原发性低血压中医分型与动态血压、心功能指标的关系的研究
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摘要
目的：研究原发性低血压（Essential Hypotension）患者的发病因
素，通过24小时动态血压监测技术（Ambulatory blood pressure
monitoring，ABPM）观察患者的血压平均水平及变化规律，探索原发
性低血压的诊断标准。通过检测患者的彩色超声心动图了解其心功
能（Cardiac function）指标的变化，探讨原发性低血压的发病机制。观
察原发性低血压患者气虚证、阴虚证型在心功能指标上的变化，探
讨其各自的关系，提出这两种证型各自的病理改变基础。
结果：
1．50例患者中女性39例、占78％，男性11例、占22％，8例
有家族史、占16％。体重低于标准体重者占48％，工作紧张度中等
以上者占67％。饮食上未见明显偏好及习惯。性格较内向者占
60.1％。症状上诉头晕48例（占96.4％）、头痛13例（占26％）、疲
乏无力48例（占96.4％）、健忘41例（占82％）、心悸21例（占42
％）、胸闷6例（占12％）、食欲不振5例（占10％）。偶测血压平均
值为88.5±6.5/56.4±6.7mmHg。
2．50例动态血压监测显示：24小时平均血压值为
100.9/62.1mmHg，白天血压平均值为102.8/63.7mmHg，夜间血压平
均值为95乃6．gmmHg，昼夜血压差别平均为7。8伯．7删Ilg。患者出
现低血压多在凌晨0点至清晨5点及下午3点左右，并以舒张压降低
为主。
3。C功能检测结果显示：①原发性低血压患者的室间隔厚度
（Interventrlcular sevtal thickness，IVST）、左星重量（left
ventrlcular Inass，LVM）、左呈重量指数（left ventrlctlla．r lllass
index，LVMI）及平均舒张期星壁厚度（。ean wall thickness at
d柏叭1巳M们”D）均较正常组明显减少，左室收缩末内径（1听
yen上r。cUlar lute。nal diameter。t end－systole，LVDS）、左呈舒
张末内径（left ventricula。Internal diameter at end－
diastole，LVDD）较正常组明显增力，P＜0．of。①｛血压组的左室身
血分数（left ventricular ej6ction fraction，EF）、左呈短轴缩
短率（short。en frequency of ventrlcular short－axis，l。S）、左
室收缩末室壁应力（end－systolic stress on the left ventrlcular
wall，ESS）及心 肌收 缩性（cardiac contractility）均较正常组明
显降低，其中EF值仍处正常值范围。③低血压组的舒张早期减速度
（early－dlastollc deceleration，DC）较正常组明显减低，P（．of。
其余舒张功能指标均未见明显统计学差异。
4．原发性低血压患者气虚证组与阴虚证组的心功能指标显示：
①心脏结构指标：气虚证组的IVST、IVSTS、左室后壁舒张末
及收缩末厚度uWT、PWT S）、LVM、MWTD及l。VMI均较正常组明显减
少，K0．OI及W0．05，而u“、u皿均较正常组明显增加，K0．O仁
阴虚证组的MM、LVMI均较正常组明显减少，P＜0．01，6 LVDS较正
常组明显增加；气虚证组与阴虚证组比较，气虚证组的IVSI’、IVS”rs、
PWT、PWTS、MWTD均明显减少，P＜0．01，而 LVDD明显增加，P＜0，01。
4
①心脏收缩功能显示：气虚证组及阴虚证组的Er、ESS、。C几
收缩性均较正常组明显减少，且气虚证组的FS较正常组明显减少，
处于正常值低限，但其旺值仍属正常；气虚证组与阴虚证组比较，
气虚证组勺＊、ESS均明显减少，P＜0．01。
③心脏舒张功能显示：气虚证组的二尖瓣口舒张期血流频谱E
峰与A峰t匕值u从）、DC较正常组明显减少，P州．01；阴虚证组的
DC较正常组减少，Pm．05；气虚证组与阴虚证组比较，气虚证组的
E／A明显减少，P＜0．05。
结论：原发性低血压患者多见于中青年女性，发病与体质因素、
遗传因素及生活工作压力有关。原发性低血压病是一个时域性的概
念，血压低于正常仅在一天的某些时段，且以舒张压降低为主。原
发性低血压患者的。C脏舒缩功能较正常组有相对减弱的趋势，表现
在患者的吓、FS、ESS、。G肌收缩性、DC明显降低；本病气虚证较
阴虚证在。。功能上改变明显，其左心室壁相对较薄，FS、ESS、E八
均较阴虚者明显降低。因此在治疗上采用增强。C肌收缩力的药物，
并配合使用中药补中益气、养心健脾将会取得良好的疗效。
Research on the Relationship between the Essential
Hypotension Patients' Ambulatory Blood Pressure
Cardiac Function and Their TCM-Syndrome
Major: Clinic of the Traditional Chinese Medicine Postgraduate: Li Cuiyun Tutor: Prof. Lin Songbo
Vice Prof. Zhou Guoying
ABSTRACT
Objectives: To observe the essential hypotension patients' average blood pressure and their regulation by the technology of Ambulatory Blood Pressure Monitoring(ABPM), To research the pathogenesis of essential hypotension , especially the cardiac function by the echocardiograra, To research the difference between Qi-deficiency TCM-syndrome and Yin-deficiency TCM-syndrome in cardiac function.
