高血压病中医病性证素分布与血管内皮相关性研究

Study on Correlation Between Distribution of TCM Syndrome Elements and Vascular Endothelium in Hypertension

目的探讨高血压病中医病性证素分布规律及其与血管内皮损伤相关指标的关系。方法收集198例高血压病患者四诊资料,参照"证候辨证素量表"赋予简化计量权值后,分析高血压病患者中医病性证素分布特征,检测患者血清一氧化氮(NO)、内皮素-1(ET-1)及血管性血友病因子(vWF)水平,分析其与中医病性证素的相关性。结果 198例高血压病患者前8位的中医病性证素依次为阴虚>阳亢>血瘀>痰浊>气虚>气滞>血虚>阳虚,以2个证素相兼所占比例最高(69.7%)。病性证素在各年龄、各级别高血压病患者分布差异均有统计学意义(P<0.01):中青年组以阳亢、血瘀、气滞为主,老年组以气虚、阴虚、痰浊为主,1级高血压以阳亢、血瘀为主,2级高血压以阴虚、阳亢为主,3级高血压以阴虚、痰浊、气虚为主。回归分析显示:NO为阴虚、血虚、气虚证素危险因素,ET-1为阳亢证素危险因素,v WF为血瘀、痰浊证素危险因素,体质量指数与血瘀和痰浊呈正相关,运动频度与血瘀呈负相关。结论高血压病主要中医病性证素为阴虚、阳亢、血瘀,其中以阴虚+阳亢、阴虚+血瘀比例最高。血清NO、ET-1、v WF水平变化可提示高血压病中医病性证素存在情况。

Objective To investigate the distribution of TCM syndrome elements in hypertension and its relationship with vascular endothelial injury. Methods Four diagnostic data of 198 patients with hypertension were collected, and simplified measuring weight was conducted referring to "symptoms differentiation study scale". The distribution of TCM syndrome elements in hypertension was analyzed. The levels of serum nitric oxide(NO), endothelin-1(ET-1) and von Willebrand factor(vWF) in patients with hypertension were detected, and its correlation with TCM syndrome elements was analyzed. Results The common TCM syndrome elements of 198 patients with hypertension were yin deficiency > yang excess > blood stasis > phlegm turbidity > qi deficiency > qi stagnation > blood deficiency > yang deficiency, the two syndromes with the highest proportion(69.7%). There was statistical significance in the distribution of syndrome elements among patients of different ages and different levels(P<0.01): yang excess, blood stasis and qi stagnation were dominant in the young and middle-aged group, while qi deficiency, yin deficiency and phlegm turbidity were dominant in the elder group. Grade 1 hypertension was mainly yang excess and blood stasis. Grade 2 hypertension was mainly yin deficiency and yang excess. Grade 3 hypertension was mainly yin deficiency, phlegm turbidity and qi deficiency. Regression analysis showed that NO was a risk factor for yin deficiency, blood deficiency and qi deficiency syndromes, ET-1 was a risk factor for yang excess, and vWF was a risk factor for blood stasis and phlegm turbidity. BMI was positively correlated with blood stasis and phlegm turbidity. Exercises frequency was negatively correlated with blood stasis. Conclusion The main TCM syndrome elements of hypertension are yin deficiency, yang excess and blood stasis, and the combination of yin deficiency + yang excess and yin deficiency + blood stasis accounts for the largest proportion. Changes in plasma levels of NO, ET-1 and vWF may indicate the presence of some TCM syndrome elements in hypertension.