文献类型：期刊文献

中文题名：高血压不同中医证候患者脑白质病变评估研究

英文题名：Research assessment of white matter lesions in hypertensive patients with different traditional Chinese medicine syndromes

作者：何彦虎[1,2];金华[1,3];靳利梅[1];刘敏科[1,2];刘志军[2,3];苏莉莉[2];司美龙[1];叶路亮[1];侯田田[1]

第一作者：何彦虎

机构：[1]甘肃中医药大学中医临床学院,兰州730099;[2]甘肃中医药大学附属医院;[3]敦煌医学与转化教育部重点实验室

第一机构：甘肃中医药大学中医临床学院

年份：2023

卷号：46

期号：6

起止页码：826

中文期刊名：北京中医药大学学报

外文期刊名：Journal of Beijing University of Traditional Chinese Medicine

收录：CSTPCD;;北大核心:【北大核心2020】；CSCD:【CSCD2023_2024】；

基金：国家自然科学基金项目(No.82160886,No.81860832);甘肃省中医药科研项目(No.GZK-2019-24);甘肃省自然科学基金项目(No.20JR10RA315,No.22JR5RA579);甘肃省青年科技基金项目(No.21JR11RA156);甘肃省卫生健康行业科研项目(No.GSWSKY2022-35)。

语种：中文

中文关键词：高血压;中医证候;脑白质病变;风险评估;影响因素

外文关键词：hypertension;traditional Chinese medicine syndrome;white matter lesions;risk assessment;influence factors