Results:
1. 50 patients were observed, 39 female cases > 11 male cases, 8 patients have family history of Essential Hypotension, 48 percent patients' body weight 10 percent lower than the standard weight. 67 percent have emotional stress in work. There is no obviously habit in diet. 60 percent have introversion temperament. In complaint: 48 cases dizzy , 13 cases headache , 48 cases fatigued and weak , 41 cases forgetful , 21 cases palpitation -. 6 cases have oppressive sensation in the chest , 5 cases have poor appetite. The average blood pressure were 88. 5?. 5/56. 4?. 7mmHg.
2. The ABPM indicated that: the average blood pressure in 24 hours x daytime and night were 100.9 /62. 1 mmHg > 102.8 /63.7mmHg and 95 756.9 mmHg. Most" oT TTIe blood pressure decreased during early dawn or at 3 O'clock in the afternoon. The diastolic pressure decreased more obviously than the systolic blood pressure.
3. The result of cardiac function by echocardiogram showed that: ㏕he patients' Interventricular Septal Thickness(IVST) , Left Ventricular Mass (LVM) , Left Ventricular Mass Index (LVMI) and Mean Wall Thickness at Diastole(MWTD) decreased significantly, while the left ventricular internal diameter at end-systole(LVDs) and the left ventricular internal diameter at end-diastole (LVDd) decreased, p<0. 01. (2) The patients' left ventricular ejection fraction(EF) , FS, end-systolic stress on the left ventricular wall (ESS) and the cardiac contractility descended obviously, but the EF was still in the normal field. (3) The patients' early-diastolic deceleration(DC) descended significantly, p<0.01. There was no difference in statistics of the cardiac diastolic function.
4. The indexes of the cardiac function of Qi-deficiency TCM-syndrome and Yin-deficiency TCM-syndrome in Essential Hypotension showed that: The indexes of IVST , left ventricular posterior wall thickness(PWT) , LVM and MWTD in the Qi-deficiency TCM-syndrome decreased more significantly than that in the Yin-deficiency TCM-syndrome, so did the FS, ESS and E/A.
Conclusion: The Essential Hypotension is commonest in the young female. The disease is associated with constitution and genetic factor, as well as emotional stress in work. The blood pressure of Essential Hypotension always below normal level in some period of one day, especially the diastolic blood pressure. The patients' cardiac function descended relatively, especially the systolic cardiac function of Qi-deficiency TCM-syndrome changed more significantly than that of Yin-deficiency TCM-syndrome. So if take medicine increasing the cardiac contractility .meanwhile with the Chinese herbal invigorating Qi, strengthening the spleen and reinforcing the heart, will get good curative effect.
