Study On The Effect And Prognostic Value Of Blood Stasis Syndrome In Type Ⅱ Cardiac And Kidney Syndrome

BackgroundChronic heart failure is the final destination of most cardiovascular disease, it’s also the main cause of death. Different factors such as biomarkers and TCM syndrome factors, play important roles in its progression, and ultimately lead to bad prognosis. At present, researches based on the TCM syndrome factors of chronic heart failure and cardiorenal syndrome has made some remarkable achievements, however, due to the complexity of the disease itself and the diversity of the diagnosis method, etc. the evolution standard and prognosis influence factors of the disease still remain unrecognisable. Therefore, we analyzed the prognosis of CHF patients with different renal function levels, as well as the role of blood-stasis plays in its progression, hoping to find the effective evolution standards about the progression of chronic heart failure and the cardiorenal syndrome.ObjectivesTo explore the long-term prognosis of CHF patients with different kidney function levels and the role of blood-stasis plays in its progression.MethodsWe collected 390 CHF patients who were hospitalized in Guanganmen Hospital between January 2006 and June 2014. Then we gathered the clinic data of the patient’s general information, incidence and relevant medical history, and extracted their TCM syndrome elements. All the patients were outpatient or telephone followed-up, to obtain the final events, especially focused on the CRS patients. After all these preparation works were done, we used statistic package softwares to analyse the data. To explore the prognosis of CHF patients with different renal function levels, we used Survival-analysis Methods; To explore the distribution of TCM syndrome factor,we used Frequency statistics, To explore TCM syndrome factor differences between groups, we used chi-square test and nonparametric test; To explore the relationship between TCM syndrome factor and prognosis, the relationship between syndrome factors to each other as well as the relationship between TCM syndrome factor and the biomarkers, we used Spearman-analysis; Continuous data we uesd ROC-analysis and with grouping tangent point obtained, we grouped the patients and used Compare Means,Variance-analysis and LSD multiple comparison analysis to explore their differences.Results1.The all-cause mortality of 390 CHF patients whose final events were obtained were 32.8%, the syndrome elements distribution showed that blood-stasis of 226 (68.2%) is the most common TCM syndrome factor, followed by qi-deficiency(65.9%), phlegm-turbidity(49.5%) and Yin-deficiency(47.2%), Yang-deficiency has the lowest proportion(17.2%). Among the CRS patients, blood-stasis syndrome elements and is the most common(74.1%) TCM syndrome factor, qi-deficiency(68.5%), phlegm-turbidity(51.9%) and Yin-deficiency(46.3%) were followed, Yang-deficiency(25.9%) has the lowest proportion. The difference has no statistically significance.2.Correlation-analysis showed that 1)qi-deficiency, blood-stasis and prognosis were positively related; LVEF is negatively related to the prognosis while NT- proBNP was positively related; Cr, BUN and prognosis were positively correlated.2)qi-deficiency and blood-stasis, phlegm-turbidity were positively related, qi-deficiency and Yang-deficiency were negatively related.3)WBC,UA and CRS were positively related, WBC, Hb, PH, ALT, AST, TBIL, DBIL, IBIL and CRS were negatively related.3.ROC-analysis showed the group tangent point value:Cr:101.5umol/L, the influencing area under the curve is 0.666(P=0.000), and then we explored the Hb differences between each group.4.Kaplan-Meier-survival-analysis showed that with the declining renal function, the mortality of different groups increasd, three curves separated clearly, log-rank=21.339(P=0.000).Conclusions1.The prognosis of CRS patients is worse than CHF patients, both showed the most common witness of blood-stasis.2.The cardiac function and renal function directly affect the prognosis of CHF patients, qi -deficiency, blood-stasis prompted its poor prognosis.3.CHF patients with lower RBC, Hb, ALT, AST, TBIL, DBIL, IBIL and higher WBC,UA tend to develop CRS. In other words, anemia, liver damage, inflammation contributes to CRS incidence rate.4.Blood-stasis and qi-deficiency, phlegm-turbidity were positively correlated, qi-deficiency and Yang-deficiency were negatively correlated, which reflects the development of the disease, reveals the blood-stasis is a key link in the process of its progress.5.Renal function directly affects the prognosis of CHF patients, significant difference of Hb was found in patients with different renal function levels, with the progressive renal function decline, Hb first increased then moderately decreased, alike the appearance of the blood-stasis, reflects that blood-stasis is the sign of CHF developing into CRS.