高血压病中医证型眼底改变差异研究

difference of Fundus Signs in Hypertensive Patients with different TCM Syndrome

目的:探究不同中医证型的高血压病患者眼底体征的差异。方法:选取符合标准的患有高血压病的患者进行研究。通过中医辨证进行分组,利用改进的U-Net网络对患者眼底图片进行预处理及血管分割,通过imageJ软件KaPPa插件计算视网膜血管曲度,angle tool插件测量动静脉分支夹角,使用半自动化视网膜微血管测量软件VAMPIRE(Vascular Asesment and Measuremnt Platform for Images of the Rtina)测量视网膜动静脉管径。对比分析视网膜微血管形态学指标在不同中医证型高血压病患者之间的差异。结果:共纳入相关临床资料、实验室指标、眼底照相检查完整的患者363例,通过对高血压病患者眼底图像分析发现肝火亢盛证患者视网膜病变分级多以Ⅲ级为主,而痰湿壅盛证和阴阳两虚证均以Ⅱ-Ⅲ级为主,阴虚阳亢组则以Ⅰ级为主。各组间颞上静脉、颞上动脉存在差异,其中痰湿壅盛组颞上静脉明显细于其他三组(P<0.05),肝火亢盛组颞上动脉粗于痰湿壅盛组(P<0.05)和阴虚阳亢组(P<0.05),但与阴阳两虚组无明显差异(P>0.05)。颞下动静脉各组间差异无统计学意义(P>0.05)。各证型间仅颞上静脉的血管分支夹角存在差异(P≤0.05),而其余视网膜血管组间无明显差异(P>0.05)。各证型间静脉的血管弯曲情况无明显差异(P>0.05),视网膜动脉的血管弯曲情况存在明显差异(P<0.05)。结论:不同中医证型的高血压性视网膜病变严重程度和视网膜血管形态学上存在差异,一定程度上反映中医辨证对高血压病进行中医分型的合理性,提供了眼底体征作为中医辨证分型的依据。提示或可通过高血压病的中医证型预测视网膜血管病变程度,进而预测靶器官的损伤程度。

Objective: To explore the differences of fundus signs in patients with hypertension of different TCM syndrome types. Methods: Patients with hypertension who meet the criteria were selected for research. Grouping by TCM syndrome differentiation, using the improved U-Net network to preprocess the patient’s fundus images and segment blood vessels, calculate the curvature of retinal vessels through the KaPPa plug-in of image-J software, measure the angle between arteriovenous branches with the angle tool plug-in, and use semi-automatic retinal micro-vascular Measurement software VAM PIRE(Vascular Asesment and Measurement Platform for Images of the Rtina) was used to measure retinal arteriovenous diameter. Comparative analysis of retinal micro-vascular morphological indicators in patients with hypertension of different TCM syndromes. Results: A total of 363 patients with complete relevant clinical data, laboratory indicators, and fundus photographic examination were included. Through the analysis of fundus images of patients with hypertension, it was found that the grade of retinopathy in patients with hyperactivity of liver fire syndrome was mainly grade Ⅲ, while that of patients with syndrome of excessive phlegm dampness Both deficiency syndromes and Yin and Yang syndromes are mainly grade Ⅱ-Ⅲ, while the syndrome of deficiency of Yin and Yang hyperactivity is mainly grade Ⅰ. There were differences in the superior temporal vein and superior temporal artery among the groups. The superior temporal vein in the phlegm-dampness group was significantly thinner than that of the other three groups(P<0.05), and the superior temporal artery in the liver-fire group was thicker than that in the phlegmdampness group and Yin deficiency and Yang hyperactivity group(P<0.05), but no significant difference with Yin and Yang deficiency group(P>0.05). There was no significant difference in the inferior temporal artery and vein among the groups(P>0.05). Only the vascular branch angle of the superior temporal vein was different among the syndrome types(P ≤ 0.05), while there was no significant difference among the other retinal vascular groups(P>0.05). There was no significant difference in the bending of veins among the syndrome types(P>0.05), but there was a significant difference in the bending of retinal arteries(P<0.05). Conclusion: There are differences in the severity of hypertensive retinopathy and the morphology of retinal vessels in different TCM syndrome types, which to a certain extent reflects the rationality of TCM syndrome differentiation in TCM classification of hypertension, and provides fundus signs as TCM syndrome differentiation. basis. It is suggested that the degree of retinal vascular lesions may be predicted by TCM syndrome types of hypertension, and then the degree of target organ damage may be predicted.