CAJ | 학술논문

目的：探讨原发性高血压中医证型与心率变异性的关系，评估疾病及判定预后，指导临床辨证施治。方法收集2013年1月-12月西苑医院符合临床诊断标准及中医辨证分型标准的高血压患者182例，按中医辨证标准将患者分为肝火上炎证、痰湿内阻证、瘀血内阻证、阴虚阳亢证和气血两虚证，另设同期门诊查体60例健康人为对照组，采用动态心电图检测心率变异性指标并进行对比统计分析。结果肝火上炎证与平均正常R-R间期标准差(SDNN)、相邻R-R间期差的均方(RMSSD)、低频成分(LF)、高频成分(HF)、总的域值(TP)呈正相关（r 分别为0.161、0.372、0.223、0.281、0.301）；痰湿内阻证与SDNN、HRV三角指数(HRV triangular index)、极低频成分(VLF)、LF、极低频高频比（VLF/HF）、低频高频比(LF/HF)、标一化低频(LFnorm)呈正相关（r 分别为0.175、0.211、0.174、0.262、0.159、0.264、0.263）；瘀血内阻证与 LF、HF 呈负相关（r 分别为-0.185、-0.018）；阴虚阳亢证与 SDNN、RMSSD、VLF、LF呈负相关（r分别为-0.204、-0.161、-0.184、-0.197）；气血两虚证与SDNN、每5 min正常R-R间期均值的标准差(SDANN)、RMSSD、HRV triangular index、VLF、LF、LFnorm呈负相关，与HFnorm呈正相关（r分别为-0.353、-0.348、-0.258、-0.303、-0.268、-0.361、-0.352、0.267）。结论高血压患者不同证型自主神经功能失调具有不同特征，既反映了不同中医证型重要病变机理，也与高血压病程密切相关，为临床辨证诊断提供客观依据。
목적：탐토원발성고혈압중의증형여심솔변이성적관계，평고질병급판정예후，지도림상변증시치。방법수집2013년1월-12월서원의원부합림상진단표준급중의변증분형표준적고혈압환자182례，안중의변증표준장환자분위간화상염증、담습내조증、어혈내조증、음허양항증화기혈량허증，령설동기문진사체60례건강인위대조조，채용동태심전도검측심솔변이성지표병진행대비통계분석。결과간화상염증여평균정상R-R간기표준차(SDNN)、상린R-R간기차적균방(RMSSD)、저빈성분(LF)、고빈성분(HF)、총적역치(TP)정정상관（r 분별위0.161、0.372、0.223、0.281、0.301）；담습내조증여SDNN、HRV삼각지수(HRV triangular index)、겁저빈성분(VLF)、LF、겁저빈고빈비（VLF/HF）、저빈고빈비(LF/HF)、표일화저빈(LFnorm)정정상관（r 분별위0.175、0.211、0.174、0.262、0.159、0.264、0.263）；어혈내조증여 LF、HF 정부상관（r 분별위-0.185、-0.018）；음허양항증여 SDNN、RMSSD、VLF、LF정부상관（r분별위-0.204、-0.161、-0.184、-0.197）；기혈량허증여SDNN、매5 min정상R-R간기균치적표준차(SDANN)、RMSSD、HRV triangular index、VLF、LF、LFnorm정부상관，여HFnorm정정상관（r분별위-0.353、-0.348、-0.258、-0.303、-0.268、-0.361、-0.352、0.267）。결론고혈압환자불동증형자주신경공능실조구유불동특정，기반영료불동중의증형중요병변궤리，야여고혈압병정밀절상관，위림상변증진단제공객관의거。
Objective To investigate the relationship between primary TCM syndromes and heart rate variability in hypertension, evaluate the development of disease. Methods 182 hypertension patients were recruited in accordance with the standard of hypertension. According to the Chinese medicine dialectical criteria, these patients were further divided into 5 groups, namely, hyperactivity of liver-fire group, phlegm-dampness retention group, blood stasis group, hyperactivity of Yang due to yin deficiency group and Qi and blood deficiency group. Another 60 healthy people were recruited as a control group. 24h Holter was adopted to monitor heart rate variability. Results Analysis of TCM syndromes and heart rate variability, anger on inflammation group had positive relation with SDNN, RMSSD, LF, HF and TP(r were respectively 0.161,0.372, 0.223, 0.281, 0.301);Phlegmy wet resistance groups had positive relation with SDNN, HRV triangular index, VLF, LF, VLF/HF, LF/HF, LFnorm.(r were respectively 0.175, 0.211, 0.174, 0.262, 0.159, 0.264, 0.263);blood stasis group had negative relation with LF/HF, LFnorm(r were respectively-0.185、-0.018).Yang due to yin deficiency group had negative relation with SDNN, RMSSD, VLF, LF.(r were respectively -0.204, -0.161,-0.184,-0.197);Qi and blood deficiency group had negative relation with SDNN, SDANN, RMSSD and HRV triangular index, VLF, LF, LFnorm, and had positive relation with HFnorm(r were respectively-0.353,-0.348,-0.258, -0.303, -0.268, -0.361, -0.352, 0.267). Conclusion Hypertension patients with different type of TCM syndromes had different characteristics of autonomic nerve functional disorders, which both reflected the important pathological changes of TCM syndromes and had close relation with the course of hypertension, providing objective basis for clinical diagnosis of syndrome differentiation.