文献类型：期刊文献

中文题名：不同中医证型高血压患者心率变异性及其影响因素分析

英文题名：Analysis on Heart Rate Variability and Its Influencing Factors of Hypertensive Patients from Different TCM Syndrome

作者：刘志军[1];金华[2,3];苏莉莉[2];郑龙飞[2];刘双芳[2];曹强[2];韩艳萍[1]

第一作者：刘志军

机构：[1]甘肃中医药大学附属医院;[2]甘肃中医药大学;[3]甘肃省中医方药挖掘与创新转化重点实验室

第一机构：甘肃中医药大学第二附属医院

年份：2017

卷号：24

期号：9

起止页码：15

中文期刊名：中国中医药信息杂志

外文期刊名：Chinese Journal of Information on Traditional Chinese Medicine

收录：CSTPCD;;CSCD:【CSCD_E2017_2018】；

基金：甘肃省中医药管理局科研项目(GZK-2013-41);甘肃省高等学校科学研究创新团队项目(2017)

语种：中文

中文关键词：高血压;中医证型;心率变异性;影响因素

外文关键词：hypertension; TCM syndrome types; heart rate variability; influencing factors

摘要：目的调查高血压患者证型分布情况,分析心率变异性(HRV)时域参数特征与影响因素的相关性。方法纳入高血压患者515例,进行辨证分型,记录患者的人口学资料、实验室指标、危险因素及临床症状,并分析其相关性,采用24 h动态心电图记录HRV时域参数,比较不同中医证型HRV的5项时域参数[全程NN间期标准差(SDNN)、每5分钟SDNN的平均值(SDNN Index)、HRV指数(HRV Index)、相邻NN间期之差(PNN50)、全部相邻NN间期之差的均方根(RMSSD)]差异。结果 515例患者中,阴虚阳亢证、痰瘀互结证、肝火亢盛证、肾气亏虚证、痰湿壅盛证分别为160、136、83、69、67例。阴虚阳亢证、肾气亏虚证、肝火亢盛证SDNN较痰瘀互结证、痰湿壅盛证明显降低(P<0.05);阴虚阳亢证、肝火亢盛证SDNN Index、HRV Index较痰湿壅盛证明显降低(P<0.05);肾气亏虚证SDNN Index较痰湿壅盛证明显降低(P<0.05);肾气亏虚证PNN50较阴虚阳亢证明显降低(P<0.05);阴虚阳亢证、肾气亏虚证、肝火亢盛证RMSSD较痰瘀互结证明显降低(P<0.05)。判别分析显示,收缩压、舒张压、血压晨峰值(MBPS)、SDNN、SDNN Index、HRV Index、PNN50、RMSSD与辨证分型的诊断判别具有相关性。二分类Logistic回归分析显示,性别(女性),失眠,收缩压升高,血压晨峰程度越大,SDNN Index、PNN50降低与阴虚阳亢证呈正相关;性别(女性),高龄,收缩压与舒张压升高,SDNN、HRV Index、RMSSD降低与痰瘀互结证呈正相关;高龄,高血压家族史,收缩压升高,SDNN Index、HRV Index、PNN50降低与痰湿壅盛证呈正相关。结论阴虚阳亢证、肝火亢盛证、肾气亏虚证高血压患者HRV时域参数明显降低,自主神经功能受损较重,阴虚阳亢证、痰瘀互结证、痰湿壅盛证与引发高血压患者心脑血管事件的影响因素关系较为密切。
Objective To investigate the syndrome type distribution of hypertensive patients;To analyze the correlation of characteristics of HRV time domain parameters and its influence factors.Methods Totally515cases of hypertensive patients were included and were put under syndrome type distribution.Demographic information,laboratory test parameters,risk factors and clinical symptoms were collected for correlation analysis.HRV time domain parameters were recorded by using24h ambulatory electrocardiogram.The differences in SDNN,SDNN Index,HRV Index,PNN50,and RMSSD of different TCM syndrome types were compared.Results Among515patients:160cases with hyperactivity of yang due to yin deficiency syndrome,136cases with turbid phlegm and blood stasis syndrome,83cases with overabundant liver-fire syndrome,69cases with deficiency of kidney qi,and67cases with abundant phlegm-dampness syndrome.By comparing different TCM syndromes,the level of SDNN was significantly reduced in the hyperactivity of yang due to yin deficiency syndrome,overabundant liver-fire syndrome,deficiency of kidney qi syndrome compared with turbid phlegm and blood stasis syndrome,abundant phlegm-dampness syndrome(P<0.05);SDNN Index and HRV Index decreased significantly in the hyperactivity of yang due to yin deficiency and overabundant liver-fire syndrome compared with abundant phlegm-dampness syndrome(P<0.05).SDNN Index decreased significantly in the deficiency of kidney qi compared with abundant phlegm-dampness syndrome(P<0.05).The level of PNN50was significantly reduced in the deficiency of kidney qi compared with hyperactivity of yang due to yin deficiency syndrome(P<0.05).RMSSD decreased significantly in the hyperactivity of yang due to yin deficiency syndrome,deficiency of kindney qi syndrome,overabundant liver-fire syndrome compared with turbid phlegm and blood stasis syndrome(P<0.05).Discriminant analysis showed that SBP,DBP,MBPS,SDNN,SDNN Index,HRV Index,PNN50,RMSSD were correlated with the diagnosis of five syndrome types.Logistic regression analysis showed that the factors including gender(female),insomnia,elevated systolicblood pressure,MBPS,decreased SDNN Index and PNN50were positively correlated to hyperactivity of yang due to yin deficiency;other factors including gender(female),advanced age,elevated blood pressure,decreased SDNN,HRV Index and RMSSD were positively correlated with turbid phlegm and blood stasis syndrome.And the study also showed that advanced age,family history of hypertension,elevated blood pressure,decreased SDNN Index,HRV Index and PNN50were positively correlated to abundant phlegm-dampness syndrome.Conclusion HRV time domain parameters can be significantly reduced in the hyperactivity of yang due to yin deficiency,overabundant liver-fire syndrome,and deficiency of kidney qi syndrome.The autonomic nerve function is damaged seriously.Hyperactivity of yang due to yin deficiency syndrome,abundant phlegm-dampness syndrome turbid phlegm and blood stasis syndrome are closely related to the influencing factors that lead to cardiovascular and cerebrovascular events.