不同合并症高血压患者血压昼夜节律的对比研究  

A Comparative Study of the Circadian Rhythm of Various Complications in Patients with Hypertension

作　　者：朱灵妍[1] 姚成增[2] 蒋梅先[2] 周端[3] 

机构地区：[1]上海中医药大学,上海201203 [2]上海中医药大学附属曙光医院心内科,上海200021 [3]上海中医药大学附属龙华医院心病科,上海200032

出　　处：《中华中医药学刊》2015年第9期2098-2103,I0004,共7页Chinese Archives of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81273959);海派中医流派传承研究基地建设项目(ZY3-CCCX-1-1001);上海市科委项目(12401901402);上海市卫生系统优秀青年人才培养计划项目(XYQ2011064);上海市中西医结合重点病种建设项目(zxbz2012-08)

摘　　要：目的:研究高血压合并冠心病、糖尿病、脑梗塞及单纯高血压患者血压昼夜节律情况,同时将肝、胆、肾、脾、心五个脏腑主时时段血压进行对比,分析其异同,进一步为中医药择时给药,择脏腑治疗提供临床线索。方法:对曙光医院西院2010—2013年间曾行ABPM的高血压病患者进行筛选,共入组病人128例,其中合并冠心病组30例,合并糖尿病组31例,合并脑梗塞组30例,无合并症组37例。结果:不同合并症的高血压患者ABPM基本数值无明显差异;肝、脾、心、肾、胆五个脏腑主时时段均能影响血压水平,且不同脏腑主时时段血压水平随时间变化存在一定趋势,在心主时时段,冠心病组与糖尿病组收缩压、舒张压水平有显著差异(P<0.05),高血压合并冠心病组患者舒张压低于无合并症组,有显著差异(P<0.05);在胆主时时段,两者舒张压水平亦存在差异(P<0.05)。血压在脾、肾二脏主时处于较高趋势。4组患者群体余弦中值、振幅无明显差异。结论:本研究证实,肝、脾、心、肾、胆五个脏腑所对应时辰均影响血压水平,且五个脏腑主时时段血压变化趋势与"杓型"血压模式基本吻合,不同合并症高血压患者整体存在昼夜节律,无合并症组患者血压水平偏高,但本研究所涉及的肝、脾、心、肾、胆五个脏腑主时时段与高血压各组无交互作用,各时辰中血压及其变化趋势与高血压不同合并症是否相关尚无定论。Objective： To study the differences of circadian rhythm in hypertensive patients with coronary heart disease,diabetes,cerebral infarction and those with isolated hypertension and compare the blood pressure in liver,gallbladder,kidney,spleen and heart related time,aiming to find the entry point in traditional Chinese medical treatment. Methods： We collected and analyzed ABPM reports during 2010-2013 in Shuguang Hospital,including 128 patients. Results：ABPM basic values of different complications in patients with hypertension had no significant difference. Liver,spleen,heart,kidney,gallbladder five Zangfu-related time periods could affect blood pressure and there was a certain trend of blood pressure in different organs related time. In the heart-related time period,there was a significant difference（P〈 0. 05） in systolic and diastolic blood pressure between groups of coronary heart disease and diabetes and diastolic blood pressure in hypertensive patients with coronary heart disease was lower than those without comorbidities（P〈 0. 05）. In gallbladder-related time period,the diastolic blood pressure was also different（P〈 0. 05）. Blood pressure in the spleen and kidney-related time was at a higher tendency. The blood pressure of four groups all had the overall rhythm and there was no significant difference in the mesor and amplitude. Conclusion： This study confirms that the blood pressure trends of liver,spleen,heart,kidney and gallbladder-related time period coincide with the patterns of blood pressure. Hypertensive patients with different complications overall exist the circadian rhythms,but this study involved five main Zangfu-organs which have no interaction with hypertension in each group. Whether blood pressure and its changes in each time period can contact with the disease is inconclusive.

关 键 词：高血压 昼夜节律 脏腑主时 

分 类 号：R544.1[医药卫生—心血管疾病]