Characteristics Of TCM Syndrome Elements Of Dilated Cardiomyopathy And Its Correlation With Cardiac Function Indexes And Anti-myocardial Antibodies

Objective:To observe the distribution of syndrome element of TCM in the patients in Wuxi area with dilated cardiomyopathy (DCM), using the method of four diagnostic information. To analyze the correlation between two anti-myocardial antibodies of Ant-ANT, Ant-β1, B-type natriuretic peptide(BNP), N-terminal brain natriuretic(NT-proBNP), left ventricular ejection fraction(LVEF), left ventricular end-diastolic internal diameter(LVEDd), New York Heart Association heart function classification(NYHA) and hypersensitive C-reaction protein(hs-CRP) and different syndrome elements in the patients with DCM. To analyze the differences of clinical indicators in the patients with DCM and other heart patients except DCM. It attempts to study the mechanisms of the etiology, disease prognosis,and treatment in the patients with DCM. In order to provide a theoretical basis for a better Chinese medicine treatment of DCM in future.Methods:1. According to a randomized-controlled method,49 patients matched the diagnostic criteria of DCM were enrolled into experimental group by the book of the cardiomyopathy diagnosis and treatment recommendations. Their syndrome element of TCM was assessed by a full-time Director of Chinese medicine practitione by the book of diagnostics of Chinese Medicine.45 patients who have the heart disease except DCM were enrolled into control group and 78 person who have no disease were enrolled into normal group.Qualitative detect serum Ant-ANT and Ant-β1 by enzyme-linked immunosorbent assay;measure NT-proBNP by chemiluminescent immunoassay;measure BNP by radioimmunoassay;detect hs-CRP by biochemical methods;measure LVEF,LVEDd and NYHA by normal methods. The people in all the groups should have no other diseases can attribute to the positive of anti-myocardial antibodies(rheumatoid system diseases,rheumatic valvular disease and acute infective diseases).2.All data were applied for statistical analysis by SPSS 17.0 package. Measurement data were presented as mean±standard deviation;measurable indicators between the two groups, group compared with two-tailed student-t test; multiple measurable indicators were few compared when homogeneity of variance single factor analysis of variance,variance missing, the use of multiple independent sample non-parametric K-S rank test.(P<0.05 considered statistically significant difference).Results:1.The syndrome elements of TCM in 49 cases DCM patients can be seen as follows:The single syndrome elements-qi deficiency,yang deficiency; the folder syndrome elements-yang deficiency and blood stasis, qi deficiency and blood stasis, qi deficiency and yin deficiency, qi deficiency and phlegm and blood stasis, yang deficiency and phlegm and blood stasis, qi deficiency and blood stasis and dampness, yang deficiency and blood stasis and dampness; the single syndrome elements of demonstration syndrome can not be seen. The total frequency of syndrome elements of TCM in 49 cases DCM patients are 77, in which qi deficiency 35 cases, accounting for 45.5%; yang deficiency 14 cases, accounting for 18.2%; blood stasis 19 cases, accounting for 24.7%; yin deficiency 2 cases, accounting for 2.6%; phlegm 4 cases, accounting for 5.2%; dampness 3 cases, accounting for 3.9%. The syndrome elements of TCM appear to frequency as follows:qi deficiency>blood stasis>yang deficiency> phlegm> dampness>yin deficiency. The asthenia syndrome element accounting for 66.2% and the demonstration syndrome element accounting for 33.8%. The frequency of syndrome elements of TCM in single element group are 28(57.1%), in which qi deficiency 20 cases(71.4%)>yang deficiency 8 case(28.6%). The frequency of syndrome elements of TCM in folder syndrome elements are 21(42.9%), in which qi deficiency and blood stasis 8 cases(38.1%)> yang deficiency and blood stasis 4 cases(19.0%)> qi deficiency and phlegm and blood stasis 3 cases(14.3%)>qi deficiency and yin deficiency 2 cases(9.5%)=qi deficiency and blood stasis and dampness 2 cases(9.5%)> yang deficiency and phlegm and blood stasis 1 cases(4.8%)=yang deficiency and blood stasis and dampness 1 cases(4.8%). In both single and folder elements group, qi deficiency appears most; in folder syndrome elements, blood stasis appears most in the demonstration syndrome element,it amounts 19 cases(90.5%), qi deficiency and blood stasis 13 cases(68.4%)> yang deficiency and blood stasis 6 cases(31.6%).2.The syndrome elements of TCM in control group can be seen as follows:The total frequency of syndrome elements of TCM in control group are 