高血压病患者中医体质与心血管风险相关性的巢式病例对照研究

Nested Case-control Study on Relationship Between TCM Constitution and Cardiovascular Risk in Patients with Hypertension

目的:探讨高血压病患者的中医体质类型与发生心脑血管疾病的相关性,通过中医药调理体质改善高血压病患者预后,指导高血压临床防治工作。方法:在河南省中医药研究院前期服用降压宝系列方药的高血压病患者1 000例回顾性队列研究人群的基础上,采用巢式病例对照研究的方法,对212例高血压病患者进行研究,将发生心脑血管疾病的104例患者作为病例组,队列中未发生心脑血管疾病的108例患者作为对照组;以《中医体质分类与判定》为参考设计问卷调查,对212例高血压病患者进行中医体质类型判定,分析高血压病患者中医体质类型与发生心脑血管疾病的相关性。结果:心脑血管疾病的发病率为10.4%,Logistic回归分析显示,平和质(OR=0.397,95%CI:0.223~0.705)是高血压病患者发生心脑血管疾病的保护性因素;气虚质(OR=4.605,95%CI:1.987~10.672)、阴虚质(OR=2.667,95%CI:1.266 4~5.625)、阳虚质(OR=3.091,95%CI:1.159~8.241)、痰湿质(OR=2.984,95%CI:1.483~6.004)、血瘀质(OR=4.561,95%CI:1.767~11.774)是高血压病患者发生心脑血管疾病的危险因素。结论:高血压病患者中平和质、气虚质、阴虚质、阳虚质、痰湿质及血瘀质与心脑血管疾病的发生具有相关性,其中偏颇体质中的气虚质、阴虚质、阳虚质、痰湿质及血瘀质患者可能更容易发生心脑血管疾病,因此在临床诊疗过程中,应警惕这几种体质类型,采用中西医结合疗法进行防治,减少高血压病患者不良预后的发生。

Objective:To investigate the relationship between TCM constitution types and cardiovascular and cerebrovascular diseases in patients with hypertension,to improve the prognosis of patients with hypertension and to guide the clinical prevention and treatment of hypertension through TCM conditioning.Methods:Based on a retrospective cohort study of 1 000 hypertensive patients with antihypertensive drugs in the early stage of the Henan Academy of Traditional Chinese Medicine,a nested case-control study was conducted to investigate 212 hypertensive patients.104 patients with cardiovascular and cerebrovascular diseases were treated as case group.108 patients with no cardiovascular and cerebrovascular diseases in the cohort served as the control group.A questionnaire survey was conducted with reference to the Classification and Judgment of TCM Constitution,and 212 patients with hypertension were selected so as to determine the type of TCM constitution,and to analyze the correlation between TCM constitution types and cardiovascular and cerebrovascular diseases in patients with hypertension.Results:The incidence of cardiovascular and cerebrovascular diseases was 10.4%.Logistic regression analysis showed that the quality of peace(OR=0.397,95%CI:0.223-0.705)was a protective factor for cardiovascular and cerebrovascular diseases in patients with hypertension;OR=4.605,95%CI:1.987-10.672),Yin deficiency(OR=2.667,95%CI:1.266 4-5.625),yang deficiency(OR=3.091,95%CI:1.159-8.241),phlegm(OR=2.984,95%CI:1.48~6.004),blood sputum(OR=4.561,95%CI:1.767-11.774)is a risk factor for cardiovascular and cerebrovascular diseases in patients with hypertension.Conclusion:There are correlations between Pinghe quality,Qi deficiency quality,Yin deficiency quality,Yang deficiency quality,Phlegm dampness and Blood stasis constitution and the occurrence of cardiovascular and cerebrovascular diseases in hypertensive patients,among which patients with physique quality of Qi deficiency,Yin deficiency,Yang deficiency,Phlegm and Blood stasis may be more prone to cardiovascular and cerebrovascular diseases.Therefore,in the course of clinical diagnosis and treatment,these types of constitution should be guarded,and the combination of traditional Chinese and Western medicine should be used to prevent and treat hypertensive patients and reduce the occurrence of the bad prognosis.