| Objectives: Through an observation of the changes in the content of serum digitalis-like factor in CHF patients, combined with clinical symptoms and signs, this thesis aims to discuss the relationship between the changes in the content of serum digitalis-like factor in CHF patients and CHF TCM types and possibly screen some objective indexes that can Accurately determine the TCM Syndrome. Methods: 1. Design a questionaire, fill in the clinical data and type the subjects, 160 inpatients of TCM Department and Cardiovascular Internal Medicine Department of Luzhou Medical College, into groups for comparative study; 2. The patients are typed under the guidance of the author's supervisor and the supervisor group, according to the above-mentioned clinical data and by reference to Guiding Principle of Clinical Research in Treatment of Heart Failure with New Drug of Traditional Chinese Medicine of Guiding Principle of New Drug Clinical Research of Traditional Chinese Medicine by Bureau of Drug Administration Policy of the Ministry of Public Health of P.R.China; 3. Obtain serum sample from all the subjects, and determine their sEDF content with radioimmunoassay; 4. The variables in the measurement data are expressed with x_±s, and analyzed with SPSS 13.0. One-Sample T Test is applied to compare the typed groups with normal humans and X2 Test is applied in the analysis of enumeration data. One-Way ANOVA is used to compare different groups and LSD method is used in the comparison between groups. Discriminant analysis is applied to the statistically significant parameters and the discriminant coefficient of the indexes is calculated, based on which the discriminant functions of the TCM types are established. Results: 1. sEDF content in CHF patients displays a significant decrease (P<0.05); 2. For groups of CHF patients with different heart failure levels, sEDF content displays a significant difference (P<0.05). The higher the heart failure level is, the lower the sEDF content will be, which means there is a negative correlation between them. sEDF content of Group of heart failure level III displays a decrease when compared to both that of Group of heart failure level II (P<0.05) and that of Group of heart failure level I (P<0.05). Similarly, sEDF content of Group of heart failure level II displays a decrease when compared to that of Group of heart failure level I (P<0.05). 3. Significant differences in sEDF content exist between groups of CHF patients with different types of heart disease (P<0.05), with the lowest being the group of rheumatic heart disease, followed in order by hypertensive heart disease, cardiomyopathy, and coronary heart disease, while the group of pulmonary heart disease doesn't display as big a decrease. Rheumatic heart disease patients have lower sEDF content when compared to hypertensive heart disease patients (P < 0.05), cardiomyopathy patients (P<0.05), coronary heart disease patients (P<0.05), and pulmonary heart disease patients (P<0.05). Hypertensive heart disease patients have lower sEDF content when compared to cardiomyopathy patients (P<0.05), coronary heart disease patients (P<0.05), and pulmonary heart disease patients (P<0.05). Cardiomyopathy patients have lower sEDF content when compared to coronary heart disease patients (P<0.05) and pulmonary heart disease patients (P<0.05). Coronary heart disease patients have lower sEDF content when compared to pulmonary heart disease patients (P<0.05). 4. Significant differences exist between TCM types of CHF patients in sEDF content (P<0.05), with the lowest being the group of edema due to yang deficiency, followed in order by the group of heart and kidney yang deficiency, the group of qi and yin deficiency, and the group of qi deficiency and blood stasis, while the group of lung obstruction by phlegm and fluid doesn't display as big a decrease. Significant decrease exists in sEDF content when the group of edema due to yang deficiency is compared respectively to the group of heart and kidney yang deficiency (P<0.05), the group of qi and yin deficiency (P<0.05), the group of qi deficiency and blood stasis (P<0.05), and the group of lung obstruction by phlegm and fluid (P<0.05); Significant decrease exists in sEDF content when the group of heart and kidney yang deficiency is compared respectively to the group of qi and yin deficiency (P<0.05), the group of qi deficiency and blood stasis (P<0.05), and the group of lung obstruction by phlegm and fluid (P<0.05). Significant decrease exists in sEDF content when the group of qi and yin deficiency is compared both to the group of qi deficiency and blood stasis (P<0.05) and the group of lung obstruction by phlegm and fluid (P<0.05). Significant decrease exists in sEDF content when the group of qi deficiency and blood stasis is compared to the group of lung obstruction by phlegm and fluid (P<0.05). 