素，通过24小时动态血压监测技术（Ambulatory blood pressure
monitoring，ABPM）观察患者的血压平均水平及变化规律，探索原发
性低血压的诊断标准。通过检测患者的彩色超声心动图了解其心功
能（Cardiac function）指标的变化，探讨原发性低血压的发病机制。观
察原发性低血压患者气虚证、阴虚证型在心功能指标上的变化，探
讨其各自的关系，提出这两种证型各自的病理改变基础。
结果：
1．50例患者中女性39例、占78％，男性11例、占22％，8例
有家族史、占16％。体重低于标准体重者占48％，工作紧张度中等
以上者占67％。饮食上未见明显偏好及习惯。性格较内向者占
60.1％。症状上诉头晕48例（占96.4％）、头痛13例（占26％）、疲
乏无力48例（占96.4％）、健忘41例（占82％）、心悸21例（占42
％）、胸闷6例（占12％）、食欲不振5例（占10％）。偶测血压平均
值为88.5±6.5/56.4±6.7mmHg。
2．50例动态血压监测显示：24小时平均血压值为
100.9/62.1mmHg，白天血压平均值为102.8/63.7mmHg，夜间血压平
均值为95乃6．gmmHg，昼夜血压差别平均为7。8伯．7删Ilg。患者出
现低血压多在凌晨0点至清晨5点及下午3点左右，并以舒张压降低
为主。
3。C功能检测结果显示：①原发性低血压患者的室间隔厚度
（Interventrlcular sevtal thickness，IVST）、左星重量（left
ventrlcular Inass，LVM）、左呈重量指数（left ventrlctlla．r lllass
index，LVMI）及平均舒张期星壁厚度（。ean wall thickness at
d柏叭1巳M们”D）均较正常组明显减少，左室收缩末内径（1听
yen上r。cUlar lute。nal diameter。t end－systole，LVDS）、左呈舒
张末内径（left ventricula。Internal diameter at end－
diastole，LVDD）较正常组明显增力，P＜0．of。①｛血压组的左室身
血分数（left ventricular ej6ction fraction，EF）、左呈短轴缩
短率（short。en frequency of ventrlcular short－axis，l。S）、左
室收缩末室壁应力（end－systolic stress on the left ventrlcular
wall，ESS）及心 肌收 缩性（cardiac contractility）均较正常组明
显降低，其中EF值仍处正常值范围。③低血压组的舒张早期减速度
（early－dlastollc deceleration，DC）较正常组明显减低，P（．of。
其余舒张功能指标均未见明显统计学差异。
4．原发性低血压患者气虚证组与阴虚证组的心功能指标显示：
①心脏结构指标：气虚证组的IVST、IVSTS、左室后壁舒张末
及收缩末厚度uWT、PWT S）、LVM、MWTD及l。VMI均较正常组明显减
少，K0．OI及W0．05，而u“、u皿均较正常组明显增加，K0．O仁
阴虚证组的MM、LVMI均较正常组明显减少，P＜0．01，6 LVDS较正
常组明显增加；气虚证组与阴虚证组比较，气虚证组的IVSI’、IVS”rs、
PWT、PWTS、MWTD均明显减少，P＜0．01，而 LVDD明显增加，P＜0，01。
4
①心脏收缩功能显示：气虚证组及阴虚证组的Er、ESS、。C几
收缩性均较正常组明显减少，且气虚证组的FS较正常组明显减少，
处于正常值低限，但其旺值仍属正常；气虚证组与阴虚证组比较，
气虚证组勺＊、ESS均明显减少，P＜0．01。
③心脏舒张功能显示：气虚证组的二尖瓣口舒张期血流频谱E
峰与A峰t匕值u从）、DC较正常组明显减少，P州．01；阴虚证组的
DC较正常组减少，Pm．05；气虚证组与阴虚证组比较，气虚证组的
E／A明显减少，P＜0．05。
结论：原发性低血压患者多见于中青年女性，发病与体质因素、
遗传因素及生活工作压力有关。原发性低血压病是一个时域性的概
念，血压低于正常仅在一天的某些时段，且以舒张压降低为主。原
发性低血压患者的。C脏舒缩功能较正常组有相对减弱的趋势，表现
在患者的吓、FS、ESS、。G肌收缩性、DC明显降低；本病气虚证较
阴虚证在。。功能上改变明显，其左心室壁相对较薄，FS、ESS、E八
均较阴虚者明显降低。因此在治疗上采用增强。C肌收缩力的药物，
并配合使用中药补中益气、养心健脾将会取得良好的疗效。
Research on the Relationship between the Essential
Hypotension Patients' Ambulatory Blood Pressure
Cardiac Function and Their TCM-Syndrome
Major: Clinic of the Traditional Chinese Medicine Postgraduate: Li Cuiyun Tutor: Prof. Lin Songbo
Vice Prof. Zhou Guoying
ABSTRACT
Objectives: To observe the essential hypotension patients' average blood pressure and their regulation by the technology of Ambulatory Blood Pressure Monitoring(ABPM), To research the pathogenesis of essential hypotension , especially the cardiac function by the echocardiograra, To research the difference between Qi-deficiency TCM-syndrome and Yin-deficiency TCM-syndrome in cardiac function.
