【摘要】 目的:不同中医证型的高血压患者的代谢紊乱程度也并不完全一致,观察心血管危险因素分层、高血压分期、分级、血脂和血流变学指标在不同中医证型高血压患者间的差异。方法:选择2003-01/2005-01在沈阳医学院沈州医院心内科门诊就诊或住院治疗的原发性高血压患者395例,男228例,女167例。参照1993年卫生部中药新药临床研究指导原则关于治疗高血压的临床研究指导原则所确定的辨证标准将患者分为4种证型。肝火亢盛证54例,男35例,女19例;阴虚阳亢证177例,男101例,女76例;痰湿壅盛证62例,男37例,女25例;阴阳两虚证102例,男62例,女40例。均自愿参加。①用每个证型所有患者总高血压期数、级数、层数与该证型例数之比表示高血压患者平均危险分层、级别、分期情况。②采用氧化酶法测高血压患者血清总胆固醇及三酰甘油;用化学修饰酶法测高密度脂蛋白胆固醇和低密度脂蛋白胆固醇。③采用自清洗旋转式黏度计检测高血压患者全血黏度(高、低切)、血浆比黏度、红细胞压积、全血还原黏度和K值方程。用t检验进行组间显著性测定。结果:按意向处理分析,进入结果分析原发性高血压患者395例。①各证型高血压患者平均高血压分期、分级和心血管危险因素分层:痰湿壅盛证高血压患者平均高血压分层与阴阳两虚证相近[(1.33±1.08),(1.31±0.94)层/例,P>0.05],平均高血压分期和分级明显高于阴阳两虚证[(1.57±0.89)期/例,(2.37±0.91)级/例;(1.52±0.90)期/例,(2.27±0.86)级/例,P<0.05]。肝火亢盛证、阴虚阳亢证高血压患者的平均高血压分期、分级和分层明显高于阴阳两虚证[(1.88±0.76)期/例,(2.59±0.80)级/例,(1.51±0.89)层/例;(1.63±0.84)期/例,(2.76±1.01)级/例,(1.39±0.94)层/例,P<0.05～0.01]。②各证型高血压患者空腹血脂浓度:肝火亢盛证低密度脂蛋白胆固醇与高密度脂蛋白胆固醇之比明显高于阴阳两虚证(P<0.05)。肝火亢盛证、阴虚阳亢证、痰湿壅盛证总胆固醇、三酰甘油、低密度脂蛋白胆固醇浓度和总胆固醇与高密度脂蛋白胆固醇之比明显高于阴阳两虚证(P<0.05～0.01);高密度脂蛋白胆固醇浓度明显低于阴阳两虚证(P<0.05～0.01)。③高血压患者血液流变学指标:除阴虚阳亢证全血还原黏度和痰湿壅盛证血浆比黏度、红细胞压积与阴阳两虚证相近外(P>0.05)。肝火亢盛证、阴虚阳亢证和痰湿壅盛证全血高切黏度、全血低切黏度、血浆比黏度、红细胞压积、全血还原黏度和K值方程明显高于阴阳两虚证(P<0.05～0.01)。结论:①肝火亢盛证、阴虚阳亢证和痰湿壅盛证高血压患者较阴阳两虚证有更高的发生动脉硬化危险性和更多心血管危险因素,高血压患病程度更重,有更多的合并症。②肝火亢盛证、阴虚阳亢证和痰湿壅盛证高血压患者较阴阳两虚证更易发生血脂紊乱和血流变学异常。更多还原

【Abstract】 AIM: The severity of metabolic disorder is not completely coincident in the hypertensive patients with different syndromes of traditional Chinese medicine. The aim of the study was to observe the differences of the delamination of cardiovascular risk factor, staging and grading of hypertension and the blood lipids and hemorheological indexes among the hypertensive patients with different syndromes of traditional Chinese medicine. METHODS: Totally 395 outpatients or inpatients (228 males and 167 female) with essential hypertension in the Department of Cardiology, Shenzhou Hospital, Shenyang Medical College between January 2003 and January 2005 were voluntarily involved in the study. According to the standards for the differentiation of syndrome about the clinical research instructive principles in the treatment of hypertension defined in the Principle of Clinical Research for New Traditional Herbs set by the Ministry of Health in 1993, the patients were divided into 4 types: liver-fire hyperactivity (n=54, 35 males and 19 females), hyperactivity of yang due to yin deficiency (n=177, 101 males and 76 females), excessive accumulation of phlegm-dampness (n=62, 37 males and 25 females), deficiency of both yin and yang (n=102, 62 males and 40 females).①The average risk delimination, grading and staging of the hypertensive patients were expressed by the ratios of the numbers of hypertensive stage, grade and delimination in all the patients with each syndrome to the number of cases having the syndrome.②The serum total cholesterol and triglyceride of the hypertensive patients were detected with the method of oxidase; High density lipoprotein cholesterol and low density lipoprotein cholesterol were determined by means of chemical modified enzyme. ③The whole blood viscosity (high and low shearing), plasma viscosity, haematocrit, whole blood reduced viscosity and K value equation were detected with the auto cleaning rotating viscometer. The t test was used for the intergroup difference. RESULTS: According to intention-to-treat analysis, all the 395 patients with essential hypertension were