原发性高血压患者心脏结构和功能与中医证型的关系探讨

Study of TCM syndrome types of essential hypertension based on echocardiography

目的:分析原发性高血压患者的心脏结构及功能与中医证型的相关性及差异。方法:选取2020年5月—2021年4月重庆市北碚区中医院收治的原发性高血压患者311例,根据证候调查情况进行中医辨证分型分为肝火亢盛型(n=70)、阴阳两虚型(n=87)、阴虚阳亢型(n=74)、痰湿壅盛型(n=80)4组。所有患者均经胸超声心动图检查,收集相应超声指标,包括升主动脉内径(AO)、左房前后径(LA)、左室舒张末期内径(LVDd)、左心室每搏输出量(LVSV)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室射血分数(LVEF)、左室心肌质量(LVM)、E峰、A峰、E波与A波峰速比值(E/A)、E峰减速时间(E D T),分析各证型患者在心脏结构和功能方面的差异。结果:阴虚阳亢型A O大于肝火亢盛型,差异有统计学意义(P<0.05);阴虚阳亢型L A大于阴阳两虚型,差异有统计学意义(P<0.05)。痰湿壅盛型LVM大于阴阳两虚型,差异有统计学意义(P<0.05);痰湿壅盛型EDT大于阴虚阳亢型及阴阳两虚型,差异有统计学意义(P<0.05)。结论:不同证型的原发性高血压经超声心动图测得的心脏结构及功能各有差异。临床可将超声心动图作为原发性高血压辩证的辅助方法。

Objective To analyze the correlation and difference between heart structure and function and TCM syndrome type in patients with essential hypertension.Methods A total of 311 patients with essential hypertension who were admitted to Beibei Traditional Chinese Medical Hospital from May 2020 to April 2021 were selected as the research subjects.According to the investigation of syndromes,TCM syndrome differentiation was carried out,and all patients underwent transthoracic echocardiography.Corresponding ultrasound indicators were collected,including ascending aorta diameter(AO),left atrial anteroposterior diameter(LA),left ventricular end-diastolic diameter(LVDd),left ventricular stroke volume(LVSV),ventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular ejection fraction(LVEF),left ventricular myocardial mass(LVM),E-peak,A-peak,E-wave to A-wave peak velocity ratio(E/A),E-peak deceleration time(EDT),and to analyze the differences in cardiac structure and function among patients with different syndromes.Results The AO of yin-deficiency and yang-hyperactivity type was greater than that of liver-fire hyperactivity type,and the difference was statistically significant(P<0.05).The LVM of phlegm-dampness type was greater than that of yin-deficiency and yang-hyperactivity type,and the difference was statistically significant(P<0.05);The EDT of phlegm-dampness type was higher than that of yin-deficiency and yang-hyperactivity type,and the difference was statistically significant(P<0.05).Conclusion The cardiac structure and function measured by echocardiography in different syndromes of essential hypertension have differences and characteristics.In clinical practice,echocardiography can be used as an auxiliary method for the diagnosis of essential hypertension.