Analysis Of Correlation Between Heart Failure And Subclinical Hypothyroidism And Tcm Syndrome Factors Distribution

Aims:(1)This study is aiming to explore the correlation between heart failure(HF)and Subclinical hypothyroidism(SCH),compare HF with different degrees of SCH and explore the risk factors of HF combined with SCH.(2)Aiming to summarize the distribution pattern of TCM syndrome factors in HF combined with SCH,compare the distribution differences of TCM syndrome factors between HF combined with SCH and HF with normal thyroid function,extract the main TCM pattern,and explore the TCM etiology,in order to provide new ideas for clinical treatment.Methods:Collecting clinical data of HF patients combined with SCH hospitalized in Hospital of Chengdu University of TCM from December 2006 to October 2018,finally including 92 patients as the observation group according to the inclusion and exclusion criteria,using age as the matching factor,age ± 3 years as the matching conditions,and finally including 92 heart failure patients in the same period as the control group according to a 1:1 ratio.Dividing the observation group according to TSH levels in order to subgroup analyze,in which a total of 17 patients in the HF combined with severe SCH group(TSH≥10u IU /ml)were assigned to group A,and 75 patients in the HF combined with severe SCH group(TSH5.0-9.9 u IU/ml)were assigned to group B.The information of age,gender,blood pressure,heart rate,smoking,drinking,duration of heart failure,length of hospital stay,number of hospitalizations due to cardiovascular events within one year,biochemical indexes,cardiac function indexes,and four diagnoses of TCM were collected from the two groups,and the data were processed by spss25.0 statistical software,and t-test、ANOVA、rank sum test、chi square test and LSD post hoc test were selected to compare the collected baseline resources and biochemical indexes,cardiac function indexes,differences among age and in syndrome factors distribution of TCM,Use PCC and SCC to analyze the correlation between TSH and HF,select logistic regression to summarize the peril elements of SCH tend to occur in HF patiens,statistical description was used to summarize the distribution law of pathogenic syndromes of TCM locations,and cluster analysis was selected to extract the main TCM Syndromes of HF combined with SCH.Results:(1)The correlation between heart failure and SCH :(1)baseline data comparison:The observation group has a higher female composition and a lower smoking prevalence than the control group(P=0.05,P=0.013);Subgroup analysis show a higher female composition ratio and a lower smoking prevalence in group B than in group A and the control group.(all P<0.05)(2)Clinical record data:Compared with the reference group,heart failure duration,lengte of hospitalisation and nummer of hospitalizations due to cardiovascular events within one year are greater in the observation group(P=0.035,P=0.014,P<0.001),subgroup analysis show that group A had a higher number of hospitalizations and a longer duration and length of hospital stay than group B(all P<0.05);The Crea and BUN levels in the observation group are higher and the ALT and LDL-C levels are lower than the reference group(P=0.026、P=0.032、P=0.050、P=0.011),subgroup analysis show that compared with reference group,the LDL-C level is lower in group B;Compared with reference group TSH level is higher and FT3,FT4 levels are lower in observation group(P<0.001,P<0.001,P=0.003);A higher NT-pro BNP levels and a worse cardiac function are presenting in the observation group(P<0.001,P=0.008),subgroup analysis does not reveal differences between A and B.(3)Correlation analysis show that TSH level is positively correlated with NT-pro BNP,NYHA grade,length of hospital stay and the number of hospitalizations due to cardiovascular events in one year(P<0.001);FT3 level is negatively correlated with NT-pro BNP,NYHA grade and length of hospital stay(P<0.05).(4)Logistic regression show that NT-pro BNP level and the number of hospitalizations due to cardiovascular events within one year are the risk factors of HF combined with SCH(P=0.006,P=0.010).(2)Combinatorial pattern and difference of distribution of TCM syndrome factors(1)the distribution pattern of TCM syndrome factors : in the observation group the disease location is dominated by heart,lung,spleen and kidney,while the pathogenicity is dominated by qi deficiency,blood stasis,phlegm,water withdrawal,yin deficiency,Yang deficiency and drinking.(2)differential comparison of TCM syndrome factors:More spleen and kidney disease locations are observed in the observation group than in the control group(P<0.001),and Yang deficiency,water withdrawal,drinking,sputum pathogenicity factors are more prominent.(3)Differences in the distribution of factors stratified by age show that the distribution of the pathology factors as wet is higher in patients aged 81-100 years and 40-60 years than in those aged 61-80 years(P<0.05)(4)Cluster analysis concern that Qi deficiency-blood stasis and Yang deficiency-water diffusion are the major TCM Syndrome of HF combined with SCH.Conclusion:(1)HF patients with SCH are sicker and have poor prognosis than HF patients with normal thyroid function,and there may be a relationship between TSH levels \FT3 levels and the degree of HF and prognosis NT-pro BNP levels,the number of hospitalizations due to cardiovascular events in a year are risk factors for the development of SCH in HF patients.(2)The prominent syndrome,pathological factors and location of HF combined with SCH are Yang deficiency,water withdrawal,phlegm,drinking,spleen and kidney,the more severe the degree of SCH is,the more prominent kidney,Yang deficiency and water withdrawal are,and the most common syndrome of HF combined with Sch is Qi Deficiency Blood Stasis and yang deficiency water.