Clinical Features Of Chronic Heart Failure Combined With Renal Dysfunction And TCM Syndromes

ObjectiveTo discuss the clinical characteristics and TCM syndrome distribution of Chronic Heart Failure (CHF) with renal dysfunction preliminarily, in order to provide certain clinical basis and reference for the Chinese and western medicine combined with early prevention and treatment of Chronic Heart Failure with renal dysfunction.MethodsRetrospective method is adopted.The case of the research are 131 patients of CHF in cardiovascular internal wards of Dong Zhimen Hospital from October 2013 to September 2014. Modified glomerular filtration rate(GFR) Estimating Equation for Chinese patients was used to evaluate the patients’ renal function.According to eGFR, all the patients were devided into two groups:the renal dysfunction group (eGFR< 60 ml/min) 52 cases and the CHF group(eGFR> 60 ml/min) 79 cases.The General information, the result of biochemical parameters, NT-proBNP, blood routine, urine routine, echocardiographic results and symptoms of TCM, etc were recorded. Arrangement questionnaire data and established a database.The two groups’TCM syndrome and objective index etc were analysised by SPSS 17.0 statistical software.Results(1) The research including 131 cases CHF patients, there are 52 patientds with eGFR< 60(ml/min)and 79 patientds with eGFR≥ 60(ml/min).General situation:differences between the two groups in classification of cardiac function,hospitalization days statistically significant.Cardiac functionclassification is positively correlation with eGFR.(2) The results ofobjective compare:differences between the two groups in potassium, uric acid, blood urea nitrogen, hemoglobin, red blood cell, urine protein, left ventricular ejection fraction are statistically significant.Hb, RBC, LVEF and eGFR are positively correlated. Potassium, UA, BUN, NT-proBNP, CRP and eGFR are negatively correlated.(3) Accordingto result of Logistic regression, among the basis of disease and complicating disease, Hypertension, Hyperuricemiaand Anemiaare risk faetors in patients with CHF complicated withrenal dysfunction.(4) TCM syndrome distribution of CHF with renal dysfunction:qi deficiency syndrome (71.2%), blood stasis syndrome (69.2%), water stagnation syndrome(57.7%), yang deficiency syndrome(46.2%), phlegm turbidity syndrome(32.7%), yin deficiency syndrome(25%).(5) Combination of CHF with renal dysfunction TCM syndrome characteristics:combine to three card combination most common(36%), followed by four card combination(31%).The change rules of syndromes is that as the development of the disease the syndrome of water stagnation due to yang deficiency gradually appear based on the syndrome of qi deficiency. Blood stasis runs through the whole course of disease development.(6) The result of Logistic regression showsr:If diabetes mellitus patients with chronic heart failure with impaired renal function to yang deficiency symptoms, merger of renal damage in patients with high uric acid hematic disease heart associated with the emergence of water stagnation card.The levels of BUN, Cr and NT-proBNP increase significantly for the patients with yang deficiency syndrome or water stagnation syndrome.ConclusionHigh incidence of chronic heart failure with renal dysfunction is seriously ill, the CHF patients with renal dysfunction had longer hospital stay. CHF patients with renal impairment aggravating Hb, RBC and LVEF decreases gradually, the level of potassium, UA, BUN, NT-proBNP and CRP increased. Hypertension, Hyperuricemiaand Anemiaare main risk faetors in patients with CHF complicated with renal dysfunction.The common syndromes of CHF with renal dysfunction are qi deficiency syndrome, blood stasis syndrome, water stagnation syndrome, yang deficiency syndrome. With the deterioration of heart and kidney function the syndrome of water stagnation due to yang deficiency gradually appear based on the syndrome of blood stasis due to qi deficiency. Yang deficiency syndrome and water stagnation syndrome are the common syndromes for the end-stage CHF.They prompt serious lesion of heart and kidney function. If diabetes mellitus patients with chronic heart failure with impaired renal function to yang deficiency symptoms, merger of renal damage in patients with high uric acid hematic disease heart associated with the emergence of water stagnation card.The TCM and western medicine prevention and control of CHF complicated with renal dysfunction principle shouldprevent and treat early, control of risk factors actively and intervene in the related factorsinfluencing syndrome appear. TCM treatment based on the theory of heart kidney intersect, pay attention to the balance of water and fire.