高血压不同中医证候患者脑白质病变评估研究

何彦虎; 金华; 靳利梅; 刘敏科; 刘志军; 苏莉莉; 司美龙; 叶路亮; 侯田田

doi:10.3969/j.issn.1006-2157.2023.06.013

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高血压不同中医证候患者脑白质病变评估研究

临床研究 | 更新时间：2023-07-05

- 高血压不同中医证候患者脑白质病变评估研究
- Research assessment of white matter lesions in hypertensive patients with different traditional Chinese medicine syndromes
- 北京中医药大学学报 2023年46卷第6期页码：826-835
- 作者机构：
  
  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
- 作者简介：
  
  何彦虎，男，硕士
  # 金华，男，博士，教授，主任医师，博士生导师，主要研究方向：心脑血管疾病的中医药防治与研究，E-mail：lanzhoujinhua@126.com
- 基金信息：
  
  国家自然科学基金项目(82160886;81860832);甘肃省中医药科研项目(GZK-2019-24);甘肃省自然科学基金项目(20JR10RA315;22JR5RA579);甘肃省青年科技基金项目(21JR11RA156);甘肃省卫生健康行业科研项目(GSWSKY2022-35)
- DOI：10.3969/j.issn.1006-2157.2023.06.013
  中图分类号： R259.441
- 纸质出版日期：2023-06-30，
  
  网络出版日期：2023-05-06，
  
  收稿日期：2022-12-17，
- 稿件说明：
移动端阅览
何彦虎, 金华, 靳利梅, 等. 高血压不同中医证候患者脑白质病变评估研究[J]. 北京中医药大学学报, 2023,46(6):826-835.

HE Yanhu, JIN Hua, JIN Limei, et al. Research assessment of white matter lesions in hypertensive patients with different traditional Chinese medicine syndromes[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(6):826-835.
何彦虎, 金华, 靳利梅, 等. 高血压不同中医证候患者脑白质病变评估研究[J]. 北京中医药大学学报, 2023,46(6):826-835. DOI： 10.3969/j.issn.1006-2157.2023.06.013.

HE Yanhu, JIN Hua, JIN Limei, et al. Research assessment of white matter lesions in hypertensive patients with different traditional Chinese medicine syndromes[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(6):826-835. DOI： 10.3969/j.issn.1006-2157.2023.06.013.

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(

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(

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(

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(

＝0.22、0.23、0.18、0.24，

0.05)，与高尿酸血症(HUA)、高同型半胱氨酸血症(HHcy)呈负相关(

＝－0.19、－0.21，

0.05)；肝火亢盛证组患者WMLs程度与UA呈正相关(

＝0.48，

0.05)，与HUA呈负相关(

＝－0.47，

0.05)；阴虚阳亢证组患者WMLs程度与HUA、年龄、Cys C呈正相关(

＝0.27、0.37、0.27，

0.05)，与UA呈负相关(

＝－0.32，

0.05)；肾气亏虚证组患者WMLs程度与Hcy呈正相关(

＝0.33，

0.05)，与HHcy、舒张压呈负相关(

＝－0.32、－0.30，

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(

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(

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(

＝0.57，

0.05)，与HUA呈负相关(

＝－0.58，

0.05)；肝火亢盛证组患者WMLs程度与UA呈正相关(

＝0.34，

0.05)，与HUA呈负相关(

＝－0.44，

0.05)；肾气亏虚证组患者WMLs程度与Cys C呈正相关(

＝0.26，

0.05)，与糖尿病、HUA呈负相关(

＝－0.30、－0.28，

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(

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。

Abstract

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

and Cys C among different TCM syndrome types (

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 (

0.05). The WMLs Fazekas and ARWMC risk classification analysis of different TCM syndrome types were significantly different (

0.05). According to the Fazekas scale assessment

there were differences in WMLs among all of the syndrome types (

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 (

=0.22

0.23

0.18

0.24

0.05). The WMLs degree was negatively correlated with HUA and HHcy (

=-0.19

-0.21

0.05). The degree of WMLs was positively correlated with UA (

=0.48

0.05)

and negatively correlated with HUA (

=-0.47

0.05). The degree of WMLs in yin deficiency and yang hyperactivity syndrome group was positively correlated with age

HUA

and Cys C (

=0.37

0.27

0.05)

and negatively correlated with UA (

=-0.32

0.05). The degree of WMLs in the kidney qi deficiency syndrome group was positively correlated with Hcy (

=0.33

0.05)

but negatively correlated with HHcy and DBP (

=-0.32

-0.30

0.05). The phlegm and blood stasis syndrome had more risk factors with a statistically significant difference (

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 (

0.05). Spearman rank correlation analysis showed that the WMLs degree was positively correlated with UA (

=0.57

0.05) and negatively correlated with HUA (

=-0.58

0.05) in patients with hypertension and the ARWMC rating. The degree of WMLs was positively correlated with UA (

=0.34

0.05)

and negatively correlated with HUA (

=-0.44

0.05). The degree of WMLs in the kidney qi deficiency syndrome group was positively correlated with Cys C (

=0.26

0.05)

and negatively correlated with diabetes mellitus and HUA (

=-0.30

-0.28

0.05).There were more risk factors with statistically significant differences (

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.

关键词

高血压中医证候脑白质病变风险评估影响因素

Keywords

hypertensiontraditional Chinese medicine syndromewhite matter lesionsrisk assessmentinfluence factors

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