摘要
目的:探讨围绝经期高血压中医证型与性激素、心血管相关危险因素的关系,为不同证型的围绝经期高血压患者的早期干预及治疗提供依据;为中医辨证提供客观化指标。方法:将体检的820例45～55岁汉族女性,依据围绝经期综合征的诊断标准纳入,并依据2005中国高血压防治指南,分为高血压组和非高血压组,共收集围绝经期高血压患者180例,根据《中药新药临床研究指导原则》中高血压中医辨证原则、结合本研究辨证分为:阴虚内燥、肝郁痰阻、心脾两虚、阴阳两虚4型,从围绝经期非高血压组随机抽取30例作为对照组。检测性激素、血脂、血糖、超敏C反应蛋白,计算体重指数,并做相关统计分析。结果:1)经单因素方差分析,结果示:阴虚内燥型E2低于肝郁痰阻、心脾两虚、阴阳两虚、对照组E2;阴虚内燥、肝郁痰阻、心脾两虚、阴阳两虚型FSH、PRO、TG、TC、LDLC、BMI、hs-CRP高于对照组(P<0.05);阴虚内燥、肝郁痰阻、心脾两虚、阴阳两虚型HDLC较对照组降低;肝郁痰阻型TG高于阴虚内燥、心脾两虚、阴阳两虚型和对照组;肝郁痰阻型BMI较阴虚内燥、心脾两虚、阴阳两虚型BMI值升高;阴阳两虚型空腹血糖较阴虚内燥、肝郁痰阻、心脾两虚型、对照组升高具有统计学意义(P<0.05);2)经多因素Logistic回归分析,结果示:E2(OR=7.703,P=0.004)为阴虚内燥型围绝经期高血压最显著的独立危险因素,TC为阴虚内燥型围绝经期高血压的保护因素。HDLC(OR=9.562,P=0.004)、TG(OR=4.484,P=0.048)、BM(IOR=4.346,P=0.034),是肝郁痰阻型围绝经期高血压的独立危险因素,LDLC(OR=8.605,P=0.002)、FPG(OR=4.105,P=0.04)是阴阳两虚型围绝经期高血压的独立危险因素,TC(OR=8.655,P=0.002)、hs-CRP(OR=4.165,P=0.04)是心脾两虚型围绝经期高血压的独立危险因素。结论:E2为阴虚内燥型围绝经期高血压最显著相关的独立危险因素,HDLC、TG、BMI是肝郁痰阻型围绝经期高血压的独立危险因素,LDLC、FPG是阴阳两虚型围绝经期高血压的独立危险因素,TC、hs-CRP是心脾两虚型围绝经期高血压的独立危险因素,以上客观指标可为围绝经期高血压的中医分型提供依据,有助中医辨证的客观化。
Objective: To observe the relationship between different TCM dialectical type and associate with sex hormones and risk factors of cardiovascular disease, provide the evidence for the early intervention and treatment as different dialectical type in perimenopausal women of hypertension. then provide objective index for TCM dialectical type in perimenopausal women of hypertension. Methods: 820 cases who joined the healthy physical examination were included in the study and were divided into two groups according to perimenopausal syndrome diagnostic criteria incorporated, of 45～55 years old Han women, and on the basis of Chinese hypertension preventing and controlling guide 2005, divided into hypertension group and healthy control group, together collected 180 cases in perimenopausal patients with hypertension, then according to the Guideline about clinical research of new traditional Chinese drugs, combined with the research of syndrome differentiation was divided into four groups; yin deficiency and internal dryness, stagnation of phlegm, heart lienal two deficiency, yin and yang two deficiency, from perimenopausal healthy control group randomly selected 30 cases as control group. All cases were recorded of sex hormone, blood lipids, blood glucose, high sensitivity C reactive protein, body mass index, and do statistical analysis. Results: To the single factor analysis of variance, the results showed; yin deficiency and internal dryness type of E2 lower than liver stagnation and phlegm, heart lienal two deficiency, yin and Yang two deficiency and the control group E2; Yin deficiency and internal dryness, stagnation of phlegm, heart lienal two deficiency, yin and yang two deficiency type FSH, PRO, TG, TC, LDLC, BMI, hs-CRP higher than that of the control group (P<0.05); Yin deficiency and internal dryness, stagnation of phlegm, heart lienal two deficiency, yin and yang two deficiency type HDLC lower than the control group; liver stagnation and phlegm type TG higher than Yin deficiency and internal dryness, heart lienal two deficiency, yin and yang two deficiency type and the control group; liver stagnation and phlegm type BMI higher than Yin deficiency and internal dryness, heart lienal two deficiency, yin and yang two deficiency type BMI and the control group; Yin and yang two deficiency type fasting blood glucose higher than Yin deficiency and internal dryness, stagnation of phlegm, heart and spleen two deficiency type, the control group had statistical significance (P<0.05). According to the Logistic regression analysis, the results show; E2 (OR=7.703, P=0.004) is the most significant independent risk factor related of hypertension in perimenopausal women, TC is protective factor in perimenopausal women with hypertension. HDLC (OR=9.562, P=0.004), TG (OR=4.484, P=0.048), BMI (OR=4.346, P=0.034), are the significant risk factors of hypertension in perimenopausal women with accumulation of stagnation of phlegm type, LDLC (OR=8.605, P=0.002), FPG (OR=4.105, P=0.04) are the significant risk factors of hypertension in perimenopausal women with the Yin and Yang two deficiency, TC (OR=8.655, P=0.002), hs-CRP (OR=4.165, P=0.04) are the significant risk factors of hypertension in perimenopausal women with is the heart lienal two empty type climacteric hypertension independent risk factors. Conclusion:E2 is the most significant independent risk factor related of hypertension in perimenopausal women, HDLC, TG, BMI are the significant risk factors of hypertension in perimenopausal women with accumulation of stagnation of phlegm type, LDLC, FPG are the significant risk factors of hypertension in perimenopausal women with the Yin and Yang two deficiency, TC, hs-CRP are the significant risk factors of hypertension in perimenopausal women with is the heart lienal two empty type climacteric hypertension independent risk factors.These objective index can provide evidence for TCM dialectical type of hypertension in perimenopausal women, and helpful to objectification and quantification of TCM dialectical type.
引文
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