Bilirubin System Metabolism In Patients With Chronic Heart Failure Syndromes Type And Prognosis

BackgroundChronic Heart Failure(CHF) is a complicate clinical syndrome, which is also the end stage of most cardiovascular disease. And the CHF leads to most death. Serum bilirubin system is usually treated as a representative index of liver function. Recently, along with the TCM development, the TCM objectified research spread. The researches on the relationship between clinical index and CHF prognosis based on TCM syndrome have achieved a lot. Because of the disease complexity, clinical characteristic polytrope and heterogeneity of TCM differentiation method and syndrome estimation, which lead to less research on the serum bilirubin system influence on CHF syndrome factors and prognosis.My article will concentrate on the serum bilirubin system influence on CHF syndrome factors and prognosis. And also my article will involve the relationship between serum bilirubin system and some clinical index.ObjectivesTo discuss serum bilirubin system influence on CHF syndrome factors and prognosisMethodsFirst of all, we collected236cases of CHF patients who met the inclusion criteria and were hospitalized in Guang Anmen Hospital from June2006to August2013.Secondly we set up a retrospective collection form of the medical record data including the basic information, the relevant medical history, the auxiliary examination results, the clinical diagnosis and the final events of all patients which were followed-up by outpatient or telephone.Thirdly, we explored the group standard about the serum bilirubin level which has the prognostic value of CHF by ROC curve and analysis it by Survival-Analysis Method. At last, we explored the relationship between the serum bilirubin level and CHF syndrome factors and the other clinical index.Results:1. The survival rate in patients with CHF was66%and the all-cause mortality rate was34%. The Single syndrome elements distributions from more to less were Qi deficiency (75.4%), blood stasis (66.1%), phlegm block (56.7%), Yin deficiency (31.8%) and Yang deficiency (16.5%). 2. We adopt ROC curve to calculate the cut-off point of TBIL, DBIL and IDIL, which is16.55μmol/L,3.05μmol/L,18.00μmol/L. And then we grouping the BIL according to the cut-off point. We adopt Kaplan-Meier-Survival-Analysis showed that higher BIL level representative a worse prognosis. The differences were statistically significant.3.In the research on the relationship between serum bilirubin level and CHF TCM syndrome. We have the conclusion that serum bilirubin level only related to yang deficiency. The differences were statistically significant.4.The correlation analysis showed that HRmax, ventricular premature beat, atrium premature beat, LVEDD, atrial remodeling, ventricular remodeling, EF%, FS, RBC, PLT, AST, ALT, NT-proBNP, gender, age, diabetes or not, CHD or not, HT or not were related to serum bilirubin level. The differences were statistically significant. Conclusion:1. Serum bilirubin level can be used as an independent factor affecting the prognosis of patients with CHF. The patients with higher serum bilirubin level have a worse prognosis.2.The CHF commom dyndromes are qi deficiency, yang deficiency, yin deficiency, blood stasis and phlegm block syndrome. The yang deficiency syndrome of CHF is related to serum bilirubin level. While, for the other syndrome, further researches are needed.3. When HRmax, ventricular premature beat, atrium premature beat, LVEDD, atrial remodeling, ventricular remodeling, RBC, AST, ALT, NT-proBNP, NYHA level rise, the serum bilirubin level tends to be higher and the prognosis of the patient is much worse. The serum bilirubin level in women is much higher than in men. The patients don’t have diabetes, HT and CHD, have higher serum bilirubin level.