involved in the analysis of results. ①The average hypertensive risk delimination, grading and staging in the hypertensive patients with each differentiation of syndrome: The average risk delimination in the hypertensive patients with excessive accumulation of phlegm-dampness was close to that in those with deficiency of both yin and yang [(1.33±1.08),(1.31±0.94) deliminations/case, P > 0.05], the average hypertensive staging and grading were obviously higher than those in the hypertensive patients with deficiency of both yin and yang [(1.57±0.89) stages/case,(2.37±0.91) grades/cases; (1.52±0.90) stages/case, (2.27±0.86) grades/cases, P < 0.05]. The average hypertensive staging, grading and delimination were all obviously higher in the hypertensive patients with liver-fire hyperactivity and hyperactivity of yang due to yin deficiency than in those with deficiency of both yin and yang [(1.88±0.76) stages/case,(2.59±0.80) grades/cases,(1.51±0.89) deliminations/case; (1.63±0.84) stages/case,(2.76±1.01) grades/cases,(1.39±0.94) deliminations/case, P < 0.05 to 0.01]. ②The concentrations of fasting blood lipids in the hypertensive patients with each differentiation of syndrome: The ratio of high density lipoprotein cholesterol to low density lipoprotein cholesterol was obviously higher in the hypertensive patients with liver-fire hyperactivity than in those with deficiency of both yin and yang (P < 0.05); The concentrations of total cholesterol, triglyceride and low density lipoprotein cholesterol and the ratio of total cholesterol to high density lipoprotein cholesterol in the hypertensive patients with liver-fire hyperactivity, hyperactivity of yang due to yin deficiency and excessive accumulation of phlegm-dampness were obviously higher than those in the patients with deficiency of both yin and yang (P < 0.05 to 0.01), and the concentration of high density lipoprotein cholesterol was obviously lower than that in those with deficiency of both yin and yang (P < 0.05 to 0.01). ③The hemorheological indexes in the hypertensive patients: Except that the whole blood reduced viscosity of hyperactivity of yang due to yin deficiency and the plasma viscosity and haematocrit of excessive accumulation of phlegm-dampness were close to those of deficiency of both yin and yang (P > 0.05), the whole blood high and low shearing viscosity, plasma viscosity, haematocrit, whole blood reduced viscosity and K value equation were all obviously higher in the syndromes of liver-fire hyperactivity, hyperactivity of yang due to yin deficiency and excessive accumulation of phlegm-dampness than in the syndrome of deficiency of both yin and yang (P < 0.05 to 0.01). CONCLUSION:①The hypertensive patients with the syndromes of liver-fire hyperactivity, hyperactivity of yang due to yin deficiency and excessive accumulation of phlegm-dampness have higher risk of the incidence of arteriosclerosis, more cardiovascular risk factors, more serious hypertensive severity and more complications than those with the syndrome of deficiency of both yin and yang. ②Blood lipid disorder and hemorheological abnormality are much easier to occur in the hypertensive patients with the syndromes of liver-fire hyperactivity, hyperactivity of yang due to yin deficiency and excessive accumulation of phlegm-dampness than those with the syndrome of deficiency of both yin and yang.更多还原