81.The syndrome elements of TCM appear to frequency as follows:qi deficiency 32(39.5%)>blood stasis 24(29.6%)>yang deficiency 13(16.0%)>phlegm 4(4.9%)=dampness 4(4.9%)=yin deficiency 4(4.9%). The asthenia syndrome element accounting for 60.4% and the demonstration syndrome element accounting for 39.6%. The frequency of syndrome elements of TCM in single element group are 17(37.8%), in which qi deficiency 11 cases(64.7%)>yang deficiency 6 case(35.3%). The frequency of syndrome elements of TCM in folder syndrome elements are 28(62.2%), in which qi deficiency and blood stasis 13 cases(46.4%)>qi deficiency and yin deficiency 4 cases(14.3%)> yang deficiency and blood stasis 3 cases(10.7%)> qi deficiency and phlegm and blood stasis 2 cases(7.1%)=qi deficiency and blood stasis and dampness 2 cases(7.1%)=yang deficiency and phlegm and blood stasis 2 cases(7.1%)= yang deficiency and blood stasis and dampness 2 cases(7.1%). In both single and folder elements group, qi deficiency appears most; in folder syndrome elements, blood stasis appears most in the demonstration syndrome element.it amounts 24 cases(85.7%), qi deficiency and blood stasis 17 cases(70.8%)> yang deficiency and blood stasis 7 cases(29.2%). The syndrome elements of TCM in DCM group and control group has no significant (P>0.05).3.The male patients are more than the female patients both in the three groups,there is no significant (P>0.05).The average age has no significant (P>0.05). The average age in single element groups in 49 DCM patients from highest to lowest are:yang deficiency>qi deficiency,there is no significant (P>0.05). The average age in folder syndrome elements groups in 49 DCM patients from highest to lowest are:qi deficiency and yin deficiency>qi deficiency and blood stasis> yang deficiency and phlegm and blood stasis>yang deficiency and blood stasis> qi deficiency and blood stasis and dampness>qi deficiency and phlegm and blood stasis> yang deficiency and blood stasis and dampness, there is no significant (.P>0.05). The folder syndrome element-qi deficiency and yin deficiency are all female patients,there is no significant (P>0.05).4. The positive rate of Ant-β1 and Ant-ANT in DCM group is respectively 13.3%,43.3%. In control group is respectively 15.6%,33.3%. There is no significant difference(P>0.05). Ant-β1 and Ant-ANT can not be found in normal group. There is significant difference (P<0.05).When the heart function is below Ⅱ, the positive rate of Ant-ANT in DCM group and control group is respectively 50% and 0%, there is significant difference (P<0.05);the positive rate of Ant-(31 in DCM group and control group is respectively 25% and 5.3%,there is no significant difference(P>0.05).When the heart function is above Ⅱ, the positive rate of Ant-ANT in DCM group and control group is respectively 40.9% and 57.7%, there is no significant difference (P>0.05); the positive rate of Ant-β1 in DCM group and control is respectively 9.1% and 23.1%,there is no significant difference (P>0.05).5. In single element groups in DCM patients,expression levels of hs-CRP from highest to lowest as follows:yang deficiency(9.18±16.43mg/L)>qi deficiency(2.11±1.91mg/L),but there has no significant difference (P>0.05).In folder syndrome elements groups in DCM patients,expression levels of hs-CRP from highest to lowest as follows:yang deficiency and blood stasis(4.51± 4.34mg/L)>qi deficiency and blood stasis(2.54±2.79mg/L)>qi deficiency and yin deficiency(0.66±0.17mg/L), but there has no significant difference (P>0.05).In qi deficiency group(2.19±2.23mg/L), the expression levels of hs-CRP is lower than other groups besides qi deficiency group(7.18±12.58mg/L)and has significant difference (P<0.05).6.In single element groups in DCM patients,NYHA IV yang deficiency accounts most,NYHA Ⅲ and Ⅱ qi deficiency accounts most, there has significant difference (P<0.05).In folder syndrome elements groups in DCM patients,NYHA IV yang deficiency and blood stasis accounts most, NYHA Ⅲ,Ⅱ qi deficiency and blood stasis accounts most, there has significant difference (P<0.05).7. In single element groups in DCM patients,expression levels of NT-proBNP from highest to lowest as follows:yang deficiency(11118.36±11719.59pg/mL)>qi deficiency(956.57± 1418.22pg/mL), there has significant difference (P<0.05). In folder syndrome elements groups in DCM patients,expression levels of NT-proBNP from highest to lowest as follows:yang deficiency and blood stasis(7240.45±2471.57pg/mL)>qi deficiency and blood stasis(1619.87± 2861.53pg/mL)>qi deficiency and yin deficiency,there has significant difference (P<0.05). The expression levels of NT-proBNP qi deficiency and blood stasis is obviously lower than