原发性高血压中医证型与心率变异性的关系

The relationship between TCM syndromes of primary hypertension and heart rate variability

目的：探讨原发性高血压中医证型与心率变异性的关系，评估疾病及判定预后，指导临床辨证施治。方法收集2013年1月-12月西苑医院符合临床诊断标准及中医辨证分型标准的高血压患者182例，按中医辨证标准将患者分为肝火上炎证、痰湿内阻证、瘀血内阻证、阴虚阳亢证和气血两虚证，另设同期门诊查体60例健康人为对照组，采用动态心电图检测心率变异性指标并进行对比统计分析。结果肝火上炎证与平均正常R-R间期标准差（SDNN）、相邻R-R间期差的均方（RMSSD）、低频成分（LF）、高频成分（HF）、总的域值（TP）呈正相关（r 分别为0.161、0.372、0.223、0.281、0.301）；痰湿内阻证与SDNN、HRV三角指数（HRV triangular index）、极低频成分（VLF）、LF、极低频高频比（VLF/HF）、低频高频比（LF/HF）、标一化低频（LFnorm）呈正相关（r 分别为0.175、0.211、0.174、0.262、0.159、0.264、0.263）；瘀血内阻证与 LF、HF 呈负相关（r 分别为-0.185、-0.018）；阴虚阳亢证与 SDNN、RMSSD、VLF、LF呈负相关（r分别为-0.204、-0.161、-0.184、-0.197）；气血两虚证与SDNN、每5 min正常R-R间期均值的标准差（SDANN）、RMSSD、HRV triangular index、VLF、LF、LFnorm呈负相关，与HFnorm呈正相关（r分别为-0.353、-0.348、-0.258、-0.303、-0.268、-0.361、-0.352、0.267）。结论高血压患者不同证型自主神经功能失调具有不同特征，既反映了不同中医证型重要病变机理，也与高血压病程密切相关，为临床辨证诊断提供客观依据。

Objective To investigate the relationship between primary TCM syndromes and heart rate variability in hypertension, evaluate the development of disease. Methods 182 hypertension patients were recruited in accordance with the standard of hypertension. According to the Chinese medicine dialectical criteria, these patients were further divided into 5 groups, namely, hyperactivity of liver-fire group, phlegm-dampness retention group, blood stasis group, hyperactivity of Yang due to yin deficiency group and Qi and blood deficiency group. Another 60 healthy people were recruited as a control group. 24h Holter was adopted to monitor heart rate variability. Results Analysis of TCM syndromes and heart rate variability, anger on inflammation group had positive relation with SDNN, RMSSD, LF, HF and TP（r were respectively 0.161,0.372, 0.223, 0.281, 0.301）;Phlegmy wet resistance groups had positive relation with SDNN, HRV triangular index, VLF, LF, VLF/HF, LF/HF, LFnorm.（r were respectively 0.175, 0.211, 0.174, 0.262, 0.159, 0.264, 0.263）;blood stasis group had negative relation with LF/HF, LFnorm（r were respectively-0.185、-0.018）.Yang due to yin deficiency group had negative relation with SDNN, RMSSD, VLF, LF.（r were respectively -0.204, -0.161,-0.184,-0.197）;Qi and blood deficiency group had negative relation with SDNN, SDANN, RMSSD and HRV triangular index, VLF, LF, LFnorm, and had positive relation with HFnorm（r were respectively-0.353,-0.348,-0.258, -0.303, -0.268, -0.361, -0.352, 0.267）. Conclusion Hypertension patients with different type of＆nbsp;TCM syndromes had different characteristics of autonomic nerve functional disorders, which both reflected the important pathological changes of TCM syndromes and had close relation with the course of hypertension, providing objective basis for clinical diagnosis of syndrome differentiation.