原发性高血压心率变异性-中医证候-炎症指标的关联网络分析  

Association network analysis of heart rate variability-TCM syndrome typeinflammatory indicator in essential hypertension

作　　者：张高钰 王子涵 何清 李玲玲 樊佳溶 黄力[3] 肖响 石皓月 李琳[3] ZHANG Gaoyu;WANG Zihan;HE Qing;LI Lingling;FAN Jiarong;HUANG Li;XIAO Xiang;SHI Haoyue;LI Lin(Beijing University of Chinese Medicine,Beijing 100029;The First Hospital of Hebei Medical University;China-Japan Friendship Hospital;Beijing Hospital of Traditional Chinese Medicine,Capital Medical University)

机构地区：[1]北京中医药大学,北京100029 [2]河北医科大学第一医院 [3]中日友好医院 [4]首都医科大学附属北京中医医院

出　　处：《现代中医临床》2024年第4期24-33,共10页Modern Chinese Clinical Medicine

基　　金：首都卫生发展科研专项项目(No.2018-2-4063);北京市自然科学基金(No.7232320);中央高水平医院临床科研业务费资助项目(No.ZRJY2021-TD03);北京中医药大学教育科学研究课题(No.XJZD2005)。

摘　　要：目的探讨158例不同心率变异性(heart rate variability,HRV)的原发性高血压患者中医证候分布、炎症指标等临床特征差异及其相关性。方法选取2019年2月至2021年2月就诊于中日友好医院中西医结合心内科的158例原发性高血压患者为研究对象。采用SPSS 24.0统计软件进行统计学分析。首先比较不同证候患者之间心率变异性及炎症指标等临床特征差异。其次根据24 h正常RR间期的标准差(SDNN)中位数将患者分为HRV高值组与低值组(≤SDNN值中位数),比较2组患者差异。进一步多因素logistic回归分析,得到影响HRV值的独立相关因素,最后绘制ROC曲线评价效能。结果不同证候之间BMI、高血压病程、IL-1β、IL-6、TNF-α、HDL-C以及心率变异性指标SDNN、SDANN之间存在统计学差异(P均<0.05)。HRV高值组与HRV低值组之间的证候分布存在差异(P<0.05),HRV低值组中证候分布比例阴虚阳亢证>痰湿壅盛证>肝火亢盛证>阴阳两虚证,HRV高值组中痰湿壅盛证>肝火亢盛证>阴虚阳亢证>阴阳两虚证;2组之间的炎症指标亦有差异,HRV低值组的IL-1β、IL-6、TNF-α均高于HRV高值组(P<0.05)。多因素logistic回归分析显示阴虚阳亢证(OR=2.503,95%CI 1.102~5.684)、性别(OR=4.69095%CI 1.940~11.338)、年龄(OR=1.09595%CI 1.042~1.151)、高血压家族史(OR=2.96795%CI 1.218~7.226)、24 h平均舒张压(OR=1.10795%CI 1.051~1.167)与高血压患者HRV存在一定相关性(P均<0.05)。ROC曲线分析结果显示,总预测模型的曲线下面积最大AUC=0.827,年龄、阴虚阳亢证、女性、TNF-α、24 h平均舒张压、高血压家族史的曲线下面积分别为0.633、0.657、0.625、0.603、0.657、0.587。结论原发性高血压患者的中医证候、炎症指标与心率变异性均具有相关性,阴虚阳亢证与TNF-α存在交互作用,阴虚阳亢证联合TNF-α等可作为较低心率变异性的预测指标。Objective To explore the distribution of TCM syndromes,differences in inflammatory indicators,and their correlation in 158 hypertension patients with different heart rate variability(HRV).Methods From February 2019 to February 2021,158 patients with essential hypertension in the Department of Integrated Cardiology of China-Japan Friendship Hospital were selected.Statistical analyses were performed using SPSS 24.0.First,the differences in clinical characteristics between patients with different syndromes were compared.Second,according to the median standard deviation of the 24-hour normal RR interval(SDNN),the patients were divided into high-value HRV group and lowvalue HRV group(≤median SDNN value),and the differences between the two groups were compared.Further multivariate logistic regression analysis was carried out to identify the independent factors affecting HRV values,and finally,an ROC curve was drawn to evaluate the predictive efficiency.Results There were statistical differences in BMI,hypertension duration,IL-1β,IL-6,TNF-α,HDL-C,and HRV indices(SDNN,SDANN)among different syndromes(all P<0.05).There was a significant difference in the distribution of syndrome types between the high-value HRV group and the low-value HRV group(P<0.05).In the low-value HRV group,the distribution ratio of syndrome types was yin deficiency and yang hyperactivity syndrome>phlegm-dampness congestion syndrome>overabundant liver-fire syndrome>yin and yang deficiency syndrome.In the high-value HRV group,it was phlegm-dampness congestion syndrome>overabundant liver-fire syndrome>yin deficiency and yang hyperactivity syndrome>yin and yang deficiency syndrome.There were also differences in inflammatory indicators between the two groups,with IL-1β,IL-6,and TNF-αbeing higher in the low HRV group compared to the high HRV group(P<0.05).Multivariate logistic regression analysis showed that yin deficiency and yang hyperactivity syndrome(OR=2.503,95%CI 1.1025.684),gender(OR=4.690,95%CI 1.94011.338),age(OR=1.095,95%CI 1.0421.151),fami

关 键 词：高血压 心率变异性 中医证候 炎症指标 相关性分析 

分 类 号：R259[医药卫生—中西医结合]