2型糖尿病合并射血分数正常心力衰竭患者的超声指标与中医证型相关性研究
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摘要
目的:通过分析2型糖尿病(T2DM)合并射血分数正常心力衰竭(心衰)(HFpEF)患者中医证型与超声心动图指标的相关性,探讨T2DM合并HFpEF各证型与心衰进展的相关性。方法:将150例T2DM合并HFpEF患者,根据中医证候、舌苔及脉象等分为阴虚热盛组、湿热困脾组、气阴两虚组、血瘀水停组、血瘀脉络组5组,对各组心脏结构、功能的超声指标及血浆B型钠尿肽(BNP)进行统计学分析。结果:T2DM合并HFpEF阴虚热盛证、湿热困脾证、气阴两虚证、血瘀水停证、血瘀脉络证的心功能量呈逐渐降低趋势;血瘀水停组、血瘀脉络组的超声指标左房容积指数、室间隔厚度、左室后壁厚度、二尖瓣环收缩期平均速度及血浆BNP与其他3组比较,差异均有统计学意义(均P<0.05),血瘀脉络组射血功能与其他4型比较差异有统计学意义(均P<0.05)。结论:血瘀水停组、血瘀脉络组左心形态及功能改变明显,血瘀脉络组可能是T2DM合并HFpEF发展晚期的证型,超声心动图指标有可能作为中医辨证分型的参考。
Objective:To explore the relationship between TCM syndrome differentiations and echocardiographic parameters in the patients of T2 DM combined with HFpEF(heart failure with preserved left ventricular ejection fraction). Methods:150 cases of T2 DM combined with HFpEF were selected,according to the patient's syndromes,tongue and pulse devided into five TCM syndrome types:yin deficiency and heat syndrome,syndrome of dampness-heat blocking spleen,qi-yin deficiency syndrome,blood stasis swelling syndrome and blood stasis vein syndrome. The echocardiography indexes and BNP values for each type were statistically analyzed. Results:Their heart function showed a trend of gradual deterioration as the former sequence. The values of LAVI,IVS,LVPW,s' mean and BNP of patients with blood stasis swelling syndrome and blood stasis vein syndrome had significant differences compared with those of patients of other three syndrome(all P< 0.05). The ejection function of blood stasis vein syndrome had significant differences comparison with the other four groups(P< 0.05). Conclusion:With the aggravation of the imaginary,cardiac function progressively decreases in deficiency of Blood stasis syndrome group. The echocardiography can be used as objective and quantitative indexes of Syndrome differentiation of TCM.
Objective:To explore the relationship between TCM syndrome differentiations and echocardiographic parameters in the patients of T2 DM combined with HFpEF(heart failure with preserved left ventricular ejection fraction). Methods:150 cases of T2 DM combined with HFpEF were selected,according to the patient's syndromes,tongue and pulse devided into five TCM syndrome types:yin deficiency and heat syndrome,syndrome of dampness-heat blocking spleen,qi-yin deficiency syndrome,blood stasis swelling syndrome and blood stasis vein syndrome. The echocardiography indexes and BNP values for each type were statistically analyzed. Results:Their heart function showed a trend of gradual deterioration as the former sequence. The values of LAVI,IVS,LVPW,s' mean and BNP of patients with blood stasis swelling syndrome and blood stasis vein syndrome had significant differences compared with those of patients of other three syndrome(all P< 0.05). The ejection function of blood stasis vein syndrome had significant differences comparison with the other four groups(P< 0.05). Conclusion:With the aggravation of the imaginary,cardiac function progressively decreases in deficiency of Blood stasis syndrome group. The echocardiography can be used as objective and quantitative indexes of Syndrome differentiation of TCM.
引文
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[2]中华医学会内分泌学分会.中国成人2型糖尿病预防的专家共识[J].中华内分泌代谢杂志,2014,30(4):277-283.
[3]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:79-80.
[4] Sorensen BM,Houben AJ,Berendschot TT,et al. Prediabetes and type 2 diabetes are associated with generalized microvascular dysfunction:the maastricht study[J]. Circulation,2016,134:1339-1352.
[5]何怀阳,黄春林.心衰中医病机探讨[J].辽宁中医杂志,2007,34(4):413-415.
[6] Gul K,Celebi AS,Kacmaz F,et al. Tissue Doppler imaging must be performed to detect early left ventricular dysfunction in patients with type 1 diabetes mellitus[J]. Eur J Echocardiogr,2009,10:841-846.
[7] Yip G,Wang M,Zhang Y,et al. Left ventricular long axis function in diastolic heart failure is reduced in both diastole and systole:time for a redefinition[J]. Heart,2002,87:121-125.
[8] Aslan AN,Ayhan H,Cicek OF,et al. Relationship between aortic stiffness and the left ventricular function in patients with prediabetes[J]. Intern Med,2014,53:1477-1484.
[9] Prunier F,Gaertner R,Louedec L,et al. Doppler echocardiographic estimation of left ventricular end-diastolic pressure after MI in rats[J]. Am J Physiol Heart Circ Physiol,2002,283:H346-H352.
[10]蔡琳.《2007 ESC心力衰竭和超声协会对诊断左室射血分数正常心力衰竭的共识》如何诊断舒张性心力衰竭[J].心血管病学进展,2008,29(1):17-20.