高血压合并阻塞性睡眠呼吸暂停综合征患者证型特点与血流动力学的相关性

Relationship between hemodynamic parameters and traditional Chinese medicine syndromes in patients with hypertension and obstructive sleep apnea syndrome

目的探讨高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者证型特点与血流动力学的关系。方法选取2021年3—10月在中日友好医院心脏科住院的初发高血压患者214例,将患者按照是否合并OSAS分为单纯高血压组(118例)和高血压合并OSAS组(96例)。收集患者的基本资料及实验室指标、血流动力学指标及中医临床证型资料。分析高血压合并OSAS患者的证型特点及其与血流动力学的关系。结果高血压合并OSAS组男性比例、体重指数、舒张压水平高于单纯高血压组,高密度脂蛋白胆固醇水平低于单纯高血压组,差异均有统计学意义(均P<0.05)。单纯高血压组中医证型构成为肝火亢盛证(69例,58.5%)、痰瘀互结证(18例,15.3%)、阴虚阳亢证(16例,13.6%)、阴阳两虚证(15例,12.7%);高血压合并OSAS组中医证型构成为痰瘀互结证(58例,60.4%)、肝火亢盛证(17例,17.7%)、阴虚阳亢证(14例,14.6%)、阴阳两虚证(7例,7.3%)。痰瘀互结证在高血压合并OSAS患者中占主导地位。高血压合并OSAS组外周血管阻力指数(SVRI)、主动脉硬化指数(AS)高于单纯高血压组,差异均有统计学意义(均P<0.05)。高血压合并OSAS组患者中,痰瘀互结证患者SVRI、AS均高于非痰瘀互结证患者,差异均有统计学意义(均P<0.001)。高血压合并OSAS组患者痰瘀互结证与SVRI、AS呈正相关(r=0.401,P<0.001;r=0.378,P=0.001)。结论痰瘀互结证是高血压合并OSAS患者的主要证型,血流动力学方面表现为“高阻”模式,可能与血管损伤有关。

Objective To investigate the relationship between hemodynamic parameters and traditional Chinese medicine(TCM) syndromes in patients with hypertension and obstructive sleep apnea syndrome(OSAS). Methods From March to October 2021, 214 patients with newly diagnosed hypertension in Department of Cardiology, China-Japan Friendship Hospital were enrolled. They were divided into simple hypertension group(118 cases) and hypertension complicated with OSAS group(96 cases) according to whether or not OSAS was combined. The general data, laboratory indexes, hemodynamic parameters and TCM symptoms of patients were recorded, and the relationship of between TCM symptoms and hemodynamic parameters in patients with hypertension and OSAS was analysed. Results The male proportion, body mass index and diastolic blood pressure in hypertension complicated with OSAS group were higher than those in simple hypertension group, and the level of high-density lipoprotein cholesterol in hypertension complicated with OSAS group was lower than that in simple hypertension group(all P<0.05). TCM syndromes of simple hypertension group were hyperactivity of liver-fire(69 cases, 58.5%), phlegm and blood stasis(18 cases, 15.3%), Yin deficiency and Yang hyperactivity(16 cases, 13.6%), and Yin and Yang deficiency(15 cases, 12.7%);the TCM syndromes of hypertension complicated with OSAS group were phlegm and blood stasis(58 cases, 60.4%), hyperactivity of liver-fire(17 cases, 17.7%), Yin deficiency and Yang hyperactivity(14 cases, 14.6%), and Yin and Yang deficiency(7 cases, 7.3%). Phlegm and blood stasis is dominant in patients with hypertension complicated with OSAS. System vascular resistance index(SVRI) and aortic sclerosis index(AS) in hypertension complicated with OSAS group were significantly higher than those in simple hypertension group(both P<0.05). In hypertension complicated with OSAS group, SVRI and AS in patients with phlegm blood stasis were higher than those in patients with non phlegm blood stasis syndrome, and the differences were statistically significant(both P<0.001). Phlegm and blood stasis in patients with hypertension complicated with OSAS was positively correlated with SVRI and AS(r=0.401, P<0.001;r=0.378, P=0.001). Conclusions Phlegm and blood stasis is dominant in patients with OSAS and hypertension, and the hemodynamic phenotypes shows "high resistance" pattern, which may be related to vascular damage.