基于真实世界的难治性高血压临床特征和中药治疗组方规律分析  

Analysis of Clinical Characteristics and Traditional Chinese Medicine Prescription Regulirities of Refractory Hypertension Based on Real World

作　　者：王姗姗[1,2] 王昱琪 张丹[1] 宋月月 姜枫[3] 李运伦[1] 辛梅[2] 宋荣刚[2] 李明[2] 刘军 杨雯晴[1] WANG Shanshan;WANG Yuqi;ZHANG Dan;SONG Yueyue;JIANG Feng;LI Yunlun;XIN Mei;SONGRonggang;LI Ming;LIU Jun;YANG Wenqing(Shandong University of Traditional Chinese Medicine,Jinan 250355,China;The Fifth People’s Hospital of Jinan,Jinan 250022,China;Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China)

机构地区：[1]山东中医药大学,山东济南250355 [2]济南市第五人民医院,山东济南250022 [3]山东中医药大学附属医院,山东济南250014

出　　处：《山东中医杂志》2024年第10期1103-1111,共9页Shandong Journal of Traditional Chinese Medicine

基　　金：山东省自然科学基金重点项目(编号:ZR2020KH034);山东省中医药科技发展计划项目(编号:2019-0123);济南市“高校20条”资助项目(编号:2020GXRC017)。

摘　　要：目的:探讨难治性高血压区别于非难治性高血压的临床特征,挖掘难治性高血压的中药治疗组方规律,为其有效防治提供参考。方法:纳入2010年1月至2024年1月在山东中医药大学附属医院、济南市中医医院、济南市第五人民医院住院治疗的难治性高血压患者520例(难治性高血压组)和非难治性高血压患者550例(非难治性高血压组)。比较两组患者的一般资料、合并症、实验室指标等临床资料,研究难治性高血压和非难治性高血压在临床特征方面的差异,并利用Logistic回归分析探索难治性高血压的危险因素或保护因素。从医院电子医疗系统中收集难治性高血压组患者的中药处方,应用中医传承辅助系统分析处方中药物的使用频次、药性、归经及常用药物组合等规律。结果:与非难治性高血压组比较,难治性高血压组高血压病史更长(P<0.05),合并冠心病、脑梗死的患者占比更高(P<0.05),血钾水平更低(P<0.05),空腹血糖(FBG)、游离四碘甲腺原氨酸(FT4)水平更高(P<0.05)。FBG、FT4水平偏高为难治性高血压的危险因素,钾为难治性高血压的保护因素。中药组方分析显示,使用频次较高的中药包括川芎、天麻、白术、茯苓、钩藤等,中药“四气”中寒性频次最高、“五味”中甘味频次最高、归经中肝经频次最高,使用频次较高的药物组合包括川芎-天麻、钩藤-天麻、川芎-当归、川芎-茯苓、白术-茯苓等。结论:与治疗非难治性高血压相比,治疗难治性高血压更应注重患者血钾、FBG和FT4水平的变化,积极采取干预措施;目前中医治疗难治性高血压多采用活血化瘀、平肝息风、健脾利湿类中药。Objective:To explore the clinical characteristics that distinguish refractory hypertension from non-refractory hypertension,and to explore the prescription regularities of traditional Chinese medicine(TCM)treatment for refractory hypertension,so as to provide reference for effective prevention and treatment of refractory hypertension.Methods:A total of 520 patients with refractory hypertension(refractory hypertension group)and 550 patients with non-refractory hypertension(non-refractory hypertension group)who were hospitalized in Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan Hospital of Traditional Chinese Medicine,and the Fifth People’s Hospital of Jinan from January 2010 to January 2024 were included.The general data,comorbidities,laboratory indicators and other clinical data of the two groups were compared to study the differences in clinical characteristics between refractory hypertension and nonrefractory hypertension,and the risk factors or protective factors for refractory hypertension were explored by Logistic regression analysis.The TCM prescriptions for patients with refractory hypertension were collected from the electronic medical system of the hospital,and Traditional Chinese Medicine Inheritance Assistance System was used to analyze the regularities of TCM prescriptions,such as the Chinese medicinal frequency,properties,channel tropism and common medicinal combinations.Results:Compared with the non-refractory hypertension group,the refractory hypertension group had a longer history of hypertension(P<0.05),a higher proportion of patients with coronary heart disease and cerebral infarction(P<0.05),lower blood potassium level(P<0.05),and higher levels of fasting blood glucose(FBG)and free tetraiodothyronine(FT4)(P<0.05).Elevated levels of FBG and FT4 were risk factors for refractory hypertension,and potassium was a protective factor for refractory hypertension.The analysis of TCM prescriptions showed that the most frequently used Chinese medicinlas included Chuanxio

关 键 词：难治性高血压 临床特征 危险因素 组方规律 真实世界 

分 类 号：R259.441[医药卫生—中西医结合]