| Purpose: This thesis focuses on the characters of different TCM syndromes in chronic-heart- failure patients with B-type Natriuretic Peptide(BNP) and the related factors of their life quality. By the research, some clinical references for Chinese medicine treatment for the heart failiure can be achieved.Method: 152 inpatient or outpatient cases of heart failure from March 2012 to December 2014 were chosen as analyze samples from University Hospital of Gansu Traditional C hinese Medicine. Patients’ data such as past medical history, BNP, liver function, kidney function was collected. According to Chinese Medicine Treatment Program for Heart Failure(CHF)(Trial), the patients were classified as four groups:(a) Q i-deficiency on cardiopulmonary, blood-stasis and stop-drinking;(b) Qi and Yin-deficiency and blood-stasis;(c) Yang-deficiency, blood-stasis and water-stop;(d) loss of kidney essence and deficiency on both Yin and Yang. MOS SF-36(C hinese version) rating scale is carried out to apply a questionnaire. The collected data is statistics analyzed.Results:(1). In the 152 cases, BNP of male patients is higher than female patients(P<0.05). BNP increases with the patients’ cardiac function level from Ⅱ to Ⅳ(P<0.05). However, patients of different ages show no evident difference on BNP(P>0.05).(2). Descending order of TCM syndromes of the fo ur groups is: Yang-deficiency, blood-stasis and water-stop(51 cases, 33.55%), Q i-deficiency on cardiopulmonary, blood-stasis and stop-drinking(38 cases, 25%), Q i and Yin-deficiency and blood-stasis(35 cases, 23.03%), loss of kidney essence and deficienc y on both Yin and Yang(28 cases, 18.42%). Distribution of different TCM syndromes shows no evident discrepancy on different ages(P>0.05). BNP level of the four groups from lower to higher are: Q i-deficiency on cardiopulmonary, blood-stasis and stop-drinking, Q i and Yin-deficiency and blood-stasis, loss of kidney essence and deficiency on both Yin and Yang, Yang-deficiency, blood-stasis and water-stop(P<0.05).(3). Discrepancies are detected on the TCM syndromes of the patients with different BNP level. Among the 75 patients with BNP 100-400pg/m L, Q i-deficiency on cardiopulmonary, blood-stasis and stop-drinking are detected for the most(26 cases, 34.67%). And among the 77 patients with BNP>400pg/m L, Yang-deficiency, blood-stasis and water-stop are detected for the most(34 cases, 44.16%).(4). The top three symptoms emerge in the total 152 cases are short of breath(134 cases, 88.16%), chest distress(129 cases, 84.87%), and cardiopalmus(99cases, 65.13%). By comparing the TCM symptoms of the two groups with different BNP levels, five syndromes(lower extremity edema, unable lying, cough, oliguria, and chills) are more popular in the patients with BNP>400 than that with BNP100-400. In addition, patients with BNP>400 achieve obvious higher severe- level-score than patients with BNP level(100-400). Blood-stasis was detected for the most in the TCM syndromes, counting for 124 cases.(5). SF-36 shows a good internal consistency. The two factors generated by factor analysis are basically consistent with the theoretical structure of SF-36.(6). Life quality of the patients are found no significant difference(P>0.05) between genders. Two health dimensions(RP and VT) are more obviously affected by increasing age(P<0.05). BNP of the 152 patients were negatively cor related with the eight dimensions. Four health dimensions(PF, GH, RE and MH) of the 152 patients have significant differences(P <0.05) between different TCM syndrome.(7). Three factors(age, whether suffering from cardiomyopathy or not, and liver function) correlate with SF-36 life quality score of the patients who suffering from Q i-deficiency on cardiopulmonary, blood-stasis and stop-drinking, and the coefficient of determination is 0.219. Two factors(cardiac function level and whether suffering from valvular heart disease or not) correlate with SF-36 life-quality score of the patients suffering from Q i and Yin-deficiency and blood-stasis, and the coefficient of determination is 0.580. Three factors(whether suffering from coronary heart disease or not, heart function level and smoking history) correlate with SF-36 life quality score of the patients who suffering from Yang-deficiency, blood-stasis and water-stop, and the coefficient of determination is 0.415. Three factors(whether suffering from coronary heart disease or not, whether suffering from chronic obstructive pulmonary disease or not and disease duration) correlate with SF-36 life quality score of the patients who suffering from loss of kidney essence and deficiency on both Yin and Yang, and the coefficient of determination is 0.440.Conclusion: 1. In the 152 heart failure patients, BNP of male patients is higher than female patients. BNP increases with the patients’ cardiac function level. BNP level of the four groups from lower to higher are: Q i-deficiency on cardiopulmonary, blood-stasis and stop-drinking, Q i and Yin-deficiency and blood-stasis, loss of kidney essence and deficiency on both Yin and Yang, Yang-deficiency, blood-stasis and water-stop. 2. Syndromes of lower extremity edema, unable lying, cough, oliguria, and chills is more evident in the patients whose BNP is higher than 400pg/m L. The main elements of TCM syndromes are blood-stasis, water-drinking, and heart Q i deficiency. 3. SF-36(Chinese version) used in this study shows good validity and reliability on evaluate of the life quality of heart failure patients. 4. Patients of different ages are significantly different in RP and VT health dimensions. There are significant differences in PF, GH, RE and MH health dimensions among different TCM syndromes. 5. Age and myocardiopathy are the main factors that affect the life quality of patients suffering from Q i-deficiency on cardiopulmonary, blood-stasis and stop-drinking. Heart function and valvular heart disease are the main factors that affect the life quality of patients suffering from Q i and Yin-deficiency and blood-stasis. Coronary heart disease, kidney function and smoking history are the main factors that affect the life quality of patients suffering from Yang-deficiency, blood-stasis and water-stop. Coronary heart disease, chronic obstructive pulmonary disease, and liver function are the main factors that affect the life quality of the patients who suffering from loss of kidney essence and deficiency on both Yin and Yang. |
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