不同中医证候盐敏感性高血压病人24 h动态血压及心率变异性差异研究

Study on 24 Hours Ambulatory Blood Pressure and Heart Rate Variability of Different TCM Syndromes in Patients with Salt-sensitive Hypertension

目的探讨盐敏感性高血压不同中医证候间血压特点及差异,并对心率变异性进行研究,以明确自主神经张力对不同中医证候盐敏感性高血压病人血压的影响。方法选择131例盐敏感性高血压病人,运用动态血压及动态心电图对不同中医证候组间血压及心率变异性差异进行分析。结果 24 h平均收缩压(24 h ASBP)、日间平均收缩压(DASBP),脾肾阳虚、水饮内停组>阴虚阳亢组,差异有统计学意义(P<0.05);夜间平均收缩压(NASBP),脾肾阳虚、水饮内停组明显高于其他两组,差异有统计学意义(P<0.05);24 h平均舒张压(24 h ADBP),痰湿壅盛及脾肾阳虚、水饮内停组明显高于阴虚阳亢组(P<0.05);日间平均舒张压(DADBP)、夜间平均舒张压(NADBP)脾肾阳虚、水饮内停组明显高于阴虚阳亢组(P<0.05);24 h平均动脉压(24 h APP)、日间平均动脉压(DAPP),脾肾阳虚、水饮内停组明显高于阴虚阳亢组(P<0.05);24 h收缩压变异系数(24 h SBPV)、日间收缩压变异系数(DSBPV)、24 h舒张压变异系数(24 h DBPV)、日间舒张压变异系数(DDBPV)、夜间舒张压变异系数(NDBPV),脾肾阳虚、水饮内停组明显高于阴虚阳亢组(P<0.05);24 h舒张压负荷(24 h DBPL)、日间舒张压负荷(DDBPL)、夜间舒张压负荷(NDBPL),脾肾阳虚、水饮内停组明显高于阴虚阳亢组(P<0.05)。夜间收缩压下降率(NSBPRR)、夜间舒张压下降率(NDBPRR),脾肾阳虚、水饮内停组明显低于痰湿壅盛组(P<0.05)。心率变异性比较结果:脾肾阳虚、水饮内停组24 h总心搏数及平均心率均明显高于阴虚阳亢组和痰湿壅盛组(P<0.05);脾肾阳虚、水饮内停组窦性R-R间期(NN间期)(SDNN)、RR间期平均值标准差(SDANN)、相邻NN间期差的标准差(SDSD)、三角指数明显低于其他两组(P<0.05);而RR间期差值的均方根(RMSSD)、相邻NN之差>50 ms占总心搏百分比(PNN50)组间比较,差异无统计学意义(P>0.05)。结论盐敏感性高血压脾肾阳虚、水饮内停证血压程度最高,血压负荷最重,血压节律紊乱且夜间血压下降不足,相应的交感神经张力增高最明显,提示脾肾阳虚、水饮内停证交感神经张力增高可能是其血压高于其他证候的原因之一。

ObjectiveTo investigate the characteristics of blood pressure and heart rate variability(HRV)in patients with salt-sensitive hypertension and different traditional Chinese medicine(TCM)syndromes,to determine the effect of autonomic nerve tension on the blood pressure of different TCM syndromes in salt-sensitive hypertension.MethodsOne hundred and thirty-one patients with salt-sensitive hypertension were selected,and the differences of blood pressure and HRV among different TCM syndrome were analyzed by ambulatory blood pressure and ambulatory electrocardiogram.ResultsThe levels of 24 h average systolic blood pressure(ASBP)and daytime ASBP(DASBP)in patients with spleen-kidney yang deficiency syndrome and harmful fluid retention syndrome were higher than that in patients with yin deficiency and yang excess syndrome(P<0.05).The levels of night-time ASBP(NASBP)in patients with spleen-kidney yang deficiency syndrome and harmful fluid retention syndrome were higher than that in patients with yin deficiency and yang excess syndrome and phlegm-dampness syndrome(P<0.05).The levels of 24 h average diastolic blood pressure(ADBP)in patients with spleen-kidney yang deficiency syndrome,harmful fluid retention syndrome,and phlegm-dampness syndrome were higher than that in patients with yin deficiency and yang excess syndrome(P<0.05).The levels of daytime ADBP(DADBP)night-time ADBP(NADBP)and in patients with spleen-kidney yang deficiency syndrome and harmful fluid retention syndrome were higher than that in patients with yin deficiency and yang excess syndrome(P<0.05).The levels of 24 hAPP,DAPP in patients with spleen-kidney yang deficiency syndrome and harmful fluid retention syndrome were higher than that in patients with yin deficiency and yang excess syndrome(P<0.05).The levels of 24 hSBPV,DSBPV,24 hDBPV,DDBPV,and NDBPV in patients with spleen-kidney yang deficiency syndrome and harmful fluid retention syndrome were higher than that in patients with yin deficiency and yang excess syndrome(P<0.05).The levels of 24 hDBPL,DDBPL,and NDBPL in patients with spleen-kidney yang deficiency syndrome and harmful fluid retention syndrome were higher than that in patients with yin deficiency and yang excess syndrome(P<0.05).The levels of NSBPRR,and NDBPRR in patients with spleen-kidney yang deficiency syndrome and harmful fluid retention syndrome were lower than that in patients with phlegm-dampness syndrome(P<0.05).The levels of 24 hours total heart rate and average heart rate in patients with spleen-kidney yang deficiency syndrome and harmful fluid retention syndrome were higher than that in patients with yin deficiency and yang excess syndrome and phlegm-dampness syndrome(P<0.05).The levels of SDNN,SDANN,SDSD,and triangle index in patients with spleen-kidney yang deficiency syndrome and harmful fluid retention syndrome were lower than that in patients with yin deficiency and yang excess syndrome and phlegm-dampness syndrome(P<0.05).Conclusion Salt-sensitive hypertensive patients with spleen and kidney yang deficiency and harmful fluid retention syndrome have the highest blood pressure,the most severe blood pressure load,the most disordered blood pressure rhythm,insufficient nighttime blood pressure,and most obvious increasement of sympathetic nerve tension.It suggests that the elevation of sympathetic nerve tension in patients with spleen and kidney yang deficiency and harmful fluid retention syndrome may be one of the reasons for its higher blood pressure than other syndromes.