不同中医辨证分型的高血压患者颈动脉血管重构变化

Changes ofReconstitution of Carotid Arterial Vesselof Patients with Hypertension by Using Different Dialectical Types of TCM

目的:观察不同中医证型高血压患者的颈动脉血管重构变化,并与正常人对照,探讨其规律性。方法:选择原发性高血压病患者105例和同期进行健康体检的正常人35例(对照组),全部对象在治疗前接受中医辨证分型和彩色多普勒超声检查,常规探测双侧颈总动脉、颈总动脉分叉处、颈内动脉等部位,检测动脉血管重构指标及血流速度指标。结果:105例原发性高血压病中医证型分布如下:肝火亢盛证24例(22.9%)、阴虚阳亢证37例(35.3%)、痰湿壅盛证16例(15.2%)、阴阳两虚证28例(26.7%)。高血压病患者平均内膜增厚数和平均斑块形成数明显高于对照组。不同中医证型高血压患者及对照组颈动脉血管重构计数指标比较中,阴阳两虚证和痰湿壅盛证患者的颈动脉内膜增厚和动脉硬化斑块形成例数明显高于对照组(均P<0.05)。颈动脉各部位血管重构计量指标比较中,对照组的大部分LCCAIMT、RCCAIMT、LB IFIMT、RB IFIMT、LICAIMT和R ICAIMT等内膜-中膜厚度指标均明显低于不同中医证型高血压患者(均P<0.05),而各证型高血压患者组间比较中,肝火亢盛证和阴虚阳亢证等证型组的上述指标也明显低于阴阳两虚证和痰湿壅盛证组(均P<0.05)。在颈动脉血流速度指标比较中,对照组的大部分PSV、EDV、PSV/EDV和V等血流速度指标均明显高于不同中医证型高血压患者,而PI和R I多数指标明显低于前者(均P<0.05)。各中医证型上述指标组间比较中,肝火亢盛证和阴虚阳亢证等证型高血压患者的PSV、EDV和V等部分指标也明显高于阴阳两虚证和痰湿壅盛证组,PI和R I少数指标明显低于前两者(均P<0.05),而各组间多数PSV/EDV指标无明显区别(均P>0.05)。结论:各中医证型高血压常有不同程度的颈动脉血管重构和血流速度异常表现,特别是阴阳两虚证和痰湿壅盛证病人,对后者控制血压的同时,进行辨证施治有可能改善颈动脉血循环和减少靶器官损害的发生。

Objective： To investigate changes of reconstitution of carotid arterial vessel of patients with hypertension by using different dialectical types of traditional Chinese medicine （TCM） as compared with the normals in order to prohe into their regularity. Methods： Totally 105 in - patients or out - patients with primary hypertension and 35 normal people （ control group） were selectel. All subjects received dialectical typing of TCM and cardiac functional examination with Doppler ultrasonic cardiogram before treatment. The normal assay was common carotid artery of both sides, crotch of common carotid artery and internal carotid artery, then the index of reconstitution of carotid arterial vessel and index of blood flow rate. Results： The TCM dialectical types of 105 patients with primary hypertension were distributed as follow： 24 cases with florid anger （22.9%）, 37 with weak yin and strong yang （35.3%）, 16 with wet sputum and florid emphraxis （ 15.2% ） and 28 with weakness both on yin and yang （26.7%）. Average thickness of tunica intima and average plaque were obviously higher than those in control group. According to the distribution of abnormal cases, increased thickness of tunica intima of artery and number of plaque were higher than those in control group （ all P 〈 0.05）. In Comparison of vascular reconstitution, indexes such as LCCAIMT, RCCMMT, LBIFIMT, RBIFIMT, LICMMT and RICMMT in the control group were obviously lower than these of patients with different TCM dialectical typing hypertension （ all P 〈 0.05）. However, among comparisons in different TCM dialectical types ,above -mentioned indexes in hypertensive patients with florid anger and weak Yin and strong Yang were higher than those of patients with weakness both on Yin and Yang group and wet sputum and florid emphraxis group （ all P 〈 0.05 ）. Comparisons of arterial flow - rate index, indexes such as PSV, EDV, PSV/ EDV and V in the control group were lower than those of patients with different TCM dialectical typing hypertensions （ all P 〈 0.05）. Among comparisons of different TCM dialectical types, above - mentioned indexes such as PSV, EDV and V of patients with florid anger and weak Yin and strong Yang were higher than those of patients with weakness both on Yin and Yang group and wet sputum and florid emphraxis group, but a part indexes of PI and RI were lower than those in the former two （ all P 〈 0.05 ）, and indexes of PSV/EDV in each group were not significantly different （ all P 〉0.05 ）. Conclusion： Patients with different TCM dialectical typing hypertension show abnormality of vascular reconstitution of carotid artery and blood flow rate, especially patients of weakness both on Yin and Yang and with wet sputum and florid emphraxis. When blood pressure of the latter one is controlled, it is possible that blood circulation of carotid artery will be improved and injury of target organ will be reduced by using dialectical treatment.