| BackgroundChronic heart failure is the terminal stage of various cardiovascular diseases.Traditional Chinese medicine treatment based on syndrome differentiation has a good clinical effect in the prevention and treatment of chronic heart failure.At present,its syndrome differentiation mainly relies on information from the four diagnoses of traditional Chinese medicine,and the information is highly subjective,so it is difficult to promote in clinical practice.Therefore,objective syndromes differentiation is a new direction to assist traditional Chinese medicine syndrome differentiation.The biological indicators detected by modern medical technology can be quantified and are highly maneuverable.Exploring the differences of the biological indicators of different syndromes plays an important role in distinguishing different syndromes and exploring the biological basis of different syndromes.Traditional Chinese medicine syndromes are complex and changeable,and it is difficult to reveal its changes with a single level of biological indicators.Based on this,our study will explore the biological indicators that may be related to diagnosis of the Qi deficiency syndrome of chronic heart failure from two aspects including clinical physical and chemical indicators and urine metabolomics,in order to provide an auxiliary reference for the objective diagnosis of Qi deficiency syndrome of chronic heart failure.ObjectiveBased on physical and chemical indicators and urine metabonomics,then screen the physical and chemical indicators and urine metabolites related to Qi deficiency syndrome of chronic heart failure,in order to provide a reference for the objective syndrome differentiation and biological basic research of Qi deficiency syndrome of chronic heart failure.Methods1.Use Epidata software to input the patients’ clinical information collected in Xiyuan Hospital CACMS,China-Japan Friendship Hospital,Fuwai Hospital Chinese Academy of Medical Sciences,Dongzhimen Hospital of Beijing University of Chinese Medicine,and Guang’anmen Hospital China Academy of Chinese Medical Sciences to construct a database,use SPSS23.0 software to finish difference analysis,multivariate analysis,ROC curve analysis.2.Collect chronic heart failure patients’ urine samples from China-Japan Friendship Hospital,and healthy control cases’ urine samples from the Physical Examination Center of the Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine,and then use nuclear magnetic resonance spectrometer to obtain metabolite information of each sample.Use MestRenova,SIMCA,MetaboAnalyst for data analysis and bioinformatics analysis.Finally,use SPSS23.0 software to perform ROC analysis to determine the predictive ability of differential metabolites for Qi deficiency syndrome of chronic heart failure.Results1.Our study included 126 patients with chronic heart failure,including 98 patients with Qi deficiency syndrome and 28 patients with non-qi deficiency syndrome.There were no statistically significant differences between the two groups in age,gender,hypertension and other comorbid diseases,and cardiac function classification.The results of the difference analysis showed that physical sleepiness(P=0.004),waist and knee weakness(P=0.004),shortness of breath(P=0.015),dreams(P=0.047),loss of appetite(P=0.017),and cold hands and feet(P=0.027)were different between the Qi deficiency group and the no-qi deficiency group,and the difference was statistically significant(P<0.05).The results of the difference analysis in physical and chemical indicators showed that hemoglobin(P=0.015)and total bilirubin(P=0.026)were different between Qi deficiency and no-qi deficiency syndrome,and the difference was statistically significant(P<0.05).The physical and chemical indicators of P<0.2,hemoglobin,total bilirubin,and homocysteine were included in the multivariate analysis.The analysis results showed that hemoglobin(P=0.018)and homocysteine(P=0.041)were entered into the model.The ROC analysis results of the combined three physical and chemical indicators showed that the area under the curve was 0.712.Multivariate analysis of hemoglobin,total bilirubin,homocysteine,physical sleepiness,waist and knee weakness,shortness of breath,dreams,loss of appetite,and cold hands and feet showed that hemoglobin(P=0.010),dreams(P=0.021),physical sleepiness(P=0.028),and loss of appetite(P=0.048)entered the model.ROC analysis showed that the area under the curve was 0.832.2.Our study included 48 patients with chronic heart failure,including 35 patients with Qi deficiency syndrome and 13 patients with no-qi deficiency syndrome,and 16 healthy control cases.Urine metabolomics screened out 9 different metabolites,including glucose,cisaconitate,5-hydroxy lysine,3-methylglutarate,anserine,fucose,O-phosphoserine,homocysteine,and creatinine.The pathway enrichment analysis was performed based on the selected metabolites,and pathways were screened under the conditions of influence value>0.1 and P<0.05.The results showed that the pathway involved the metabolism of methionine and cysteine.ROC curve analysis of nine metabolites showed that 3-methylglutarate,homocysteine,fucose,creatinine,and cis-aconitate had relatively good distinguishing ability for Qi deficiency of chronic heart failure syndrome,the area was respectively 0.714,0.804,0.754,0.789,0.741。Conclusion1.The difference between hemoglobin in Qi deficiency of chronic heart failure and the no-qi deficiency group is statistically significant,and it is associated with the Qi deficiency syndrome of chronic heart failure.It has a certain distinguishing effect in the Qi deficiency syndrome of chronic heart failure.A large sample of clinical verification is required in the follow-up,in order to consider whether to include it as an objective indicator of differentiation Qi deficiency syndrome of chronic heart failure.2.Urine metabolites 3-methylglutarate,homocysteine,fucose,creatinine,and cisaconitate had certain differences between the Qi deficiency group and the no-qi deficiency group of chronic heart failure.They had a certain ability to distinguish Qi deficiency syndrome of heart failure,a large sample of clinical verification is required in the follow-up,in order to consider whether to include them as objective indicators of differentiation Qi deficiency syndrome of chronic heart failure.The pathological changes of Qi deficiency syndrome of chronic heart failure may related to disorders of the body’s immunity and oxidative stress. |
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