原发性高血压患者认知功能状态与辨证分型的关系(英文)

Relationship between cognition and typology of syndrome differentiation of primary hypertension

背景:原发性高血压属于中国医学“眩晕”、“痴呆”范畴,近年来发现高血压等血管性危险因素对阿尔茨海默病患病风险构成影响。目的:探讨原发性高血压患者的认知功能状态及其与辨证分型的关系。设计:病例-对照分析。单位:江苏职工医科大学及扬州市汶河医院。对象:苏北某市2000-05/06期间初中以上文化程度,愿意配合调查的原发性高血压患者90例,并选择健康体检者共30名作为对照组。方法:原发性高血压患者先进行辨证分型,分成实证组(痰湿壅盛型、肝阳上亢型),虚证组(肝肾阴虚型、阴阳两虚型),虚中夹实组(兼血瘀、兼痰浊)以及对照组,应用神经心理学方法评定认知功能状态。主要观察指标:神经心理学指标:Fuld物品记忆测验,言语流畅性试验,积木测验,数字广度测验,Hachinski缺血指数量表,简易智能量表,日常生活能力量表。①各组内证型认知状态比较。②各组之间认知状态比较。③各组之间认知状态两两比较。结果:90例原发性高血压患者和30例健康体检者的数据均进入结果分析。与对照组比较,实证组各项观察指标统计学无显著性差异(P>0.05),虚证组除简易智能量表、日常生活能力量表外其他各项观察指标有统计学差异(P<0.05～0.01),而虚中夹实组各项观察指标均有统计学差异(P均<0.01),其中兼痰浊型较兼血瘀型重(Fuld物品记忆分别为11.3±3.7,13.5±2.5;数字广度分别为6.4±3.9,8.3±3.5,P<0.05)。结论:原发性高血压对患者智能状态有影响,虚证组有轻度认知功能减退。虚中夹实组有痴呆症状,其中兼痰浊型较兼血瘀型重。中医辨证分型结合神经心理学捡测有助于痴呆的早期发现和诊断。

BACKGROUND： Primary hypertension is in the category of ＂dizziness＂and ＂dementia＂ in Chinese medicine. It is discovered in recent years that vascular dangerous factors, like hypertension affect the risk constitution of Alzheimer disease.OBJECTIVE： To probe into relationship between cognition and syndrome differentiation of primary hypertension.DESIGN： Case-control analysis was designed.SETTING： Jiangsu Staff University of Medical Science and Yangzhou Wenhe Hospital.PARTICIPANTS： Totally 90 cases of primary hypertension were employed from May to June 2000. They were from some city in the north of Jiangsu province, graduated from middle school and cooperated with the investigation. Totally 30 cases were collected from physical-check group and taken in the control.METHODS： The cases of primary hypertension were differentiated as excess-syndrome group （excessive phlegm and damp and hyperactivity of liver yang）, deficiency-syndrome group （yin deficiency of liver and kidney and deficiency of yin and yang）, excess within deficiency group （complicated with blood stasis and with turbid phlegm） and the control group. Neuropsychological method was used to evaluate the cognition.MAIN OUTCOME MEASURES： Indexes of neuropsychology： Fuld object-memory Evaluation （FOM）, rapid verbal retrieve （RVR）, block design WISE （BD）, digit span WISE （DS）, Hachinski ischemic score （HACH）, mini-mental state examination （MMSE） and activity of daily living scale among groups.RESULTS： The data of 90 cases of primary hypertension and 30 cases in physical-check group entered result analysis. Compared with the control group, significant difference was not indicated in every statistical index in excess-syndrome group （P 〉 0.05）. In deficiency-syndrome group, except MMSE and ADL, the rest observed indexes indicated statistical difference.In excess within deficiency group, statistical difference presented in every observed index （P 〈 0.01）, in which the results in the complication of turbid phlegm was worse than blood stasis （FOM was 11.3±3.7,13.5±2.5 respectively; DS was 6.4±3.9,8.3±3.5, respectively）CONCLUSION： Primary hypertension affects mental state of patient, in which, cognition is declined mildly in deficiency-syndrome group. Dementia symptoms present in excess within deficiency group which is severe in phlegm type compared with blood stasis type. Differentiation of syndromes in Chinese medicine integrated with neuropsychological assessment benefits early discovery and diagnosis of dementia.