探究慢性心力衰竭患者阳虚血瘀证与心功能及血清B型氨基端利钠肽原（NT-proBNP）表达的相关性以及二者对 患者预后的影响。【方法】 选取2019年1月至2021年1月期间唐山市中医医院收治的320例慢性心力衰竭患者作为研究对象， 根据中医辨证分型结果，将辨证为阳虚血瘀证的160例患者作为观察组，将辨证为气虚血瘀证或气阴两虚证的160例患者作 为对照组；并对慢性心力衰竭阳虚血瘀证患者出院后进行为期1年的随访，根据随访结果，将患者分为良好预后组104例和 不良预后组56例。采用Spearman相关性分析患者中医证型与血清NT-proBNP水平及心功能指标左室射血分数（LVEF）、左室 舒张末期内径（LVEDD）、每分钟搏出量（SV）、心排血量（CO）之间的相关性；采用多因素 Logistic回归分析探讨影响患者不 良预后的危险因素。【结果】（1）观察组患者的血清 NT-proBNP 水平及 LVEDD 值均明显高于对照组，LVEF、SV、CO值均低 于对照组，差异均有统计学意义（P＜0.05或P＜0.01）。（2）Pearson相关性分析结果显示，慢性心力衰竭患者中医证型与血清 NT-proBNP水平及LVEDD值呈正相关，与LVEF、SV、CO值呈负相关，差异均有统计学意义（P＜0.01）。（3）慢性心力衰竭阳 虚血瘀证患者不良预后组血清 NT-proBNP 水平及 LVEDD 值均明显高于良好预后组，LVEF、SV、CO值均低于良好预后组， 差异均有统计学意义（P＜0.01）。（4）血清 NT-proBNP 联合心功能指标对预后不良评估的曲线下面积（AUC）为 0.942。Logistic 回归分析结果显示，血清NT-proBNP高水平、LVEDD高水平均为影响慢性心力衰竭阳虚血瘀证患者发生不良预后的危险因 素（P＜0.01），而 LVEF高水平、SV高水平、CO高水平均为保护因素（P＜0.05或 P＜0.01）。【结论】 慢性心力衰竭阳虚血瘀 证患者血清 NT-proBNP 水平升高，阳虚血瘀证与血清 NT-proBNP 水平及心功能关系密切，且 NT-proBNP水平及心功能与 患者预后有关。

To investigate the correlation of yang deficiency and blood stasis syndrome with cardiac function and serum B-type N-terminal pro-brain natriuretic peptide （NT-proBNP） expression in patients with chronic heart failure and their influence on the prognosis of patients. Methods A total of 320 patients with chronic heart failure admitted to Tangshan Hospital of Traditional Chinese Medicine from January 2019 to January 2021 were selected as the research objects. According to the results of traditional Chinese medicine （TCM） syndrome differentiation， 160 patients differentiated as yang deficiency and blood stasis syndrome were allocated to the observation group， and 160 patients differentiated as qi deficiency and blood stasis syndrome or qi and yin deficiency syndrome were allocated to the control group. The patients with chronic heart failure of yang deficiency and blood stasis syndrome were followed up for one year after discharge. Based on the follow-up results， the followed-up patients were divided into good prognosis group （104 cases） and poor prognosis group （56 cases）. Spearman correlation analysis was used to analyze the correlation of TCM syndromes with serum NT-proBNP levels and cardiac function indicators such as left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVEDD），stroke volume per minute （SV），and cardiac output （CO）. Multivariate logistic regression analysis was used to explore the risk factors affecting the poor prognosis of patients. Results （1） The serum NTproBNP level and LVEDD value of the observation group were significantly higher and the LVEF， SV and CO values were lower than those of the control group，and the differences were statistically significant （P＜0.05 or P＜ 0.01）.（2） Pearson correlation analysis showed that TCM syndromes in patients with chronic heart failure were positively correlated with serum NT-proBNP level and LVEDD value，and were negatively correlated with LVEF， SV and CO values，the differences being statistically significant （P＜0.01）.（3） The levels of serum NT-proBNP and LVEDD in the poor prognosis group were significantly higher and the values of LVEF，SV and CO were lower than those in the good prognosis group，and the differences were statistically significant （P＜0.01）.（4） The area under the curve （AUC） of serum NT-proBNP combined with cardiac function indicators for predicting the poor prognosis was 0.942. Logistic regression analysis showed that high levels of serum NT-proBNP and LVEDD were the risk factors for poor prognosis （P＜0.01），while high levels of LVEF，SV and CO were the protective factors （P＜0.05 or P＜0.01） in the patients with chronic heart failure of yang deficiency and blood stasis syndrome. Conclusion The serum NTproBNP level in patients with chronic heart failure of yang deficiency and blood stasis syndrome is increased. Yang deficiency and blood stasis syndrome is closely related to the serum NT-proBNP level and cardiac function indicators，and NT-proBNP level and cardiac function indicators are correlated with the prognosis of the patients.

R259.416

河北省中医药管理局科研项目（编号：2018327）