CAJ | 학술논문

目的：观察3个不同城乡社区老年高血压各中医证型分布情况,并分析其与心血管预后危险因素的相关性。方法从参加中国中医科学院健康管理课题组“健康监测调查问卷”的896例受访者中筛选出符合老年高血压诊断标准的患者299例,根据《中药新药临床研究指导原则(试行)》中高血压中医证型分型标准及血瘀证分型标准对其中医四诊信息进行辨证分型,采用放射免疫法、循环酶法等方法检测血糖、血脂、血肌酐(SCr)、血浆内皮素(ET)、同型半胱氨酸(Hcy)及尿微量白蛋白(mALB)等相关风险指标,并采集记录其年龄、性别、体质指数(BMI)、血压等一般资料。结果299例老年高血压患者中,阴阳两虚证74例,阴虚阳亢证65例,瘀血阻络证62例,痰湿壅盛证61例,肝火亢盛证37例。单因素分析显示,心血管预后风险指标中BMI、空腹血糖、糖化血红蛋白、SCr、总胆固醇、低密度脂蛋白胆固醇、ET、Hcy及mALB在5种中医证型之间差异有统计学意义(P＜0.05,P＜0.01),其中痰湿壅盛证、瘀血阻络证、阴虚阳亢证之间差异较为明显。判别分析表明BMI及Hcy对老年高血压中医证型的诊断具有一定的参考价值。二分类Logistic回归分析表明病程与阴阳两虚证型呈正相关。结论与其他证型相比,痰湿壅盛证、瘀血阻络证与引发老年高血压的诸多心血管预后危险因素关系较为密切。
목적：관찰3개불동성향사구노년고혈압각중의증형분포정황,병분석기여심혈관예후위험인소적상관성。방법종삼가중국중의과학원건강관리과제조“건강감측조사문권”적896례수방자중사선출부합노년고혈압진단표준적환자299례,근거《중약신약림상연구지도원칙(시행)》중고혈압중의증형분형표준급혈어증분형표준대기중의사진신식진행변증분형,채용방사면역법、순배매법등방법검측혈당、혈지、혈기항(SCr)、혈장내피소(ET)、동형반광안산(Hcy)급뇨미량백단백(mALB)등상관풍험지표,병채집기록기년령、성별、체질지수(BMI)、혈압등일반자료。결과299례노년고혈압환자중,음양량허증74례,음허양항증65례,어혈조락증62례,담습옹성증61례,간화항성증37례。단인소분석현시,심혈관예후풍험지표중BMI、공복혈당、당화혈홍단백、SCr、총담고순、저밀도지단백담고순、ET、Hcy급mALB재5충중의증형지간차이유통계학의의(P＜0.05,P＜0.01),기중담습옹성증、어혈조락증、음허양항증지간차이교위명현。판별분석표명BMI급Hcy대노년고혈압중의증형적진단구유일정적삼고개치。이분류Logistic회귀분석표명병정여음양량허증형정정상관。결론여기타증형상비,담습옹성증、어혈조락증여인발노년고혈압적제다심혈관예후위험인소관계교위밀절。
Objective To observe the regularities of distribution of TCM syndrome types and correlation between TCM syndrome types and cardiovascular prognosis risk factors of elderly hypertensive patients in three different urban and rural communities.Methods Totally 299 elderly hypertensive patients who conformed to the hypertensive diagnostic criteria from 896 respondents which participated in the health monitoring questionnaire drafted by health management team of China Academy of Chinese Medical Sciences were screened. The syndrome types were differentiated according to Guiding Principle of Clinical Research on New Drugs of Traditional Chinese Medicine (for Trial Implementation). The levels of some risk indicators, such as blood glucose, blood lipid, CREA, ET, Hcy and mALB were measured by radioimmunoassay, enzymatic cycling assay and other methods. Age, gender, BMI and pulse pressure were recorded.Results The TCM syndrome types of 299 elderly hypertensive patients were deficiency of yin and yang type (74 cases), hyperactivity of yang due to yin deficiency type (65 cases), blood stasis syndrome type (62 cases), stagnation of phlegm-dampness type (61 cases), hyperactivity of liver-fire type (37 cases). Single factor analysis showed that there existed statistical significance among BMI, FBG, GHbA1c, CREA, TC, LDL-C, ET, Hcy and mALB in the 5 TCM syndromes (P<0.05,P<0.01), and the statistical significance was more apparent in the stagnation of phlegm-dampness type, blood stasis syndrome type and hyperactivity of yang due to yin deficiency type. Discriminant analysis showed BMI and Hcy have certain reference value for the diagnosis of TCM syndrome types in elderly hypertensive patients. Binary-Logistic regression analysis showed that the course of disease had a positive correlation with syndrome of deficiency of yin and yang.Conclusion Compared with other types of elderly hepertensive patients, stagnation of phlegm-dampness type and blood stasis syndrome type are more closely related to hypertension cardiovascular prognosis risk factors.