基于高血压中医证型定量评价颈动脉弹性与PWVES、NLR的相关性

Quantitative Evaluation of the Relationship between Carotid Elasticity and PWVES and NLR Based on TCM Syndromes of Hypertension

目的:基于高血压中医证型定量评价颈动脉弹性与PWVES、NLR的相关性,为早期预测和中医辨证施治提供无创的检查方法。方法:选取2018年3月16日—2019年6月23日,符合纳入条件的高血压患者均来自我院心内科,共计104例(颈动脉208条),104例患者的病历资料完善。正常组选自治未病中心健康体检人群57例。测量收缩早期脉搏波速度(PWVBS)、收缩末期脉搏波速度(PWVES)、中性粒细胞/淋巴细胞比值(Neutrophil lymphocyte ratio, NLR),比较正常组与高血压组各中医证型间的差异。结果:高血压组中PWVES、PWVBS及NLR水平显著高于正常组;正常组与高血压组各中医证型的PWVES、PWVBS及NLR也存在明显差异;其中气阴两虚型的ES值和NLR明显高于肝火亢盛型、阴虚阳亢型及痰湿壅盛证(P<0.05);高血压组PWVES与NLR水平呈正相关;通过ROC曲线分析NLR、BS、ES对气阴两虚型高血压引起的早期动脉硬化的诊断价值:NLR特异性为71%,敏感度约为73%,BS的特异性为52%,敏感性约为67%, ES值的特异性86%,敏感性82%。结论:PWVES、NLR在早期高血压动脉硬化中医辨证中具有临床应用价值,尤其对气阴两虚引起的高血压动脉硬化的早期预测提供量化指标。

Objective:To provide a non-invasive examination method for early prediction and dialectical TCM treatment based on the quantitative evaluation of the correlation between carotid artery elasticity and PWVES and NLR based on the TCM syndromes of hypertension.Methods:104 patients(208 carotid arteries)who met the inclusion criteria for hypertension were included into the hypertension group,another 57 healthy people were taken as the normal control.Pulse wave velocity of beginning systole(PWVBS),pulse wave velocity of ending systole(PWVES)and neutrophil/lymphocyte ratio(NLR)were measured to compare the differences between the normal group and the hypertension group,and to compare the differences among the different syndromes in the two groups.Results:The levels of PWVES,PWVBS and NLR in the hypertension group were significantly higher than those in the normal control group.There were also statistical differences in PWVES,PWVBS and NLR among different syndromes in the normal control group and the hypertension group.The values of PWVES and NLR were significantly higher in the syndrome of Qi and Yin deficiency than those in the syndromes of Liver-fire hyperactivity,Yin deficiency and Yang hyperactivity and excessive accumulation of phlegm-dampness(P<0.05).PWVES was positively correlated with NLR level in the hypertension group.ROC curve was used to analyze the diagnostic value of NLR,PWVBS and PWVES in early atherosclerosis caused by hypertension of Qi and Yin deficiency,specificity and sensitivity of NLR were 71%and 73%;specificity and sensitivity of PWVBS were 52%and 67%;specificity and sensitivity of PWVES were 86%and 82%.Conclusion:PWVES and NLR have clinical application value in TCM syndrome differentiation of early hypertensive arteriosclerosis,especially it can provide quantitative indexes for early prediction of hypertensive arteriosclerosis caused by deficiency of Qi and Yin.