原发性高血压中医证型与客观化指标相关性研究进展

Research progress on the correlation between TCM syndrome types and objective indexes of essential hypertension

中医辨证论治的标准化、客观化是中医研究领域的热点。笔者查阅了近5年来原发性高血压(essential hypertension,EH)客观化指标研究相关类文献,从肾功能指标、心功能指标、炎症介质、激素水平、盐敏感性、靶器官损害、基因多态性表达等总结了EH中医证型与客观化指标的相关性,如肾功能指标尿微量白蛋白尿阳性多表现为气虚痰浊证,心功能指标左房前后径及左室后壁厚度增高多表现为阴阳两虚证,高水平同型半胱氨酸与痰湿体质有关,痰湿壅盛证超敏C-反应蛋白水平显著高于其他证型,血清肌酐值升高多表现为肝肾阴虚证等,可见EH中医证型与客观化指标有密切的联系。提出目前中医证型与客观化指标相关性研究的不足,如:缺乏定量研究、缺乏动态观察、采用辨证分型标准不一、对现有指标研究深度不够、缺乏多因素相关性研究等。笔者认为应开展大样本、多中心的临床研究,规范科研设计,加强动态观察和定量研究,更深入地探讨EH中医证型的本质及规律,量化制定统一的标准,建立完善的辨证方法乃至新的辨证体系。

Standardization and objectification of TCM syndrome differentiation are hot topics in the field of TCM research.This paper reviewed the literatures of essential hypertension(EH)related to the objective index research in recent 5 years,and summarized the correlation between the type of TCM syndrome and objective index from renal function index,cardiac function index,inflammatory mediators,hormone level,salt sensitivity,target organ damage,gene polymorphism expression,etc.For instance,kidney index urinary MAU positive performance for deficiency of phlegm turbidity syndrome,cardiac function indexes after the left front diameter and left ventricular posterior wall thickness increased performance for both Yin and Yang deficiency syndrome,high levels of homocysteine and phlegmy wet predisposition,phlegmy wet card indicates sheng allergic C-reactive protein level is significantly higher than other syndromes,higher serum creatinine values more performance for liver and kidney Yin deficiency syndrome,etc.,It can be seen that there is a close relationship between TCM syndromes of EH and objectification indexes.This paper points out the shortcomings of the correlation research between TCM syndrome types and objectified indicators,such as lack of quantitative research,lack of dynamic observation,different standards of syndrome differentiation,lack of in-depth research on existing indicators,lack of multi-factor correlation study,etc.This paper show that large-sample,multi-center clinical studies should be carried out,the scientific research design should be standardized,the dynamic observation and quantitative research should be strengthened,the nature and law of TCM syndrome types of EH should be further explored,unified standards should be quantified,and perfect syndrome differentiation methods and even new syndrome differentiation system should be established.