摘要
目的:观察老年人高血压病分型特点以及是否以肾虚证为主,老年高血压肾虚证与收缩压、脉压增高是否具有相关性。方法:收集老年高血压病例,通过问卷形式收集人口学信息、偶测肱动脉血压、心脑血管病史、中医证候分级量化等资料,通过统计学分析观察老年高血病人辩证分型情况以及肾虚证与高收缩压、高脉压的关系。结果:1.老年高血压病的虚实证候分布情况:各组间的构成比不等或不全相等,虚证和虚实夹杂证的构成比例明显较重;考虑样本量较小(共有6个理论频数小于5),各组内证候构成比的比较无意义。2.老年高血压病的脏腑虚证分布情况:各组间的构成比不等或不全相等,肾虚证的构成比最大。3.老年高血压病脏腑虚证的基线资料:组间性别、体重(肥胖)、舒张压、平均动脉压、单纯收缩期高血压和双期高血压例数的差异均无显著性(P>0.05);年龄、收缩压、脉压的差异有显著性(P<0.05或<0.01),与心虚证和肝虚证相比,肾虚证及其复合证型的年龄、收缩压、脉压较高(P<0.05或<0.01)。4.老年高血压肾虚证的临床变量资料:组间性别、体重(肥胖)、吸烟例数、舒张压、平均动脉压的差异均无显著性(P>0.05);年龄、收缩压、脉压的差异有显著性(P<0.05或<0.01),与心虚证和肝虚证相比,肾虚证的年龄、收缩压、脉压均较高(P<0.05或<0.01)。5.多变量Logistic回归分析:有3个独立预测老年高血压肾虚证发生的危险因子:年龄(OR=1.142,95 %CI 1.118～1.189,P<0.001),收缩压(OR=3.302,95 %CI 1.951～4.752,P<0.001),脉压(OR=2.462,95 %CI 1.583～3.893,P<0.001)。在上述3个自变量中,对肾虚证影响最大的变量是收缩压(β=1.192),其次为脉压,而年龄的影响相对较小(β=0.131)。结论:肾虚证与非肾虚证相比,其年龄组成升高,收缩压和脉压明显增加,明确肾虚证的主要病机特点,将为开展补肾法防治老年高血压病,特别是加强控制收缩压和脉压的临证实践提供证候流行病学依据。
Objective:To observe if the elderly hypertensive patients are mainly kidney deficiency type and the pertinence between kidney deficiency syndrome and systolic blood pressure . Method:.Collect elderly hypertension case, and collect the information of basic notes, blood pressure, medical history , dialectical type though the method of questionnaire.Observe elderly hypertension 's dialectical type and the relation between Kidney Deficiency Syndrome and high systolic blood pressure high pulse pressure. Result:Elderly hypertension Positive and Empty Syndrome distributed situation :Every groups show significant difference, the Empty Syndrome and the Omnibus Syndrome constitute a obviously heavy proportion .Because the number of the case is too small(it have 6 Theory frequency <5 ),it have no means to observe the difference in every group.2. Old age hypertension Viscera Positive and Empty Syndrome distributed situation :Every groups showed significant difference, the Kidney Deficiency Syndrome constitute a obviously heavy proportion .3. Elderly hypertension Viscera Positive and Empty Syndrome basic notes: It do not have obvious difference in gender, body weight (obesity), diastolic blood pressure, mean arterial pressure, isolated systolic hypertension double time hypertension (P>0.05);It have obvious difference in age, systolic blood pressure and pulse pressure(P<0.05或<0.01),compared with Heart Deficiency Syndrome and Liver Deficiency Syndrome, the Kidney Deficiency Syndrome's age, systolic blood pressure and pulse pressure are all high(P<0.05或<0.01).4.Old age Kidney Deficiency Syndrome's Clinical material: It have no significant difference in gender, body weight (obesity), smoking cases, diastolic blood pressure, mean arterial pressure (P>0.05);age, systolic blood pressure and pulse pressure have significant difference (P<0.05或<0.01=,compared with Heart Deficiency Syndrome and Liver Deficiency Syndrome, the Kidney Deficiency Syndrome's age, systolic blood pressure and pulse pressure are all high(P<0.05或<0.01=.5.Multivariate Logistic regression analysis: There are three independent factors forecast elderly hypertensive kidney deficiency syndrome ,age(OR=1.142,95 %CI 1.118～1.189,P<0.001=,systolic blood pressure (OR=3.302,95 %CI 1.951～4.752,P<0.001=,pulse pressure (OR=2.462,95 %CI 1.583～3.893,P<0.001=.In the 3 factors, the kidney deficiency syndrome is the most influential one(β=1.192),next is the pulse pressure, and the age influence have relatively little influences (β=0.131). Conclusion: Compared with other syndrome the Empty Syndrome shows that,with the increasing of the age,systolic blood pressure and pulse pressure promote obviously. Definitude the main characteristic of Kidney Deficiency Syndrome will help to prevent the old age hypertension , especially to provide a epidemiology basis for control systolic blood pressure and pulse pressure .
引文
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