310例原发性高血压病中医证型与心率变异性的关系

Correlation between TCM Syndrome and Heart Rate Variability in 310 Patients with Essential Hypertension

目的:探讨310例原发性高血压病不同中医证型与心率变异性的关系。方法:收集符合纳入标准的310例原发性高血压病患者中医四诊信息,对其进行辨证分型;另选取非高血压体检者50人作为健康对照组。360例观察对象均行24 h动态心电图检测,结合动态心电图结果提取心率变异性信息,心率变异指标包含SDANN(24 h内连续每5 min节段平均正常R-R间期的标准差)、SDNN(24 h内全部R-R间期的标准差)、rMSSD(相邻正常R-R间期差值的均方根)、pNN50(相邻正常R-R间期差值>50 ms的心搏占正常心搏总数的百分比)、VLF(超低频功率)、LF(低频功率)、HF(高频功率)、LF/HF,比较高血压患者不同证型的心率变异特点。结果:高血压病中医证型分布表现为痰湿壅盛证(37.10%)>肝肾阴虚证(28.71%)>肝阳上亢证(21.29%)>阴阳两虚型证(12.90%);高血压病各中医证型患者心率变异性指标均低于健康对照组,差异有统计学意义(P<0.05);阴阳两虚证组SDNN低于其他证型;痰湿壅盛证r MSSD低于肝肾阴虚证、肝阳上亢证,差异有统计学意义(P<0.05);肝阳上亢证组LF低于其他证型,差异有统计学意义(P<0.01)。结论:原发性高血压病中医证型以痰湿壅盛证出现的频率最高;原发性高血压病患者心率变异性低于健康正常组,其中各证型组心率变异性也有不同程度的降低;心率变异性对于评估高血压病不同中医证型的病情及预后有重要意义。

Objective:To investigate the relationship between different TCM syndrome types and heart rate variability in 310 patients with essential hypertension.Methods:A total of 310 patients with essential hypertension who met the inclusion criteria were enrolled in the TCM diagnosis,and the other 50 non-hypertensive patients were selected as the healthy control group.All the 360 subjects underwent 24 h dynamic electrocardiogram detection.The ECG results were used to extract heart rate variability information.The heart rate variability indicators included SDNN-24,SDANN,rMSSD,pNN50,VLF,LF,HF and LF/HF,and the heart rate variability was compared among different syndrome groups.Results:The distribution of TCM syndromes of hypertension was as follows:phlegm-dampness syndrome(37.10%)>liver and kidney Yin deficiency syndrome type(28.71%)>excessive rising of liver Yang syndrome(21.29%)>Yin-Yang deficiency syndrome(12.90%);Patients of all TCM syndromes showed lower heart rate variability index than healthy control group,and the difference was statistically significant(P<0.05).Yin-Yang deficiency syndrome group showed lower SDNN than other syndrome groups;Phlegm-dampness syndrome group showed lower r MSSD than liver and kidney Yin deficiency syndrome and excessive rising of liver Yang syndrome groups,and the difference was statistically significant(P<0.05);Excessive rising of liver Yang syndrome group showed lower LF other syndrome groups,and the difference was statistically significant(P<0.01).Conclusion:Among the TCM syndrome types of hypertension,the frequency of occurrence of phlegm-dampness syndrome is the highest;the heart rate variability of patients with hypertension is lower than that of healthy control group,and the heart rate variability of each syndrome group is also reduced to varying degrees;heart rate variability is important for assessing the condition and prognosis of different TCM syndrome types of hypertension.