CAJ | 학술논문

目的：探讨慢性心力衰竭（CHF）患者中医辨证分型与血清胱抑素C（Cys-C）和同型半胱氨酸（Hcy）的相关性。方法选择浙江中医药大学附属第一医院心内科收治的115例CHF患者作为CHF组，以同期本院30例健康体检者作为健康对照组，再将CHF患者按中医辨证分型标准分为气阴两虚证30例，气虚血瘀证30例，心肾阳虚证30例和阳虚水泛证25例。检测各组血清Cys-C和Hcy水平，采用Spearman等级相关分析评价不同中医证型与血清Cys-C和Hcy的相关性。结果 CHF组Cys-C和Hcy水平显著高于健康对照组〔Cys-C（mg/L）：1.24±0.34比0.77±0.22，Hcy（μmol/L）：18.66±4.57比11.65±3.21，均P＜0.05〕。与健康对照组比较，Cys-C和Hcy水平按气阴两虚证、气虚血瘀证、心肾阳虚证和阳虚水泛证的顺序呈逐渐增高趋势〔Cys-C（mg/L）：1.02±0.27、1.09±0.31、1.32±0.22、1.59±0.25；Hcy（μmol/L）：14.94±2.20、17.66±3.04、19.79±3.48、22.96±5.31〕，且以阳虚水泛证的升高程度最明显（P＜0.05）。相关分析显示，不同中医证型与血清Cys-C和Hcy水平呈显著正相关（r1＝0.73，r2＝0.79，均P＜0.05）。结论 CHF患者血清Cys-C和Hcy水平的变化与其辨证分型规律的演变相一致，两者可作为CHF中医辨证分型的客观指标。
목적：탐토만성심력쇠갈（CHF）환자중의변증분형여혈청광억소C（Cys-C）화동형반광안산（Hcy）적상관성。방법선택절강중의약대학부속제일의원심내과수치적115례CHF환자작위CHF조，이동기본원30례건강체검자작위건강대조조，재장CHF환자안중의변증분형표준분위기음량허증30례，기허혈어증30례，심신양허증30례화양허수범증25례。검측각조혈청Cys-C화Hcy수평，채용Spearman등급상관분석평개불동중의증형여혈청Cys-C화Hcy적상관성。결과 CHF조Cys-C화Hcy수평현저고우건강대조조〔Cys-C（mg/L）：1.24±0.34비0.77±0.22，Hcy（μmol/L）：18.66±4.57비11.65±3.21，균P＜0.05〕。여건강대조조비교，Cys-C화Hcy수평안기음량허증、기허혈어증、심신양허증화양허수범증적순서정축점증고추세〔Cys-C（mg/L）：1.02±0.27、1.09±0.31、1.32±0.22、1.59±0.25；Hcy（μmol/L）：14.94±2.20、17.66±3.04、19.79±3.48、22.96±5.31〕，차이양허수범증적승고정도최명현（P＜0.05）。상관분석현시，불동중의증형여혈청Cys-C화Hcy수평정현저정상관（r1＝0.73，r2＝0.79，균P＜0.05）。결론 CHF환자혈청Cys-C화Hcy수평적변화여기변증분형규률적연변상일치，량자가작위CHF중의변증분형적객관지표。
ObjectiveTo investigate the relationships between traditional Chinese medicine(TCM) syndrome differentiation and serum cystatin C(Cys-C) and homocysteine(Hcy) in patients with chronic heart failure(CHF). Methods 115 cases with CHF admitted into the Department of Cardiology of the First Affiliated Hospital of Zhejiang Chinese Medical University were selected in the CHF group, and 30 cases who had taken health examination in the same period were chosen in the healthy control group. According to the TCM syndrome differentiation, the CHF cases were subdivided into four groups with different types of syndrome: 30 cases of deficiency of both Qi and Yin syndrome, 30 cases of Qi deficiency syndrome and blood stagnation syndrome, 30 cases of heart and kidney Yang deficiency syndrome and 25 casesof flooding due to Yang deficiency syndrome. The serum levels of Cys-C and Hcy in different groups were tested, and the relationships between TCM syndrome differentiation and serum Cys-C and Hcy were analyzed by using Spearman rank correlation analysis.Results The serum levels of Cys-C and Hcy in the patients with CHF were significantly higher than those in the healthy control group〔Cys-C(mg/L):1.24±0.34 vs. 0.77±0.22, Hcy(μmol/L):18.66±4.57 vs. 11.65±3.21,bothP<0.05〕. Compared with the healthy control group, the serum levels of Cys-C and Hcy in the above four groups of different syndromes had a tendency of gradual elevation in the sequence as follows: deficiency of both Qi and Yin, Qi deficiency and blood stagnation, heart and kidney Yang deficiency and flooding due to Yang deficiencygroups〔Cys-C(mg/L):1.02±0.27,1.09±0.31,1.32±0.22, 1.59±0.25; Hcy(μmol/L): 14.94±2.20, 17.66±3.04, 19.79±3.48, 22.96±5.31〕, and the elevation in levels of flooding due to Yang deficiency group was the most prominent compared with that in other groups(P<0.05). The correlation analyses showed that different types of TCM syndrome in patients with CHF were positively correlated with the levels of Cys-C and Hcy(r1=0.73,r2=0.79,bothP<0.05).ConclusionThe changes of serum Cys-C and Hcy levels are consistent with the evolution of regular pattern of TCM syndrome differentiation in patients with CHF, and these two markers can be regarded as the objective indicators of TCM syndrome differentiation of CHF.