摘要：目的评估并预测高血压不同中医证候患者脑白质病变(WMLs)的危险性,探讨高血压不同中医证候与脑白质病变间的相互关系及其影响因素。方法2019年9月—2021年12月,根据纳入、排除标准选择甘肃中医药大学附属医院心血管科等相关科室就诊患者309例,辨证分为痰瘀互结证、肾气亏虚证、肝火亢盛证、阴虚阳亢证4种证候,检测患者舒张压(DBP)、同型半胱氨酸(Hcy)、尿酸(UA)、血清胱抑素C(Cys C),并运用Fazekas与ARWMC量表评估各证候高血压患者WMLs部位、量表评分、危险程度(低危、中危、高危),归纳并总结不同证候与各危险因素间的相关性。结果不同中医证候患者间舒张压、Hcy、UA、Cys C差异具有统计学意义(P<0.05)。经Fazekas、ARWMC量表评估,各证候间WMLs部位分布差异无统计学意义;各证候间WMLs Fazekas量表评分差异无统计学意义,ARWMC量表评分差异具有统计学意义(P<0.05);WMLs Fazekas与ARWMC量表危险度分级,不同中医证候间WMLs差异有统计学意义(P<0.05)。高血压患者与WMLs Fazekas量表相关的危险因素经Spearman秩相关分析,痰瘀互结证组患者WMLs程度与年龄、Hcy、UA、Cys C呈正相关(r_(s)=0.22、0.23、0.18、0.24,P<0.05),与高尿酸血症(HUA)、高同型半胱氨酸血症(HHcy)呈负相关(r_(s)=-0.19、-0.21,P<0.05);肝火亢盛证组患者WMLs程度与UA呈正相关(r_(s)=0.48,P<0.05),与HUA呈负相关(r_(s)=-0.47,P<0.05);阴虚阳亢证组患者WMLs程度与HUA、年龄、Cys C呈正相关(r_(s)=0.27、0.37、0.27,P<0.05),与UA呈负相关(r_(s)=-0.32,P<0.05);肾气亏虚证组患者WMLs程度与Hcy呈正相关(r_(s)=0.33,P<0.05),与HHcy、舒张压呈负相关(r_(s)=-0.32、-0.30,P<0.05);痰瘀互结证组相比于肝火亢盛证组、阴虚阳亢证组、肾气亏虚证组,差异有统计学意义(P<0.05)的危险因素最多。WMLs经ARWMC量表评估,各证型间WMLs存在差异(P<0.05),高血压患者与WMLs ARWMC量表相关的危险因素经Spearman秩相关分析,阴虚阳亢证组患者WMLs程度与UA呈正相关(r_(s)=0.57,P<0.05),与HUA呈负相关(r_(s)=-0.58,P<0.05);肝火亢盛证组患者WMLs程度与UA呈正相关(r_(s)=0.34,P<0.05),与HUA呈负相关(r_(s)=-0.44,P<0.05);肾气亏虚证组患者WMLs程度与Cys C呈正相关(r_(s)=0.26,P<0.05),与糖尿病、HUA呈负相关(r_(s)=-0.30、-0.28,P<0.05);肾气亏虚证组相比于痰瘀互结证组、肝火亢盛证组、阴虚阳亢证组,差异有统计学意义(P<0.05)的危险因素最多。结论痰瘀互结证和(或)肾气亏虚证可能是高血压病患者WMLs发病率较高的中医证候。
Objective We aimed to analyze and predict the risk of white matter lesions(WMLs)in hypertensive patients with different traditional Chinese medicine(TCM)syndromes,and to explore the relationship and influencing factors between them.Methods From September 2019 to December 2021,309 patients were enrolled from the cardiovascular departments of the Affiliated Hospital of Gansu University of Traditional Chinese Medicine according to the inclusion and exclusion criteria,and they were divided into four syndromes:phlegm and blood stasis syndrome,kidney qi deficiency syndrome,liver fire hyperactivity syndrome,and yin deficiency and yang hyperactivity syndrome.Diastolic blood pressure(DBP),homocysteine acid(Hcy),uric acid(UA),and serum cystatin C(Cys C)were measured.The ARWMC and Fazekas scales were used to assess the site,score,and the degree of WMLs(mild,moderate,or severe)in hypertensive patients with different syndromes,and the correlation between risk factors and different syndromes was summarized.Results There were significant differences in DBP,Hcy,UA,and Cys C among different TCM syndrome types(P<0.05).WMLs were assessed by the Fazekas and ARWMC scales,and there was no significant difference in the distribution of WMLs sites among different syndrome types.There was no significant difference in the Fazekas scores of WMLs,but there was a significant difference in the ARWMC ratings among different syndrome types(P<0.05).The WMLs Fazekas and ARWMC risk classification analysis of different TCM syndrome types were significantly different(P<0.05).According to the Fazekas scale assessment,there were differences in WMLs among all of the syndrome types(P<0.05).Spearman rank correlation analysis showed that the WMLs degree was positively correlated with age,Hcy,Cys C,and UA in the phlegm and blood stasis syndrome group(r_(s)=0.22,0.23,0.18,0.24,P<0.05).The WMLs degree was negatively correlated with HUA and HHcy(r_(s)=-0.19,-0.21,P<0.05).The degree of WMLs was positively correlated with UA(r_(s)=0.48,P<0.05),and negatively correlated with HUA(r_(s)=-0.47,P<0.05).The degree of WMLs in yin deficiency and yang hyperactivity syndrome group was positively correlated with age,HUA,and Cys C(r_(s)=0.37,0.27,0.27,P<0.05),and negatively correlated with UA(r_(s)=-0.32,P<0.05).The degree of WMLs in the kidney qi deficiency syndrome group was positively correlated with Hcy(r_(s)=0.33,P<0.05),but negatively correlated with HHcy and DBP(r_(s)=-0.32,-0.30,P<0.05).The phlegm and blood stasis syndrome had more risk factors with a statistically significant difference(P<0.05)compared with the liver fire hyperactivity syndrome,yin deficiency and yang hyperactivity syndrome,and kidney qi deficiency syndrome.According to the ARWMC rating,there were differences in WMLs among all syndrome types(P<0.05).Spearman rank correlation analysis showed that the WMLs degree was positively correlated with UA(r_(s)=0.57,P<0.05)and negatively correlated with HUA(r_(s)=-0.58,P<0.05)in patients with hypertension and the ARWMC rating.The degree of WMLs was positively correlated with UA(r_(s)=0.34,P<0.05),and negatively correlated with HUA(r_(s)=-0.44,P<0.05).The degree of WMLs in the kidney qi deficiency syndrome group was positively correlated with Cys C(r_(s)=0.26,P<0.05),and negatively correlated with diabetes mellitus and HUA(r_(s)=-0.30,-0.28,P<0.05).There were more risk factors with statistically significant differences(P<0.05)in the kidney qi deficiency syndrome compared with phlegm and blood stasis syndrome,liver fire hyperactivity syndrome,and yin deficiency and yang hyperactivity syndrome.Conclusion The phlegm and blood stasis syndrome and kidney qi deficiency syndrome may be TCM syndrome types with higher incidences of WMLs in hypertensive patients.