脑钠肽或脑钠肽前体、肌钙蛋白与胸痹心痛中医证型相关性的研究  

Association of Brain Natriuretic Peptide or Pro-brain Natriuretic Peptide and Troponin with Traditional Chinese Medicine Syndrome Types of Chest Stuffiness and Pain

作　　者：何仲瑾 马峰[1] 张涛[1] 雷靖祎[1] 王昌育[1] 梁小平[1] 

机构地区：[1]西安市中心医院,陕西西安710003

出　　处：《中医药信息》2017年第1期83-87,共5页Information on Traditional Chinese Medicine

基　　金：陕西省科技厅社会发展攻关计划(No.2014K11-02-03-04)

摘　　要：目的:探讨脑钠肽前体(NT-pro BNP)水平和肌钙蛋白(c Tn I)与胸痹心痛不同中医证型之间的内在联系,为胸痹心痛患者进行针对性的中医辨证治疗提供客观依据。方法:将1 157例冠状动脉造影检查患者,胸痹心痛中医辨证分为心气不足、心阳不振、心阴不足、痰浊闭塞、心血瘀阻、阴寒凝结、气滞胸痛和胸痹心痛的变证真心痛证型:痰瘀交阻、气阴两虚、阳虚欲脱共10个证型,1个对照组;并设立冠心病组、动脉粥样硬化组、正常组,搜集正常组,冠状动脉粥样硬化组和各个中医证型NT-pro BNP、c Tn I的数据分析他们之间的相关性。由ROC曲线确定NT-pro BNP水平从而诊断(辨证)心阳不振证型。结果:NT-pro BNP冠心病组、冠状动脉粥样硬化组高于正常组(P<0.001),冠心病组高于冠状动脉粥样硬化组(P<0.001),冠心病组NT-pro BNP、c Tn I低于急性心梗组,有显著性差异(P<0.001);NTpro BNP:心阳不振>阳虚欲脱>气阴两虚>痰瘀交阻>心气不足、心血瘀阻>痰浊闭塞、寒凝气滞>气滞胸痛、心阴不足>对照组。心阳不振与心气不足、心阴不足、痰浊闭塞、寒凝气滞、心血瘀阻、气滞胸痛、痰瘀交阻、气阴两虚、对照组比较,P<0.001;与阳虚欲脱比较,P>0.05;ROC曲线AUC面积为0.874(P<0.001),有统计学意义,说明NT-pro BNP对心阳不振的辨证(诊断)有意义。c Tn I冠心病组高于正常组(P<0.001),冠状动脉粥样硬化组与正常组比较,P>0.05。c Tn I真心痛的证型值(痰瘀交阻、气阴两虚、阳虚欲脱)最高分别与心阳不振、心气不足、心阴不足、痰浊闭塞、寒凝气滞、心血瘀阻、气滞胸痛、痰瘀交阻、气阴两虚、对照组比较,P<0.001。结论:NT-pro BNP可以作为心阳不振辨证的客观指标,最佳临界值是NT-pro BNP为563,约登指数为(Youden index)0.588。c Tn I可以作为辨证真心痛证型的客观指标。Objective ： To investigate the correlation of N - terminal pro - brain natriuretic peptide （ NT - proBNP） and troponin （cTnI） with different traditional Chinese medicine （TCM） syndrome types of chest stuffiness and pain, so as to provide the objective basis for dialectical TCM treatment in patients with chest stuffiness and pain. Methods ： This study included 1,157 cases of patients examined by coronary artery angiography. TCM syndrome types were deficiency of heart - Qi, devitalization of heart Yang, deficiency of heart Yin, phlegm muddy and out - of - the - way, eariac blood stasis, cold inducing stagnation, Qi stagnation and chest pain, as well as angina pectoris types of chest stuffiness and pain： phlegm - blood - stagnancy - type, deficiency of both Qi and Yin as well as deficiency of Yang （ 10 types of syndrome totally）, and the control group （ n = 1 ） ; furthermore, coronary heart disease group, atherosclerosis group and control group were also set up to illustrate the correlation and relationship between NT -proBNP and cTnI among the above three groups with different TCM syndrome types. ROC curve was applied to determine the concentration of NT - proBNP in the diagnosis （differentiation） of devitalization of heart Yang. Results： NT- proBNP levels were both higher in the coronary heart disease group and atherosclerosis group than those in the control group （P 〈0. 001 ）, and such level was higher in the coronary heart disease group than that in the atherosclerosis group （P 〈 0.001 ）, whereas NT - proBNP and cTnI in the coronary heart disease group were lower compared with those in the acute infarct group, with a significantly statistical difference （ P 〈 0. 001 ） ; the trend of NT - proBNP levels in different TCM syndrome types were ： devitalization of heart Yang 〉 deficiency of Yang 〉 deficiency of both Qi and Yin 〉 phlegm - blood - stagnancy - type 〉 deficiency of heart - Qi, cariac blood stasis 〉 phlegm muddy and out - of - the - way, cold obs

关 键 词：胸痹心痛 冠心病 中医证型 脑钠肽 肌钙蛋白 

分 类 号：R256.22[医药卫生—中医内科学]