Clinical Study On The Relationship Between Syndrome Differentiation Of Tcm And Doppler Echocardiography, Bnp And Tnf-α In Patients With Dilated Cardiomyopathy

Objective:To study the relationship between Syndrome Differentiation of Dilated Cardiomyopathy (DCM) and Plasma Brain Natriuretic Peptide (BNP) and Plasma Tumor Necrosis Factor-alpha (TNF-α); so as to supply objective index for miorocosmic syndrome differentiation for DCM.Methods:89 selected patients with DCM were classified into three groups/types: Deficiency of Xinqi and Phlegm and Dampness stay in Body (DXQ&PDB),qi Dificiency and Blood-stasis Syndrome (QDBS) and yang Deficiency of both Heart and Kidney Syndrome and Dropsy due to serious Heart Failure Syndrome (YDHK&DHF). Then 15 cases of healthy people were selected as normal control group (NCG). The three different groups of DCM were compared with each other by Doppler Echocardiograhy, BNP and TNF-α, and then compared with the normal group. In this way the relationship among them were observed and studied.The results:1. DCM can be classified into the following groups:(1)the DXQ& PDB group; (2) the QDBS group; (3) the YDHK&DHY group.2. Comparison of the Doppler Echocardiography of the three groups(The Doppler data includes heart structure, left ventricular systaltic function and left ventricular diastolic function.).(1) The heart structure data (LVDd,LVSd,LA,RV,IVST,LVPWT) shows as follows:1)The data of LVDd shows:YDHK&DHF> QDBS> DXQ&PDB and all the data of the above three groups are higher than NCG. There are clear difference(P<0.01), the data of each of DCM groups has clear difference compared with NCG (P<0.01).2)The data of LVSd shows as follows in order:YDHK&DHF> QDBS> DXQ&PDB and all the data of the above three groups are higher than NCG. There are clear difference(P<0.01), the data of each of DCM groups has clear difference compared with NCG(P<0.01).3)The LA data is the following:the data of each of DCM groups has clear difference compared with NCG (P<0.01), and the YDHK&DHF data is higher the the DXQ& PDB data (P<0.01), and the YDHK&DHF data is higher the the QDBS data (P<0.05).4)The data of RV shows:YDHK&DHF>QDBS> DXQ& PDB,YDHK&DHF and QDBS>NCG(P<0.01).5)The data of IVST shows that there is no clear difference among all the groups (P>0.05).6)The data of LVPWT shows as follows:YDHK&DHF> QDBS, DXQ&PDB and the difference is clear (P<0.05).(2) The data of left ventricular systaltic (LVEDV, LVESV, LVEF, FS and SV) shows as follows:1)The data of LVEDV shows that YDHK&DHF is higher than the other groups and the difference is clear (P<0.01); QDBS> DXQ& PDB and NCG(P<0.01, P<0.05)..2)The data of LVESV shows that YDHK&DHF is higher than the other groups and there is clear difference (P<0.01); QDBS> DXQ& PDB (P<0.01);QDBS and DXQ& PDB are higher than NCG (P<0.01).3)The data of LVEF shows:YDHK&DHF< QDBS< DXQ& PDB<NCG; all the three groups re lower than NCG (P<0.01).4)The data of FS shows:QDBS< DXQ& PDB<NCG; all the DCM groups are lower than NCG and difference is clear (P<0.01).5)The data of SV shows:all the DCM groups are lower than NCG and difference is clear (P<0.01); YDHK&DHF> QDBS and DXQ& PDB(P<0.01).(3) The data left ventricular diastolic function (EV,AV,EV/AV) shows as follows:1)The data of EV shows That QDBS is lower than YDHK&DHF and NCG (P<0.01,P<0.05), DXQ& PDB is lower than YDHK&DHF and NCG (P<0.01,P<0.05).2)The data of AV shows that all of the DCM groups are higher than NCG and there is clear difference (P<0.01).3)The data of EV/AV shows that QDBS and DXQ& PDB is lower than YDHK&DHF (P<0.01); all the DCM groups are lower than NCG and difference is clear (P<0.01).3. Comparison of BNP of the three DCM groups:the serum level of BNP is as follows: YDHK&DHF>QDBS> DXQ& PDB>NCQ; the level of BNP of each group is higher than NCG (P<0.01); the BNP level of YDHK&DHF is higher than QDBS and DXQ& PDB (P<0.01); and the level of BNP of QDBS is higher than DXQ& PDB (P<0.01).4. Comparison of TNF-a of the three DCM groups:the serum level of TNF-a of the 3 groups is as follows:each group is higher than normal and there is clear difference (P<0.01). TNF-αlevel of YDHK&DHF is higher than DXQ& PDB (P<0.01), and TNF-αlevel of YDHK&DHF is higher than the QDBS (P<0.01).Conclusion:1.Dilated Cardiomyopatch can be classified into three types:(1)Type DXQ& PDB (2)Type QDBS (3)Type YDHK&DHF.2.Doppler Echocardiography can be used as an important measure to monitor and check up DCM; the verious data of the three types of DCM have clear differences with one and another and they can be used as reference index for syndome differentiation of TCM in DCM..3.There is relationship between DCM and the level of BNP, TNF-a; the levels of the three types of DCM have clear differences and so they can be used as objective basis for syndome differentiation of TCM.