5. The scores of clinical symptoms and signs of TCM types of CHF patients display significant differences: the group of lung obstruction by phlegm and fluid score lower than the group of qi deficiency and blood stasis (P<0.05), the group of qi and yin deficiency (P<0.05), the group of heart and kidney yang deficiency (P<0.05), and the group of edema due to yang deficiency (P<0.05). The group of qi deficiency and blood stasis score lower than the group of qi and yin deficiency (P<0.05), the group of heart and kidney yang deficiency (P<0.05), and the group of edema due to yang deficiency (P<0.05). The group of qi and yin deficiency score lower than the group of heart and kidney yang deficiency (P<0.05) and the group of edema due to yang deficiency. The group of heart and kidney yang deficiency score lower than the group of edema due to yang deficiency. 6. The following are the results of the comparison of heart rate between TCM types of CHF patients. The group of qi and yin deficiency have a lower frequency of heart rate than the group of heart and kidney yang deficiency (P<0.05) and the group of edema due to yang deficiency (P<0.05); the group of lung obstruction by phlegm and fluid have a lower frequency than the group of qi deficiency and blood stasis (P<0.05) and the group of edema due to yang deficiency (P<0.05); the group of heart and kidney yang deficiency have a lower frequency than the group of edema due to yang deficiency (P<0.05), while no statistically significant differences (P﹥0.05) exist between the group of qi and yin deficiency and the group of lung obstruction by phlegm and fluid, the group of qi and yin deficiency and the group of heart and kidney yang deficiency, the group of lung obstruction by phlegm and fluid and the group of heart and kidney yang deficiency, the group of heart and kidney yang deficiency and the group of qi deficiency and blood stasis, the group of qi deficiency and blood stasis and the group of edema due to yang deficiency. 7. The following are the results of the comparison of systolic blood pressure between TCM types of CHF patients. The group of qi deficiency and blood stasis have a lower pressure when compared to the group of qi and yin deficiency (P<0.05), the group of lung obstruction by phlegm and fluid (P<0.05), the group of edema due to yang deficiency (P<0.05), and the group of heart and kidney yang deficiency (P<0.05). The group of qi and yin deficiency have a lower pressure than the group of heart and kidney yang deficiency (P<0.05). No statistically significant differences (P﹥0.05) exist between the group of qi and yin deficiency and the group of lung obstruction by phlegm and fluid, the group of qi and yin deficiency and the group of edema due to yang deficiency, the group of lung obstruction by phlegm and fluid and the group of edema due to yang deficiency, the group of lung obstruction by phlegm and fluid and the group of heart and kidney yang deficiency, the group of edema due to yang deficiency and the group of heart and kidney yang deficiency. 8. The following are the results of the comparison of diastolic blood pressure between TCM types of CHF patients. The group of heart and kidney yang deficiency have a lower pressure than the group of qi and yin deficiency (P<0.05), the group of lung obstruction by phlegm and fluid (P<0.05), and the group of qi deficiency and blood stasis (P<0.05); the group of edema due to yang deficiency have a lower pressure than the group of qi and yin deficiency (P<0.05); the group of qi and yin deficiency have a lower pressure than the group of qi deficiency and blood stasis (P < 0.05). No statistically significant differences (P﹥0.05) exist between the group of heart and kidney yang deficiency and the group of edema due to yang deficiency, the group of edema due to yang deficiency and the group of lung obstruction by phlegm and fluid, the group of edema due to yang deficiency and the group of qi deficiency and blood stasis, the group of qi and yin deficiency and the group of lung obstruction by phlegm and fluid, the group of lung obstruction by phlegm and fluid and the group of qi deficiency and blood stasis. 