Study on the Difference of Body Mass Index and Insulin Sensitivity Index in Salt-sensitive Hypertension Patients of Different Traditional Chinese Medicine Syndrome Types

OBJECTIVE: To explore the difference of body mass index(BMI) and insulin sensitivity index(ISI) in saltsensitive hypertension patients of different traditional Chinese medicine(TCM) syndrome types, so as to elucidate the effect of the distribution of each syndrome on the degree of insulin resistance in salt-sensitive hypertension patients. METHODS: A total of 131 patients with salt-sensitive hypertension were included in the study. Factor analysis and cluster analysis were used to study the characteristics of TCM viscera, syndrome elements and syndrome differentiation. Furthermore, the following parameters were observed and corresponding differences were analyzed, including BMI, waist circumference, abdominal circumference, neck circumference and insulin sensitivity index among group s of different TCM syndrome types. RESULTS: There were 131 cases of saltsensitive hypertension. The results of factor analysis showed that the total variance contribution of F1-5 common factors was 75.8%. According to the pattern differentiation of zang-fu organs, a basic theory of traditional Chinese medicine(TCM), the main zang-fu organs involved in the five common factors are: liver, spleen, and kidney.The main syndrome factors that had been extracted include yin de?ciency, ?re, qi stagnation, yang hyperactivity,dampness, phlegm, qi reversal, heat, retained fluid, essence deficiency, qi descending, qi deficiency, and yang deficiency. Among them, factor 1 accounted for 18.32%, factor 2 accounted for 21.37%, factor 3 accounted for20.43%, factor 4 accounted for 20.61%, and factor 5 accounted for 22.14%. The proportion of zang-fu organs involvement was: 21.37% of the spleen, 17.56% of the kidney, 18.32% of the liver and spleen, and 42.75% of the spleen and kidney. Syndrome elements: yin de?ciency 18.32%, phlegm-dampness 21.37%, qi stagnation 39.69%, qi de?ciency 42.75%, retained ?uid 20.61%, yang de?ciency 60.31%, essence de?ciency 17.56%, qi sinking 17.56%,heat 21.37%, qi reversal 21.37%. Results of cluster analysis: there were 3 categories when the distance variance was 20-Category 1: Factor 1; Category 2: Factor 2; Category 3: Factor 3, Factor 4, Factor 5. Combined with the clinical practice of TCM, the classi?cation based on TCM syndromes was:Category 1, yin de?ciency and yang hyperactivity pattern(accounting for 18.32%); Category 2, excessive accumulation of phlegm-dampness(accounting for 21.37%); Category 3, spleen-kidney yang de?ciency and pattern of water-rheum collecting internally(accounting for 60.31%), including 24 cases of yin-de?ciency and yang-hyperactivity(YDYH), 28 cases of excessive phlegmdampness syndrome(EPDS), 79 cases of spleen and kidney yang-de?ciency and ?uid retention stagnating in the interior(SKFR). There was no difference in the distribution of age and sex among groups. In addition, no signi?cant difference was found regarding BMI, waist circumference, abdominal circumference, neck circumference among groups of salt-sensitive hypertension of different TCM syndrome types. Meanwhile, ISI was signi?cantly lower in cases of spleen and kidney yang-de?ciency and ?uid retention stagnating in the interior than in the other 2 groups,with statistical difference. CONCLUSION: Insulin resistance is the most serious in salt-sensitive hypertension patients with spleen and kidney yang-de?ciency and ?uid retention stagnating in the interior. Besides, obesity is not a critical factor in determining the distribution of TCM syndrome types in patients with salt-sensitive hypertension.

高血压病中医证型与证素分布规律的文献研究

目的:基于现代文献探讨高血压病中医证型、证素分布与组合规律。方法:检索各数据库相关文献,筛选、数据规范化、提取证素并录入,用SPSS 17.0软件进行证型、证素统计描述。结果:高血压病常见证型为阴虚阳亢(25.25%)、肝阳上亢(15.66%)、痰湿壅盛(8.59%)、肝火亢盛、肝肾阴虚、血瘀证;常见的病位证素为肝、肾,病性证素为阳亢、阴虚、血瘀、痰、热、气虚、湿、阳虚;证素组合以二、四证素组合为多。结论:阴虚阳亢为高血压病常见证型,肝、肾、阳亢、阴虚为常见证素,血瘀、痰是高血压病发生发展的重要影响因素。

基于现代文献研究肺动脉高压中医证型分布规律

目的:基于现代文献的资料收集与统计,研究肺动脉高压中医证型分布规律与系统评价,为规范肺动脉高压中医诊疗标准提供依据。方法:采用计算机检索和手工检索相结合的方法,对肺动脉高压相关文献进行信息采集整理,运用统计软件Excel表格、SPSS 24. 0进行统计描述与分析。结果:最终筛选出合格文献42篇;病例总数3 338例;合并整理得出12种证型。频数较高的五个证型分别是:肺肾气虚证(24. 74%)、痰瘀阻肺证(23. 71%)、痰浊阻肺证(9. 28%)、阳虚水泛证(8. 25%)、瘀阻肺络证(7. 22%)。12组证型频数两两比较χ2检验显示:肺肾气虚证、痰瘀阻肺证是肺动脉高压高频证型。文献共涉及单证14种,经聚类分析后,可分为两大类,第一类所包含的5个单证:气虚、肾虚、肺虚、血瘀、痰浊,在肺动脉高压的辨证分型中有较大意义。结论:肺动脉高压主要证型为肺肾气虚证、痰瘀阻肺证。

