443例高血压病中医证型与靶器官损害的关系探讨

摘要

目的 探讨 443例高血压病人中医证型与靶器官损害的关系.方法 按照纳入标准选取 443例原发性高血压病病人,收集病人中医四诊、靶器官损害(颈动脉硬化、左心室肥厚、血清肌酐水平)相关的数据资料,对其进行辨证分型,并对不同证型病人的靶器官损害进行比较分析.结果 高血压各证型所占比例由高到低依次为肝肾阴虚证＞气阴两虚证＞阳气虚衰证＞痰湿壅盛证＞肝阳上亢证.痰湿壅盛证 24 h舒张压(24hDBP)、24h平均血压(24hMBP)高于肝肾阴虚证,差异有统计学意义(P＜0.05),其余各证型之间差异无统计学意义(P＞0.05);与气阴两虚证比较,肝肾阴虚证、阳气虚衰证平均心率较低,差异有统计学意义(P＜0.05).各中医证型颈动脉内膜中层厚度(IMT)比较差异无统计学意义(P＞0.05).与肝肾阴虚证相比,气阴两虚证室间隔厚度(IVSd)较大,差异有统计学意义(P＜0.05),其余各参数各证型之间比较差异无统计学意义(P＞0.05).各证型之间血肌酐、血尿酸、24h尿蛋白定量差异无统计学意义(P＞0.05).结论 高血压病人以肝肾阴虚证最多,肝阳上亢证最少;痰湿壅盛证高血压病人血压最高,肝阳上亢证血压最低;肝肾阴虚证颈动脉硬化程度最严重;痰湿壅盛证病人左心室肥厚程度较重;肝肾阴虚证病人血清肌酐值最高,肝阳上亢证 24 h尿蛋白定量最多.%Objective To study the relationships between traditional Chinese medicine (TCM) syndromes and target organ damage in patients with hypertention. Methods Four hundreds and forty-three patients with hypertention were selected.The data on TCM di-agnosis and target organ damage (carotid atherosclerosis,left ventricular hypertrophy,and serum creatinine levels) were collected. The target organ damages were compared and analyzed in patients with different syndromes. Results The proportion of TCM syndromes in patients with hypertension was as follows in descending order:liver-kidney yin deficiency syndrome,qi-yin deficiency syndrome, yang deficiency syndrome,phlegm-dampness syndrome,liver-yang hyperactivity syndrome. The 24-hour diastolic blood pressure (24 h DBP) and 24-hour mean blood pressure (24 h MBP) in phlegm-dampness syndrome were higher than those in liver-kidney yin deficiency syndrome ( P＜0.05). The average heart rate in liver-kidney yin deficiency syndrome and yang deficiency syndrome were lower than that in qi-yin deficiency syndrome ( P＜0.05). There was no significant difference in the carotid intima-media thick-ness (IMT) level among the different syndromes ( P＞0.05). The interventricular septal thickness at end diastole (IVSd) in qi and yin deficiency syndrome was larger than that in liver-kidney yin deficiency syndrome ( P＜0.05). There was no significant difference in the levels of creatinine,uric acid and 24-hour urinary protein among the different syndromes ( P＞0.05). Conclusion The main syn-drome is liver-kidney yin deficiency syndrome in patients with hypertention. The highest blood pressure is found in hypertensive pa-tients with phlegm-dampness syndrome,and the lowest blood pressure is found in liver-yang hyperactivity syndrome.The severity of carotid atherosclerosis is the most serious in patients with liver-kidney yin deficiency syndrome. Left ventricular hypertrophy is heav-ier in patients with phlegm-dampness syndrome. The highest value of serum creatinine is found in patients with liver-kidney yin de-ficiency syndrome. The quantification of 24-hour urine protein is the highest in liver-yang hyperactivity syndrome.