原发性高血压患者颅内动脉血流动力学与中医证候的相关性研究

Study on the correlation between intracranial artery hemodynamics and TCM syndromes in patients with essential hypertension

目的探讨原发性高血压患者颅内动脉血流动力学与中医证候的相关性。方法选择2018年1月—2019年6月在山东中医药大学附属医院就诊的189例原发性高血压患者作为研究对象,抽取同期接受健康体检的受试者47例作为对照组。由2名中医科副主任医师完成对患者的辨证分型,并由同一有经验的超声医师对所有受试者完成大脑中动脉(MCA)、大脑前动脉(ACA)血流动力学检查,记录平均血流速度(Vm)、血管脉冲指数(PI),分析高血压证型与颅内动脉血流动力学参数的相关性。结果189例患者中肝火上炎型34例(17.99%),瘀血内阻型26例(13.76%),痰湿内阻型54例(28.57%),阴虚阳亢型39例(20.63%),气血两虚型36例(19.05%)。肝火上炎型患者MCA的Vm快于对照组和其余证型患者(P均<0.05),瘀血内阻型、痰湿内阻型、气血两虚型患者MCA的Vm均慢于对照组(P均<0.05);肝火上炎型、阴虚阳亢型患者MCA的PI与对照组比较差异无统计学意义(P均>0.05),瘀血内阻型、痰湿内阻型、气血两虚型患者MCA的PI高于对照组和其余证型患者(P均<0.05);肝火上炎型、阴虚阳亢型患者ACA的Vm快于对照组(P均<0.05),瘀血内阻型和痰湿内阻型患者ACA的Vm慢于对照组(P均<0.05);肝火上炎型、阴虚阳亢型患者ACA的PI与对照组比较差异均无统计学意义(P均>0.05),瘀血内阻型、痰湿内阻型、气血两虚型患者ACA的PI均高于对照组和其余证型患者(P均<0.05)。MCA的Vm与肝火上炎型呈正相关(P<0.05),与瘀血内阻型、痰湿内阻型、气血两虚型呈负相关(P均<0.05),与阴虚阳亢型不存在相关性(P>0.05);ACA的Vm与肝火上炎型、阴虚阳亢型呈正相关(P均<0.05),与瘀血内阻型、痰湿内阻型呈负相关(P均<0.05),与气血两虚型不存在相关性(P>0.05);MCA、ACA的PI与肝火上炎型、阴虚阳亢型不存在相关性(P均>0.05),与瘀血内阻型、痰湿内阻型、气血两虚型呈正相关(P均<0.05)。结论原发性高血压颅内动脉血流动力学与辨证分型存在一定相关性,颅内动脉血流动力学有望为高血压准确辨证分型提供参考。

Objective It is to investigate the correlation between intracranial artery hemodynamics and syndromes of traditional Chinese medicine(TCM)in patients with essential hypertension(EH).Methods A total of 189 patients with EH treated in the Affiliated Hospital of Shandong University of TCM from January 2018 to June 2019 were selected as the research subjects,and 47 subjects who received physical examination during the same period were selected as the control group.Two associate senior doctor of the department of traditional Chinese medicine completed the syndrome differentiation and classification of the patients,and the same experienced sonographer completed the hemodynamic examinations of the middle cerebral artery(MCA)and anterior cerebral artery(ACA)of all subjects,and average blood flow velocity(Vm),vascular impulse index(PI)were recorded,and the correlation between hypertension syndrome and intracranial artery hemodynamic parameters was analyzed.Results Among the 189 patients,there were 34 cases of liver-fire flaming up(17.99%),26 cases of blood stasis inter-obstruction(13.76%),54 cases of phlegm-dampness inter-obstruction(28.57%),39 cases of Yin deficiency and Yang hyperactivity(20.63%),36 cases of Qi and blood deficiency(19.05%).The Vm of MCA in patients with liver-fire flaming up was faster than that that in the control group and other syndrome types(P<0.05).The Vm of MCA in patients with syndrome of blood stasis inter-obstruction,phlegm-dampness inter-obstruction,and Qi and blood deficiency were slower than those in the control group(P<0.05);there was no significant difference in PI of MCA in patients with type of liver-fire flaming up and Yin deficiency and Yang hyperactivity compared with the control group(P>0.05),the PI of MCA in patients with type of blood stasis inter-obstruction,phlegm-dampness inter-obstruction,and Qi and blood deficiency was higher than that of the control group and other syndrome types(P<0.05);the Vm of ACA in patients with type of liver-fire flaming up,Yin deficiency and Yang hyperactivity was faster than the control group(P<0.05),and the Vm of ACA in patients with syndrome of blood stasis inter-obstruction,phlegm-dampness inter-obstruction was slower than that in the control group(P<0.05);there was no significant difference in PI of ACA in patients with type of liver-fire flaming up and Yin deficiency and Yang hyperactivity compared with the control group(P>0.05),the PI of ACA in patients with type of blood stasis inter-obstruction,phlegm-dampness inter-obstruction,and Qi and blood deficiency was higher than that of the control group and other syndrome types(P<0.05).The Vm of MCA was positively correlated with syndrome of liver-fire flaming up(P<0.05),and negatively correlated with syndrome of blood stasis inter-obstruction,phlegm-dampness inter-obstruction,Qi and blood deficiency(P<0.05),and it was not related to the syndrome of Yin deficiency and Yang hyperactivity(P>0.05);the Vm of ACA was positively correlated with syndrome of liver-fire flaming up,Yin deficiency and Yang hyperactivity(P<0.05),and negatively correlated with syndrome of blood stasis inter-obstruction,phlegm-dampness inter-obstruction(P<0.05),and it was not related to the syndrome of Qi and blood deficiency(P>0.05).PI of MCA and ACA was not correlated with syndrome of liver-fire flaming up,Yin deficiency and Yang hyperactivity(P>0.05),but was positively correlated with syndrome of blood stasis inter-obstruction,phlegm-dampness inter-obstruction,Qi and blood deficiency(P<0.05).Conclusion There is a certain correlation between intracranial arterial hemodynamics and syndrome differentiation in EH.Intracranial arterial hemodynamics is expected to provide a reference for accurate syndrome differentiation of hypertension.