高血压病与中医证型的代谢组学研究探析

高血压病是以体循环动脉压升高、周围小动脉阻力增高,同时伴有不同程度代谢障碍为主要表现的临床综合征,是一种危害极大的世界范围内的疾病。虽然中医学与代谢组学在不同时代背景产生和发展,但两者具有诸多相同之处。两者均强调整体观,且具有相似的思维模式。代谢组学技术与中医证的研究相结合,可把证的研究再次推向了科学发展的前沿,成为中医现代化最重要的研究方向和有效突破口之一。

H型高血压的中医证型特点探讨

目的:观察H型高血压患者的中医证型特点及与性别、家族史、吸烟史、高血压分级、病程及年龄的相关性。方法:选取符合入选标准的H型高血压患者300例,记录其血浆同型半胱氨酸(HCY)指标;将纳入的病例辨证分为阴虚阳亢证、肝火亢盛证、阴阳两虚证、痰湿壅盛证等4个证型,统计中医证型分布与性别、家族史、吸烟史、高血压分级、病程及年龄的相关性。结果:H型高血压的证型分布特点:痰湿壅盛证占的比例最高(49.67%),与其他三型比较有显著差异(P<0.05),明显高于肝火亢盛(26.67%)、阴阳两虚(5.00%)、阴虚阳亢(18.67%),其他三型两两比较无差异(P<0.05)。结论:痰湿壅盛型为H型高血压中医辨证的主要证型。H型高血压的中医证型分布与性别、家族史、吸烟史、高血压分级无明显相关,而与病程及年龄具有明显相关性。

原发性高血压中医证型与客观化指标相关性研究进展

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。

新疆地区老年高血压中医证候初探

目的:通过回顾性调查研究新疆地区老年高血压中医证候的特点,探讨影响因素与中医辨证的关系。方法:以2007年1月至2007年12月新疆自治区中医院住院的1 344例老年高血压患者为研究对象,制定调查表,统计分析新疆地区老年高血压的中医证候特点。结果:我区老年高血压辨证以阴虚、血瘀为主要病机;瘀血阻络证为我区高血压病发展过程中不可忽视的重要证候因素。结论:高血压病部分中医证候因素的分布受性别、年龄、高血压病分级、高血压病危险度分层、病程等因素的影响。

阻塞性睡眠呼吸暂停低通气综合征相关性高血压与中医痰湿体质的中西医研究进展

睡眠呼吸障碍是一种全球慢性疾病,是很多心血管事件发生的独立危险因素,以阻塞性睡眠呼吸暂停低通气综合征最为多见。阻塞性睡眠呼吸暂停低通气综合征的发病率高,以间歇性低氧血症、高碳酸血症及反复睡眠觉醒为特征,其发病率随着年龄的增加而呈上升趋势。阻塞性睡眠呼吸暂停低通气综合征与高血压间存在密切关联,现代研究观察到将近50%的高血压病患者合并有阻塞性睡眠呼吸暂停低通气综合征,它们常同时存在并相互为病。长期阻塞性睡眠呼吸暂停低通气综合征所致的高血压病患者,血压变化有独特的特征,以夜间及晨起血压升高尤甚,表现为“杓形”甚至“反杓形”。目前临床通常采用持续正压通气以及纠正睡眠体位法治疗阻塞性睡眠呼吸暂停低通气综合征,但持续正压通气减少心血管事件风险的疗效仍不明确,故对病因病机的探讨对此病的诊疗有重要意义。其西医发病机制的核心在于间断性低氧血症导致的人体神经及内分泌紊乱。由于反复呼吸暂停引起的交感神经过度激活、全身炎症反应及氧化应激反应等,均可使机体血压升高;中医则强调“肥人多痰”,将阻塞性睡眠呼吸暂停低通气综合征及高血压病分别归于“鼾眠”“眩晕”范畴,认为痰湿质是二者发生的重要病理基础。文章将探究阻塞性睡眠呼吸暂停低通气综合征相关性高血压的发病机制以及其与中医痰湿体质的关系,以便更好地指导中西医临床用药。

高血压与血管损伤的中医研究概况

高血压病是比较常见的心血管病,发病率高、并发症多。并发症靶器官损害主要以心、脑、肾等为主,而心血管损伤事件给疾病的发展、特别是与其他靶器官的进一步损伤带来更大的影响。从中医角度分析心血管易损因子与靶器官损害关系的相关性和高血压中医辨证与心血管损伤的关系。中医从整体观念出发,辨证论治和预测高血压心血管事件发生的关系。