老年高血压左室肥厚病人虚证中医分型与心脏结构、心功能指标及Hcy、hs-CRP的关系

The Correlation between TCM Classification of Deficiency Syndrome and Cardiac Structure,Cardiac Function Index,Hcy,and hs-CRP in Elderly Patients with Hypertension and Left Ventricular Hypertrophy

目的探讨老年高血压左室肥厚病人虚证中医分型与心脏结构、心功能指标及同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)的关系。方法将118例老年高血压左室肥厚病人中医辨证分为阴虚组、阳虚组、阴阳两虚组,比较3组心脏超声结构指标[左心室舒张末期内径(LVEDD)、左心房内径(LAD)、左心室质量指数(LVMI)]、心功能指标[左室射血分数(LVEF)、二尖瓣舒张早期峰值血流速度与舒张晚期峰值血流速度比值(E/A)]以及血Hcy、hs-CRP水平。结果阴阳两虚组、阳虚组LVEDD、LVMI均较阴虚组明显升高,E/A较阴虚组明显降低,差异均有统计学意义(P<0.05);阴阳两虚组LAD较阴虚组明显升高,LVEF较阴虚组明显降低,LVMI较阳虚组明显升高,差异均有统计学意义(P<0.05)。阴阳两虚组、阳虚组Hcy、hs-CRP均较阴虚组明显升高(P<0.05),阴阳两虚组Hcy、hs-CRP均较阳虚组明显升高(P<0.05)。结论对于老年虚证高血压左室肥厚病人,阳虚病人较阴虚病人左心室扩张及左室肥厚更明显,其中左心房扩大可能是老年高血压左室肥厚病人心阳受损的心脏结构表现,LVMI大小可能提示心阳虚病程的长短;阴虚、阳虚、阴阳两虚证病人hs-CRP、Hcy水平逐渐增加,说明整个左室重构、心功能损害的过程伴随炎症的激活,高血压左心室肥厚中医证型出现阴损及阳的改变。

Objective To explore the correlation between TCM classification of deficiency syndrome and cardiac structure,cardiac function index,Hcy and hs-CRP in elderly patients with hypertension and left ventricular hypertrophy(LVH).Methods One hundred and eighteen elderly patients with hypertension and LVH were divided into Yin deficiency group,Yang deficiency group,and Yin-Yang deficiency group.The cardiac ultrasound structure indicators[left ventricular end-diastolic diameter(LVEDD),left atrial diameter(LAD),left ventricular mass index(LVMI)],cardiac function indicators[left ventricular ejection fraction(LVEF),ratio of peak early diastolic flow velocity and peak atrial diastolic flow velocity(E/A)],homocysteine(Hcy),and high-sensitivity C-reactive protein(hs-CRP)levels were compared between 3 group.Results LVEDD and LVMI levels were higher in Yin-Yang deficiency group and Yang deficiency group than that in Yin deficiency group,E/A in Yin-Yang deficiency group and Yang deficiency group was lower than that in Yin deficiency group,the differences were statistically significant(P<0.05).LAD in Yin-Yang deficiency group was higher than that in Yin deficiency group,LVEF in Yin-Yang deficiency group was lower than that in Yin deficiency group,LVMI in Yin-Yang deficiency group was higher than that in Yang deficiency group,the differences were statistically significant(P<0.05).Hcy and hs-CRP in Yin-Yang deficiency group and Yang deficiency group were higher than those in Yin deficiency group(P<0.05),and the Hcy and hs-CRP in Yin-Yang deficiency group were higher than those in Yang deficiency group(P<0.05).Conclusion For elderly hypertensive LVH patients with deficiency syndrome,left ventricular dilatation and LVH in Yang deficiency group were more obvious than those in Yin deficiency group,in which left atrial enlargement may be the cardiac structural manifestations of damaged cardiac Yang deficiency in elderly patients with hypertension and LVH,and LVMI may indicate the length of the cours of heart Yang deficiency.The levels of hs-CRP and Hcy increase gradually in Yin deficiency group,Yang deficiency group,and Yin-Yang deficiency group,which indicate that in the whole process of left ventricular remodeling and cardiac function damage,combine with the activation of inflammation,Yin loss and Yang changes occurred in the TCM syndrome type of hypertension LVH.