yang deficiency and blood stasis,there has significant difference(P<0.05).The expression levels of NT-proBNP qi deficiency and yin deficiency is obviously lower than yang deficiency and blood stasis,there has significant difference(P<0.05).In single element groups in DCM patients,expression levels of BNP from highest to lowest as follows:yang deflciency(5320.41± 2469.01pg/mL)>qi deficiency(1809.56±2050.04pg/mL), there has significant difference (P<0.05). In folder syndrome elements groups in DCM patients,expression levels of BNP from highest to lowest as follows:yang deficiency and blood stasis(6692.34±1053.15pg/mL)> qi deficiency and blood stasis(2346.34±2556.10pg/mL)> qi deficiency and yin deficiency(2027.51 ±2090.64pg/mL),there has significant difference (P<0.05). The expression levels of BNP qi deficiency and blood stasis is obviously lower than yang deficiency and blood stasis,there has significant difference(P<0.05). The expression levels of BNP qi deficiency and yin deficiency is obviously lower than yang deficiency and blood stasis,there has significant difference(P<0.05).8. In single element groups in DCM patients,expression levels of LVEF from highest to lowest as follows:qi deficiency(46.90±11.69%)>yang deficiency(28.38±5.50%), there has significant difference (P<0.05);in folder syndrome elements groups,expression levels of LVEF from highest to lowest as follows:qi deficiency and blood stasis(45.62±9.19%)>qi deficiency and yin deficiency(43.50±16.26%)>yang deficiency and blood stasis(31.67±6.09%), there has significant difference (P<0.05); the expression levels of LVEF qi deficiency and blood stasis is obviously higher than yang deficiency and blood stasis,there has significant difference(P<0.05). In single element groups in DCM patients,the expression levels of LVEDd from highest to lowest as follows:yang deficiency(68.50±9.86mm)>qi deficiency(59.15±12.62mm),but there has no significant difference (P>0.05);the expression levels of LVEDd from highest to lowest as follows:yang deficiency and blood stasis(71.00±10.94mm)> qi deficiency and blood stasis(59.85±9.08mm)> qi deficiency and yin deficiency(56.50±16.26mm), but there has no significant difference (P>0.05);the expression levels of LVEDd qi deficiency and blood stasis is obviously lower than yang deficiency and blood stasis,there has significant difference(P<0.05)9. The classification of DCM in single element groups in DCM patients as follows:in early and middle steps, qi deficiency accounts most; in the last step, yang deficiency accounts most; there has significant difference (P<0.05). The classification of DCM in folder syndrome elements groups in DCM patients as follows:in early step, qi deficiency and blood stasis accounts most; in the last step, yang deficiency and blood stasis accounts most;there has significant difference (F<0.05).10. The positive rate of Ant-ANT in single element groups in DCM patients,yang deficiency accounts 0%, qi deficiency accounts 50%,there has significant difference(P<0.05);in folder syndrome elements groups,qi deficiency and blood stasis accounts 66.7%, qi deficiency and yin deficiency accounts 0%, yang deficiency and blood stasis accounts 33.3%,there has no significant difference (P>0.05). The positive rate of Ant-β1 in single element groups in DCM patients,yang deficiency accounts 0%, qi deficiency accounts 25%,there has significant difference(P<0.05);in folder syndrome elements groups.qi deficiency and blood stasis accounts 11.1%, qi deficiency and yin deficiency accounts 0%, yang deficiency and blood stasis accounts 0%,there has no significant difference (P>0.05).In qi deficiency group and the group besides qi deficiency, the positive rate of Ant-ANT is respectively 54.5% and 12.5%, there is significant difference(P<0.05);the positive rate of Ant-β1 is respectively 18.2% and 0%, but there is no significant difference(P>0.05).The positive rate of Ant-ANT in single element groups in control group,yang deficiency accounts 66.7%, qi deficiency accounts 36.4%,there has no significant difference (.P>0.05);in folder syndrome elements groups,qi deficiency and blood stasis accounts 17.6%, qi deficiency and yin deficiency accounts 25%, yang deficiency and blood stasis accounts 42.9%,there has no significant difference (P>0.05). The positive rate of Ant-β1 in single element groups in control group,yang deficiency accounts 0%, qi deficiency accounts 9.1%,there has no significant difference(P>0.05);in folder syndrome elements groups,qi deficiency and blood stasis accounts 17.6%, qi deficiency and yin deficiency accounts 50%, yang deficiency and blood stasis accounts 14.3%,there has no significant difference (P>0.05).11.The