected were underwent Chi-square test, One-way ANOVA and correlation analysis.Results:1. There are obvious correlation among syndrome type of TCM and the heart function index in patients with chronic heart failure. When TCM syndrome types are changing, the index of NYHA heart function classification and plasma NT-proBNP level increase accordingly, while CO, CI and LVEF values decrease correspondingly. Elderly CHF patients with clinical common TCM syndromes are syndrome of Qi deficiency of cardiopulmonary and syndrome of Qi deficiency and Xue stasis.2. As for NT-proBNP index, syndrome of Qi deficiency of cardiopulmonary and syndrome of Qi deficiency and Xue stasis,syndrome of yang deficiency with water flood existe obvious difference (P<0.01); syndrome of Qi and Yin deficiency and syndrome of Qi deficiency and Xue stasis syndrome of yang deficiency with water flood existe obvious difference (P<0.05).As for CO index, syndrome of Qi deficiency of cardiopulmonary and syndrome of Qi deficiency and Xue stasis,syndrome of yang deficiency with water flood pairwise comparisons with statistical significance(P<0.05); Various syndromes between CI values are different, syndrome of yang deficiency with water flood, respectively, compared with syndrome of Qi deficiency of cardiopulmonary and Qi and Yin deficiency, are statistically significant(P<0.05). Different syndromes in LVEF values are different,compared with syndrome of Qi deficiency of cardiopulmonary,syndrome of Qi and Yin deficiency,syndrome of Qi deficiency and Xue stasis, syndrome of yang deficiency with water flood declines remarkably(P<0.05).3. Different NYHA functional level groups contribute to the changes of NT-proBNP, CO, CI and LVEF values significantly (P<0.05), and with the increases of NYHA class level,NT-proBNP value increases progressively,CO,CI,LVEF values progressively reduce. The correlation analysis shows that the correlation between the index of NT-proBNP index and CO,CI,LVEF index are negative,but the index of LVEF and CO,CI index are positive.Conclusions:1. The condition of CHF gradually progress roughly follow syndrome of Qi deficiency of cardiopulmonary, syndrome of Qi and Yin deficiency,syndrome of Qi deficiency and Xue stasis and syndrome of yang deficiency with water flood. With the evolution of TCM,plasma NT-proBNP values rise, and CO, CI, LVEF value reduce accordingly, it shows that cardiac function worsening and heart failure gradually accelerate. These results suggest that NT-proBNP and hemodynamic parameters in syndrome type of TCM have a certain objective and quantitative value.2.With the increase of NYHA class, the level of NT-proBNP elevates correlately while the level of CO, CI, LVEF decrease conversely, it indicates that with NYHA class level increased in patients with chronic heart failure, cardiac function progressive deteriorates and hemodynamic instability gradually increases. The correlation between the index of NT-proBNP index and CO,CI,LVEF index are negative,but the index of LVEF and CO,CI index are positive,it shows that NICOM in real time to reflect cardiac function,trusted findings, make it suitable for clinical timely and accurate assessment of cardiac function.