江苏省丹阳市高血压病不同中医证型患者左心室结构和功能特征的横断面研究  

Characteristics of Left Ventricular Structure and Function of Hypertension Patients with Different Traditional Chinese Medicine Syndromes: A Cross-sectional Study in Danyang City of Jiangsu Province

作　　者：梁爽 刘鸣[1] 梁君雅 方祝元[1] LIANG Shuang;LIU Ming;LIANG Junya;FANG Zhuyuan(Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,210029)

机构地区：[1]南京中医药大学附属医院,江苏省南京市210029

出　　处：《中医杂志》2022年第7期658-663,共6页Journal of Traditional Chinese Medicine

基　　金：江苏高校优势学科建设工程资助项目(中医学);南京中医药大学中医学优势学科三期项目立项开放课题(ZYX03KF070,ZYX03KF071);江苏省第五期“333工程”科研项目(BRA2018390);江苏省第十四批“六大人才高峰”高层次人才项目(WSN-050);江苏省中医院高峰学术人才项目;江苏省研究生培养创新工程研究生科研与实践创新计划(SJCX19_0397)。

摘　　要：目的 探讨高血压病不同中医证型患者左心室结构和功能特点。方法 采用横断面研究方法,共纳入受试者3030例,其中正常血压组1824例,高血压组1206例,并将高血压组辨证分为阴虚阳亢证535例、肝火亢盛证403例、痰湿壅盛证183例、阴阳两虚证85例。采集受试者个人基本资料、测量即刻血压及心率,检测常规生化指标包括血糖、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C),左心室结构和功能指标[包括左室舒张末期内径(LVDD)、左室后壁厚度(LVPW)、左室射血分数(LVEF)、左心室质量指数(LVMI)、舒张早期最大流速/舒张晚期最大流速(E/A)]及二维斑点追踪成像技术指标整体纵向应变(GLS)。结果 与正常血压组比较,高血压组患者男性占比高、年龄大,体质量指数(BMI)、腰围、收缩压、舒张压、血糖、TG、TC、LDL-C、LVDD、LVPW、LVMI升高,E/A、LVEF、GLS、HDL-C下降(P<0.01)。高血压组中,与其他证型比较,阴阳两虚证心率最慢,血糖最低;与肝火亢盛证比较,阴虚阳亢证及阴阳两虚证BMI、腰围、收缩压及舒张压降低,阴阳两虚证TG降低,阴虚阳亢证HDL-C升高;与痰湿壅盛证比较,阴虚阳亢证、阴阳两虚证BMI降低,阴虚阳亢证舒张压降低、年龄较大,而阴阳两虚证腰围较小(P<0.05)。与正常血压组比较,高血压病组各证型LVDD、LVPW、LVMI增加,E/A、GLS降低,痰湿壅盛证和阴虚阳亢证LVEF下降;与肝火亢盛证、痰湿壅盛证比较,阴虚阳亢证、阴阳两虚证LVDD降低;与肝火亢盛证比较,阴虚阳亢证LVPW下降;与痰湿壅盛证比较,阴虚阳亢证LVPW以及LVMI降低,阴阳两虚证LVPW降低、GLS增加(P<0.05)。结论 高血压病患者不同中医证型均出现不同程度的临床指标异常及左心室结构和早期收缩功能损害,其中痰湿壅盛证心脏结构及早期收缩功能改变较大。Objective To explore the characteristics of left ventricular structure and function of hypertension patients with different traditional Chinese medicine(TCM)syndromes.Methods A cross-sectional study of 3030patients were designed to compare between normotensive group(1824 cases)and hypertensive group(1206 cases).The hypertensive group was further divided into yin deficiency with yang hyperactivity syndrome(535 cases),exuberance of liver fire syndrome(403 cases),phlegm-dampness congestion syndrome(183 cases)and deficiency of both yin and yang syndrome(85 cases).The basic information was collected,and the immediate blood pressure,heart rate,the routine biochemical indicators including blood glucose,triglycerides(TG),total cholesterol(TC),highdensity lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C),the left ventricular structure and function indicators including left ventricular end-diastolic diameter(LVDD),left ventricular posterior wall thickness(LVPW),left ventricular ejection fraction(LVEF),left ventricular mass index(LVMI)and peak early to late diastolic filling velocity(E/A),as well as global longitudinal strain(GLS)by 2D speckle tracking imaging were measured.Results Compared to the normotensive subjects,hypertensive patients had a higher proportion of males,older age,greater body mass index(BMI),waist circumference(WC),higher systolic blood pressure(SBP),diastolic blood pressure(DBP),blood glucose,TG,TC,LDL-C,LVDD,LVPW and LVMI,and decreased E/A,LVEF,GLS and HDL-C(P<0.01).Among all the TCM syndromes,the deficiency of both yin and yang syndrome had lowest heart rate and blood glucose.Compared to those in the exuberance of liver fire syndrome group,BMI,WC,SBP and DBP significantly decreased in the yin deficiency with yang hyperactivity syndrome group;TG was significantly reduced in the deficiency of both yin and yang syndrome group,and HDL-C significantly increased in the yin deficiency with yang hyperactivity syndrome group.Compared to those in the phlegm-dampness congestion syndrom

关 键 词：高血压病 左心室结构 中医证型 心功能 痰湿壅盛 

分 类 号：R259[医药卫生—中西医结合]