老年高血压中医证型特征与心血管预后危险因素相关性分析

Analysis on Correlation Between TCM Syndrome Types and Cardiovascular Prognosis Risk Factors of Elderly Hypertensive Patients

目的观察3个不同城乡社区老年高血压各中医证型分布情况,并分析其与心血管预后危险因素的相关性。方法从参加中国中医科学院健康管理课题组"健康监测调查问卷"的896例受访者中筛选出符合老年高血压诊断标准的患者299例,根据《中药新药临床研究指导原则(试行)》中高血压中医证型分型标准及血瘀证分型标准对其中医四诊信息进行辨证分型,采用放射免疫法、循环酶法等方法检测血糖、血脂、血肌酐(SCr)、血浆内皮素(ET)、同型半胱氨酸(Hcy)及尿微量白蛋白(m ALB)等相关风险指标,并采集记录其年龄、性别、体质指数(BMI)、血压等一般资料。结果 299例老年高血压患者中,阴阳两虚证74例,阴虚阳亢证65例,瘀血阻络证62例,痰湿壅盛证61例,肝火亢盛证37例。单因素分析显示,心血管预后风险指标中BMI、空腹血糖、糖化血红蛋白、SCr、总胆固醇、低密度脂蛋白胆固醇、ET、Hcy及m ALB在5种中医证型之间差异有统计学意义(P<0.05,P<0.01),其中痰湿壅盛证、瘀血阻络证、阴虚阳亢证之间差异较为明显。判别分析表明BMI及Hcy对老年高血压中医证型的诊断具有一定的参考价值。二分类Logistic回归分析表明病程与阴阳两虚证型呈正相关。结论与其他证型相比,痰湿壅盛证、瘀血阻络证与引发老年高血压的诸多心血管预后危险因素关系较为密切。

Objective To observe the regularities of distribution of TCM syndrome types and correlation between TCM syndrome types and cardiovascular prognosis risk factors of elderly hypertensive patients in three different urban and rural communities. Methods Totally 299 elderly hypertensive patients who conformed to the hypertensive diagnostic criteria from 896 respondents which participated in the health monitoring questionnaire drafted by health management team of China Academy of Chinese Medical Sciences were screened. The syndrome types were differentiated according to Guiding Principle of Clinical Research on New Drugs of Traditional Chinese Medicine(for Trial Implementation). The levels of some risk indicators, such as blood glucose, blood lipid, CREA, ET, Hcy and m ALB were measured by radioimmunoassay, enzymatic cycling assay and other methods. Age, gender, BMI and pulse pressure were recorded. Results The TCM syndrome types of 299 elderly hypertensive patients were deficiency of yin and yang type(74 cases), hyperactivity of yang due to yin deficiency type(65 cases), blood stasis syndrome type(62 cases), stagnation of phlegm-dampness type(61 cases), hyperactivity of liver-fire type(37 cases). Single factor analysis showed that there existed statistical significance among BMI, FBG, GHb A1 c, CREA, TC, LDL-C, ET, Hcy and m ALB in the 5 TCM syndromes(P <0.05, P <0.01), and the statistical significance was more apparent in the stagnation of phlegm-dampness type, blood stasis syndrome type and hyperactivity of yang due to yin deficiency type. Discriminant analysis showed BMI and Hcy have certain reference value for the diagnosis of TCM syndrome types in elderly hypertensive patients. Binary-Logistic regression analysis showed that the course of disease had a positive correlation with syndrome of deficiency of yin and yang. Conclusion Compared with other types of elderly hepertensive patients, stagnation of phlegm-dampness type and blood stasis syndrome type are more closely related to hypertension cardiovascular prognosis risk factors.