| objective:Observed brain natriuretic peptide in heart failure patients (NT-proBNP) and RASS systems aldosterone, angiotensinⅡand cardiac function and Chinese Medicine Syndrome Pattern in Patients with Heart Failure.Methods:Select the Guangu Hospital District, Hubei Province Chinese Medicine Hospital from March 2010 to March 2011 into the Department of Cardiology,49 cases of hospitalized heart failure patients, aged 52-89 years, male 28, female 21 cases. Selection criteria:meet the diagnostic criteria of heart failure (CHF diagnostic criteria:Framingham diagnostic criteria) and LVEF≤50%, or E/A<1, and the functional class≥Ⅱ. Discharge criteria:exclusion criteria have renal insufficiency (BUN>2.5mg/ml), severe liver dysfunction (ALT/AST>2 times normal), acute myocardial infarction, cancer, chronic gall bladder disease, neurological disease, obstructive pulmonary disease, hyperthyroidism, pregnant women. The second day of admission, fasting blood collected elbow 4ml line with Roche chemiluminescence determination of NT-proBNP, and then taking the elbow vein 5ml,3ml of them placed with the enzyme inhibitor (kit supplied) anticoagulant tube In the mix, tested AngⅡ; 2ml placed in heparin anticoagulant tubes containing 50μl in the mix, tested ALD. And complete brain natriuretic peptide in patients with heart failure and cardiac function and the correlation between TCM Syndrome type of survey in a stable condition underwent cardiac echocardiography, based on clinical symptoms, signs, echocardiography and further improve the questionnaire.Results:1.NYHA classification of left ventricular function. NYHA Classification of cardiac function relationship between the groups were significantly different (P<0.05) heart level of NYHA functional class increased, left ventricular diastolic and systolic function was significantly reduced, that is, left ventricular function Negative correlation with the NYHA.2. RAAS NYHA classification system and the relationship between the NYHA functional class.The RASS in aldosterone (ALD) and angiotensinⅡ(AngⅡ) positive relationship with the NYHA functional class increased, the blood of AngⅡ, ALD Increased significantly. GradeⅣHeart Function in plasma aldosterone (ALD) and angiotensinⅡ(AngⅡ) higher than gradeⅡ,Ⅲgrade, were significantly different; cardiac function gradeⅢin plasma aldosterone (ALD) and angiotensinⅡ(AngⅡ) High StageⅡ, P<0.05 significant differences.3. NYHA classification and the relationship between NT-proBNP levels increased heart failure NYHA functional class increased, the plasma NT-proBNP, significantly increased P<0.05 significant differences. NYHA functional class and NT-proBNP are related.4. Left ventricular function and the relationship between TCM. Phlegm blocking the lung LVEF was significantly lower than other groups, there was significant difference (P<0.05); syndrome of water overflowing due to yang deficiency LVEF was significantly lower than syndrome of qi deficiency of heart and lung, qi asthenia and blood stasis, both qi and yin deficiency card, asthenia syndrome of heart and kidney yang, there was significant difference (P<0.05); asthenia syndrome of heart and kidney yang LVEF was significantly lower than that, syndrome of qi deficiency of heart and lung; Both Qi and Yin deficiency card LVEF was significantly lower than syndrome of qi deficiency of heart and lung, qi asthenia and blood stasis, there was significant difference (P<0.05); qi asthenia and blood stasis LVEF was significantly lower than syndrome of qi deficiency of heart and lung; syndrome of qi deficiency of heart and lung E/A ratio was significantly lower than phlegm blocking the lung. Left ventricular function decreasing order: syndrome of qi deficiency of heart and lung, qi asthenia and blood stasis, both qi and yin deficiency card, asthenia syndrome of heart and kidney yang, syndrome of water overflowing due to yang deficiency, phlegm blocking the lung.5. TCM syndrome and plasma NT-proBNP in the relationship between. Syndrome of qi deficiency of heart and lung AngⅡ, ALD was significantly lower than other groups, there was significant difference (P<0.05); with qi asthenia and blood stasis AngⅡ, ALD was significantly lower than both both qi and yin deficiency card, asthenia syndrome of heart and kidney yang, syndrome of water overflowing due to yang deficiency, phlegm blocking the lung, there was significant difference (P<0.05); both qi and yin deficiency card AngⅡ, ALD was significantly lower than asthenia syndrome of heart and kidney yang, syndrome of water overflowing due to yang deficiency, phlegm blocking the lung; asthenia syndrome of heart and kidney yang AngⅡ, ALD was significantly lower than syndrome of water overflowing due to yang deficiency, phlegm drink the lung; syndrome of water overflowing due to yang deficiency AngⅡ, ALD was significantly lower than phlegm blocking the lung, there was significant difference (P<0.05). AngⅡ, ALD elevated syndrome of qi deficiency of heart and lung, qi asthenia and blood