positive rate of Ant-ANT of NYHA Ⅲ(61.5%) is higher than NYHA Ⅳ(11.1%) and has significant difference (P<0.05). The positive rate of Ant-ANT of NYHA Ⅲ is higher than NYHA II and has no significant difference (P>0.05). The positive rate of Ant-1 of NYHA Ⅲ is higher than NYHA Ⅱ and NYHA IV and has no significant difference (P>0.05).With the classification of DCM,the positive rate of Ant-ANT is respectively 58.3%、42.9%、0%,in the early step(LVEF>40%) is obviously higher than the last step(LVEF<30%) and has significant difference (P<0.05).The positive rate of Ant-ANT of NYHA IV(58.3%) is higher than NYHA Ⅲ(57.1%) and higher than NYHA Ⅱ(0%) and has significant difference (P<0.05). The positive rate of Ant-β1 of NYHA 111(35.7%) is higher than NYHA IV(8.3%) and higher than NYHA Ⅱ(5.3%) and has significant difference (P<0.05).12. With the levels of development of cardiac function classification,the expression levels of NT-proBNP and BNP are gradually increased and have significant difference (P<0.05). With the levels of development of cardiac function classification,the expression levels of LVEF is gradually decreased and has significant difference (P<0.05). The levels of LVEF of NYHA II is higher than NYHA IV and has significant difference(P<0.05).With the levels of development of cardiac function classification,the expression levels of LVEDd has no change and has no significant difference(P>0.05).With the levels of development of cardiac function classification,the expression levels of hs-CRP is gradually increased, but there has no significant difference (P>0.05). When the heart function is above Ⅱ, the expression levels of BNP、 NT-proBNP、LVEF and hs-CRP between the DCM group and control group has no significant difference (P>0.05).Conclusions:1.In DCM group, male:female(2.5:1),this is the same as the book. To be observed the distribution of syndrome element, it has been showed that:qi deficiency,yang deficiency,yin deficiency,blood stasis, phlegm and dampness are exited in the syndrome element of patients with DCM;the distribution has its own unique characteristics,the overall solid syndrome element and imaginary element most seen. Qi deficiency acconts most,it accounts 71.4%.We can conclude that qi deficiency syndrome may be the most common seen syndrome element in DCM. The blood stasis syndrome element is as a folder form factor more often.Thus we can conclude that blood stasis syndrome elements plays an important role in DCM.Our study finds that in DCM early and middle step,the most common seen syndrome element is qi deficiency, in the last step,the most common seen syndrome element is yang deficiency.It indicates that we can use different treatment according the classification of DCM. In early and middle step we can tonify qi, In the last step we can warm yang.2. We study finds that:he expression levels of NYHA, NT-proBNP, BNP and LVEF has differences between syndrome element of TCM.With the change of qi deficiency to yang deficiency, NYHA, NT-proBNP and BNP are gradually increased,LVEF is decreased. With the change of qi deficiency to yang deficiency, NYHA, NT-proBNP and BNP are gradually increased,LVEF is decreased. With the change of yang deficiency and blood stasis, qi deficiency and blood stasis to qi deficiency and yin deficiency, NT-proBNP and BNP are gradually decreased; With the change of qi deficiency and blood stasis,qi deficiency and yin deficiency to yang deficiency and blood stasis, LVEF is gradually decreased, NYHA is gradually increased.It tips that NYHA、NT-proBNP、BNP、LVEF can be used as objective index.3.Our study finds that the expression levels of hs-CRP of qi deficiency is obviosly lower than other syndrome elements.It tips that hs-CRP can be used as a objective index between them.4. When the heart function is below II, the positive rate of Ant-ANT in DCM group is higher than control group;in early step(LVEF>40%) the positive rate of Ant-ANT is obviously higher than the last step(LVEF<30%).It tips that Ant-ANT has its specificity to diagnosis DCM.5. In DCM, the positive rate of Ant-ANT in qi deficiency is higher other groups.It tips that the positive rate of Ant-ANT may be the objective of qi deficiency syndrome element and others.6. Our study finds that the positive rate of Ant-ANT of NYHAIII is higher than NYHAII and obviously higher than NYHAIV; the positive rate of Ant-β1 of NYHAIII is higher than NYHAII and NYHAIV. It tips that the positive rate of Ant-ANT and Ant-β1 has no relationship with DCM. The positive rate of Ant-ANT and Ant-β1 of NYHAⅢ,Ⅳ is obviously higher than NYHAII,it tips that the positive rate of Ant-ANT and Ant-β1 may have relationship with cardiac disease besides DCM.