Results:
1. 50 patients were observed, 39 female cases > 11 male cases, 8 patients have family history of Essential Hypotension, 48 percent patients' body weight 10 percent lower than the standard weight. 67 percent have emotional stress in work. There is no obviously habit in diet. 60 percent have introversion temperament. In complaint: 48 cases dizzy , 13 cases headache , 48 cases fatigued and weak , 41 cases forgetful , 21 cases palpitation -. 6 cases have oppressive sensation in the chest , 5 cases have poor appetite. The average blood pressure were 88. 5?. 5/56. 4?. 7mmHg.
2. The ABPM indicated that: the average blood pressure in 24 hours x daytime and night were 100.9 /62. 1 mmHg > 102.8 /63.7mmHg and 95 756.9 mmHg. Most" oT TTIe blood pressure decreased during early dawn or at 3 O'clock in the afternoon. The diastolic pressure decreased more obviously than the systolic blood pressure.
3. The result of cardiac function by echocardiogram showed that: ㏕he patients' Interventricular Septal Thickness(IVST) , Left Ventricular Mass (LVM) , Left Ventricular Mass Index (LVMI) and Mean Wall Thickness at Diastole(MWTD) decreased significantly, while the left ventricular internal diameter at end-systole(LVDs) and the left ventricular internal diameter at end-diastole (LVDd) decreased, p<0. 01. (2) The patients' left ventricular ejection fraction(EF) , FS, end-systolic stress on the left ventricular wall (ESS) and the cardiac contractility descended obviously, but the EF was still in the normal field. (3) The patients' early-diastolic deceleration(DC) descended significantly, p<0.01. There was no difference in statistics of the cardiac diastolic function.
4. The indexes of the cardiac function of Qi-deficiency TCM-syndrome and Yin-deficiency TCM-syndrome in Essential Hypotension showed that: The indexes of IVST , left ventricular posterior wall thickness(PWT) , LVM and MWTD in the Qi-deficiency TCM-syndrome decreased more significantly than that in the Yin-deficiency TCM-syndrome, so did the FS, ESS and E/A.
Conclusion: The Essential Hypotension is commonest in the young female. The disease is associated with constitution and genetic factor, as well as emotional stress in work. The blood pressure of Essential Hypotension always below normal level in some period of one day, especially the diastolic blood pressure. The patients' cardiac function descended relatively, especially the systolic cardiac function of Qi-deficiency TCM-syndrome changed more significantly than that of Yin-deficiency TCM-syndrome. So if take medicine increasing the cardiac contractility .meanwhile with the Chinese herbal invigorating Qi, strengthening the spleen and reinforcing the heart, will get good curative effect.