stasis, both qi and yin deficiency card, asthenia syndrome of heart and kidney yang, syndrome of water overflowing due to yang deficiency, phlegm blocking the lung.6. TCM syndrome and plasma NT-proBNP in the relationship between. Phlegm in the lung resistance of plasma NT-proBNP levels were significantly higher than that of other syndromes, P<0.05 significant difference; Yang deficiency induced excessive Water in plasma NT-proBNP concentration was significantly Higher than Heart Yang and Kidney Yang Deficiency, Qi and Yin deficiency of both cards, Qi Deficiency induced Blood stasis, heart and lung qi deficiency, there was significant difference (P<0.05); Heart Yang and Kidney Yang Deficiency in the plasma concentration of NT-proBNP was significantly higher than both Qi and Yin deficiency of both cards, Qi Deficiency induced Blood stasis, Heart and lung Qi deficiency; both Qi and Yin deficiency of both cards NT-proBNP levels were significantly higher than that of Qi deficiency and blood, heart and lung qi deficiency P<0.05 significant difference; with Qi in plasma NT-proBNP Were significantly higher than heart and lung qi deficiency, there was significant difference (P<0.05). TCM syndrome in the plasma NT-proBNP concentration in the order:Heart and lung Qi deficiency< Qi Deficiency induced Blood stasis<Qi and Yin deficiency of both cards< Heart Yang and Kidney Yang Deficiency< Yang deficiency induced excessive Water< Phlegm blocking the lung. 7.Symptoms and signs score to quantify the relationship between. TCM syndrome type with the dialectic as a deficiency of both heart and lung, with Qi, Qi and Yin deficiency of both cards, heart deficiency syndrome, Yang and water pan card, phlegm drink the lung The quantitative scoring of symptoms and signs gradually increased in each group had significant differences, P<0.05.Conclusion:1. Left ventricular function and NYHA classification once again negative correlation between cardiac ultrasound confirmed the diagnosis of heart failure in the dominant position, and shows the performance of cardiac ultrasound early heart failure was mainly E A peak flow peak flow changes in the ratio of the E /A<1, mainly left ventricular diastolic dysfunction. Asymptomatic heart failure, echocardiography provides objective evidence of early diagnosis, the early diagnosis of heart failure treatment and prevention of the more cutting-edge reference.2. RAAS system, aldosterone (ALD) and angiotensinⅡ(AngⅡ) and NYHA classification showed positive correlation between, with the NYHA functional class increased the severity of heart failure, blood AngⅡ, ALD was significantly 1 High. Which confirms the pathogenesis of heart failure in a theory, namely: heart failure RASS system overactivation, with excessive activation of the RASS system to further increase heart failure, then the treatment and prevention of heart failure is one effective way to block the RASS system Over-activation.3. NYHA classification and NT-proBNP showed a positive correlation between increased level of heart failure NYHA functional class increased the severity of heart failure, plasma NT-proBNP, increased significantly, so as to provide a further classification of heart failure Reference. Also shows that BNP (NT-proBNP) in heart failure diagnosis, classification and prognosis of the have great value.4. Left ventricular function and the relationship between TCM and TCM left ventricular function showed that there is a certain type of relationship, Heart and lung qi deficiency, Qi Deficiency induced Blood stasis, Both Qi and Yin deficiency Card, Heart Yang and Kidney Yang Deficiency, Yang deficiency induced excessive Water, Phlegm blocking the lung. gradually decreasing, as the Chinese dialectic found a type of objective evaluation.5. RAAS system, AngⅡ, ALD and TCM displays the correlation between RASS system, AngⅡ, ALD elevated Heart and lung Qi deficiency< Qi Deficiency induced Blood stasis<Qi and Yin deficiency of both cards< Heart Yang and Kidney Yang Deficiency < Yang deficiency induced excessive Water< Phlegm blocking the lung. RASS system activation degree of classification of heart failure medical dialectics is also related to the dialectical type of traditional Chinese treatment provides an evaluation index.6. TCM syndrome and plasma NT-proBNP for the TCM clinical relevance of the dialectical type checking to find an objective indicator of heart failure can guide the dialectical type of Chinese medicine, Chinese medicine treatment can also be used to verify the effectiveness of clinical treatment of heart failure. 7. Quantitative scoring of symptoms and signs associated with the syndrome of traditional Chinese medicine, Chinese medicine with Chinese characteristics, to provide dialectical, objective quantification of the diagnostic criteria for the evaluation of traditional Chinese medicine diagnosis of heart failure and provide a meaningful therapeutic effect of standardized objective data. |
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