Study On The Relationships Between TCM Syndrome Type And Serum Cystatin-C In Patients With Chronic Heart Failure

Objective:Investigate the relationships between TCM syndrome type and serum Cystatin C in patients with chronic heart failure, provide an objective basis to CHF Chinese medicine diagnosis and classification, and new ideas and methods to the combine traditional Chinese and western medicine therapy for CHF.Methods:1.158 cases with CHF 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.2. Serum Cys-C was measured in CHF cases and contral cases.3. Patients with CHF were subdivided into four groups (level ⅠⅡⅢⅣ) referenced to NYHA functional levels, measured serum N-terminal pro-B-type natriuretic peptide,serum creatinine and left ventricular ejection fration and confirm TCM syndrome differentiation type of the CHF patients.Results:1.Patients with CHF serum Cys-C level of 1.69±0.43mg/L was very significantly higher than control group(0.73±0.12mg/L) (P<0.01)2. Cardiac function levels of CHF patients between the TCM syndrome types were statistically significant different(X2=66.79, P< 0.01)3.Comparison serum Cys C, serum NT-proBNP and Scr between different TCM syndrome types of CHF patients:each TCM syndrome type group patients with CHF serum Cys-C is very significantly higher than normal control group (0.73±0.12m g/L),(P<0.01).The serum levels of Cys-C in the five groups of different syndromes h as a tendency of gradual elevation in the sequence as follows:Lung phlegm retention resistance (1.27±0.20mg/L), Qi deficiency both heart and lung (1.46±0.20 m g/L), Qi deficiency and blood stagnation (1.66±0.16mg/L), heart and kidney Yang deficiency (1.89±0.30mg/L) and flooding due to Yang deficiency groups (2.20±0.47mg/ L). Qi deficiency both heart and lung group, Qi deficiency and Blood stagnation group,heart and kidney Yang deficiency group and flooding due to Yang deficiency group are very significantly higher than lung phlegm retention resistance group(P<0.0 1). Heart and kidney Yang deficiency group and flooding due to Yang deficiency group are very significantly higher than Qi deficiency both heart and lung group and Qi deficiency and Blood stagnation group (P< 0.01). Lung phlegm retention resistance group, heart and lung Qi deficiency group, Qi deficiency and blood stasis group, heart kidney Yang deficiency group and flooding due to Yang deficiency group of serum NT- proBNP、LVEF showed a trend of increasing gradually, significant diff erences between groups (P< 0.05).4. The relationships between each NYHA classification group of serum Cys-C, serum NT-proBNP serum creatinine, LVEF:Cardiac function grade Ⅱ group (1.43±0. 18 mg/L), cardiac function level Ⅲ group (1.68±0.23 mg/L), cardiac function level Ⅳ group (1.97±0.54 mg/L) serum Cys-C was significantly higher than control group (0.88 ±0.10mg/L)(P< 0.01). Cardiac function grade Ⅱ group (2014.28±276.04 ng/L), cardiac function level Ⅲ group (5079.29±330.19 ng/L) and cardiac function level Ⅳ group (8950.17±403.55 ng/L) serum NT-proBNP were very significant different(P<0. 01). Cardiac function grade Ⅱ group (77.23±13.92 umol/L), cardiac function level Ⅲ group (89.18±19.13 umol/L) and cardiac function level Ⅳ group (97.96±15.45 umol/ L) Scr were significant different(P<0.05). Cardiac function grade Ⅱ group (49.96±3. 97), cardiac function level Ⅲ group 39.86±3.32) and cardiac function level Ⅳ group (33.63±2.82) had very significant difference(P<0.05). With cardiac function increased, creatinine, NT-proBNP and serum Cys-C gradually rised, LVEF was falling. Correlation analysis of serum Cys-C (r=-0.510, P<0.01), creatinine (r=-0.486, P<0.01),the NT-proBNP (r=-0.943, P<0.01) and cardiac function classification were negatively correlated, LVEF was in a positive relationship with cardiac function classification (r=0.886, P<0.01)5. The relationships between CHF patients serum Cys-C and serum creatinine,NT-proBNP,LVEF:Correlation analysis, CHF group serum Cys-C positiveiy correlated with serum creatinine (r=0.239, P<0.01), the NT-proBNP (r=0.481, P<0.01 a nd negatively correlated with LVEF (r=-0.484, P<0.01).Conclusion:1. Patients with CHF serum Cys-C were significantly increased, serum Cys-C levels on the clinical diagnosis of CHF has reference value.2. Patients with CHF serum Cys-C level were in significantly different between TCM syndrome types. With the increase of serum Cys-C level, the lesion is serious, from the empirical to deficiency syndrome,from Qi deficiency to Yang deficiency.3. With the increase of cardiac function classification, Serum Cys-C level gradually increased. Patients with CHF serum Cys-C was positively related with the serum NT-proBNP、Scr and negatively related to the LVEF.This suggests serum Cys-C had certain value in evaluating the severity of cardiac dysfunction.