9. Significant differences exist in sEDF content between groups of different pulse conditions of CHF patients and the normal value of content (P<0.05). The results are as follows: deep thready pulse has a lower content when compared to intermittent pulse (P<0.05), knotted pulse (P<0.05), and wiry and abrupt pulse (P<0.05); intermittent pulse has a lower content when compared to knotted pulse (P<0.05) and wiry and abrupt pulse (P<0.05); knotted pulse has a lower content when compared to wiry and abrupt pulse (P<0.05). 10. Significant differences exist in sEDF content between groups of different tongue proper of CHF patients and the normal value of content (P<0.05). The results are as follows: pale and corpulent tongue with tooth marks has a lower content when compared to purple-dark tongue (P<0.05), pale tongue (P<0.05), and red tongue (P<0.05); purple-dark tongue has a lower content when compared to pale tongue (P<0.05), and red tongue (P<0.05); pale tongue has a lower content when compared to red tongue (P<0.05). 11. Significant differences exist in sEDF content between groups of different tongue coating of CHF patients and the normal value of content (P<0.05). The results are as follows: the group with little or no tongue coating have a lower content when compared to the group with white-greasy tongue coating (P<0.05), the group with yellow-greasy tongue coating (P<0.05), and the group with white moist tongue coating (P<0.05); the group with white-greasy tongue coating have a lower content when compared to the group with yellow-greasy tongue coating (P<0.05) and the group with white moist tongue coating (P<0.05); the group with yellow-greasy tongue coating have a lower content than the group with white moist tongue coating (P<0.05). 12. The accuracy of the discriminant function is 81.9% (34+27+30+20+20/160). The accuracy for the five groups of CHF patients, namely, the group of lung obstruction by phlegm and fluid, the group of qi deficiency and blood stasis, the group of qi and yin deficiency, the group of heart and kidney yang deficiency, and the group of edema due to yang deficiency is respectively76.5%, 93.1%, 85.7%, 76.9%, and 80.0%. In the actual discrimination work, heart and kidney yang deficiency is easily mistaken for edema due to yang deficiency, and lung obstruction by phlegm and fluid is easily mistaken for heart and kidney yang deficiency. Conclusion: 1. Compared to normal humans, CHF patients have a significantly lower sEDF content. 2. TCM types of CHF patients and sEDF content are closely related: the group of edema due to yang deficiency have the most significant decrease in sEDF content, followed in order by the group of heart and kidney yang deficiency, the group of qi and yin deficiency, the group of qi deficiency and blood stasis, and the group of lung obstruction by phlegm and fluid. Patients with an sEDF value between 114.49～47.39, 86.70～46.38, 62.38～31.22, 42.89～19.23, and 27.95～7.83 can be typed respectively as lung obstruction by phlegm and fluid, qi deficiency and blood stasis, qi and yin deficiency, heart and kidney yang deficiency and edema due to yang deficiency. 3. The higher the heart failure level of CHF patient is, the lower the sEDF content will be, which means there is a negative correlation between them. 4. Significant differences in sEDF content exist between groups of CHF patients with different types of heart disease (P<0.05), with the lowest being the group of rheumatic heart disease, followed in order by hypertensive heart disease, cardiomyopathy, coronary heart disease, and pulmonary heart disease. 5. When the disease is mounting in severity, the pulse conditions change from wiry and abrupt pulse to knotted pulse, intermittent pulse, and deep thready pulse, while tongue proper also changes from red tongue to pale tongue, purple-dark tongue, and pale and corpulent tongue with tooth marks. As far as tongue coating is concerned, the change is from white moist tongue coating to yellow-greasy tongue coating, white-greasy tongue coating, until finally there is little or no tongue coating. 6. sEDF is possibly the actual physical reflection of xinyangqi. 7. According to the above differences, the accuracy of the discriminant equation based on discriminant analysis is 81.9%, a relatively high discriminant efficiency. However, in the actual discrimination work, heart and kidney yang deficiency is easily mistaken for edema due to yang deficiency, and lung obstruction by phlegm and fluid is easily mistaken for heart and kidney yang deficiency.
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