引文
1．白新胜，林建富，洪国盛等．原发性低血压445例调查分析．福建医药杂志．1987；9(3)：37
2．周建飞，屈晓霞。低血压病的诊断及治疗探讨(附130例病例报告)．铁道医学．1996；24(5)：312
3．李维绥，高锦团，黄翠芬等．大学生低血压发生率调查．福建医学院学报．1988；22(2)：163
4．邓铁涛主编．中医诊断学，第五版．上海科技出版社：89、99
5. Teicholz:IE, Kreut TC, Hermarch, NW. Problems in Echocardiographic Volume determination, Am Cardial,1976,37:7
6. Deverux RB, Keichek N. Echocardiographic determination of left ventricular mass in man:Anatomic Validation of the method, Circulation, 1997,55:613
7. Simone G,.Echocardiographic accessment of arterial impedance:Relation to anotomic left Ventricular Patterns in systemic hypertension, Amg Noninvas Carkiol,1998,2:23
8. Quinones MA. Noninvasive qualification of left ventricular walls stress,Validation of method and application to accessment of chronic pressure overload, Am Cardiol 1980,48:782
9. Myrengy,mynre E.Effects of verapamil on left ventricular relaxation and filling dynamic in Coronary artery disease:a study by pulsed Doppler Echocardiography, Am Hearty,1989，117：870
10．杨泉虎．调脾升压汤治疗低血压52例．陕西中医．1994；(3)：106
11．张栓，穆晓红．低血压的中医药治疗和实验研究近况．中医药信息．1995；(1)：3
12．张汉池．中西两法治疗低血压病60例临床观察．实用中西医结合杂志．1994：7(5)：311
13．塔娜，孟桂贞，皇甫健等．原发性低血压症97例分析．实用心脑肺血管病杂志．1996：4(2)：52
14．杨为国，周岩，林红华等．原发性低血压紧张性刺激研究分析．福建医药杂志。1995；17(6)：66
15．魏厚义．89例血压偏低头痛综合症的初步报告．遵义医学院学报．1986；9(2)：57
16．严宗震，康庄，陈继芳．黄杨宁治疗低血压症45例疗效分析．中西医结合杂志．1990．10(6)：366
17．郑济国．诺迪康治疗低血压48例疗效观察．中原医刊．1997．24(10)：46
18．郑小璞，马爱群，刘治全等．小剂量美多心安对24例原发性低血压的临床疗效观察．西北药学杂志．1994：9(4)：179
19. Shutov-AA. Role of cerebral mechanisms in the development of arterial hypotension. Zh-Nevropatol Psikhiatr.1983:83(10):1509
20. Man Shikov.Functional state of the cortical and medullary layers of the adrenals in primary hypotension.mardiogiia.1976;16(11)78
21. Ziegler M.The sympathetic nervous system defect in primary othostatic hypotension.New Engl J Med 1997;293～296
22. Kaloeva-ZD,Indicators of the kallikrein-kinin system in children With Primary arterial hypotension.Pediatria 1989;4:43
23. Leont'eva-Ⅳ. Characteristics of the cardio-vascular system in children with Primary arterial hypotension.Pediatria 1991;3:23
24．李绍芝．心气虚证研究近况．湖南中医学院学报．1989；9(2)：103
25．柳文仪．心气虚证的心功能表述．实用中医内科杂志．1991；5(3)：9
2．周建飞，屈晓霞。低血压病的诊断及治疗探讨(附130例病例报告)．铁道医学．1996；24(5)：312
3．李维绥，高锦团，黄翠芬等．大学生低血压发生率调查．福建医学院学报．1988；22(2)：163
4．邓铁涛主编．中医诊断学，第五版．上海科技出版社：89、99
5. Teicholz:IE, Kreut TC, Hermarch, NW. Problems in Echocardiographic Volume determination, Am Cardial,1976,37:7
6. Deverux RB, Keichek N. Echocardiographic determination of left ventricular mass in man:Anatomic Validation of the method, Circulation, 1997,55:613
7. Simone G,.Echocardiographic accessment of arterial impedance:Relation to anotomic left Ventricular Patterns in systemic hypertension, Amg Noninvas Carkiol,1998,2:23
8. Quinones MA. Noninvasive qualification of left ventricular walls stress,Validation of method and application to accessment of chronic pressure overload, Am Cardiol 1980,48:782
9. Myrengy,mynre E.Effects of verapamil on left ventricular relaxation and filling dynamic in Coronary artery disease:a study by pulsed Doppler Echocardiography, Am Hearty,1989，117：870
10．杨泉虎．调脾升压汤治疗低血压52例．陕西中医．1994；(3)：106
11．张栓，穆晓红．低血压的中医药治疗和实验研究近况．中医药信息．1995；(1)：3
12．张汉池．中西两法治疗低血压病60例临床观察．实用中西医结合杂志．1994：7(5)：311
13．塔娜，孟桂贞，皇甫健等．原发性低血压症97例分析．实用心脑肺血管病杂志．1996：4(2)：52
14．杨为国，周岩，林红华等．原发性低血压紧张性刺激研究分析．福建医药杂志。1995；17(6)：66
15．魏厚义．89例血压偏低头痛综合症的初步报告．遵义医学院学报．1986；9(2)：57
16．严宗震，康庄，陈继芳．黄杨宁治疗低血压症45例疗效分析．中西医结合杂志．1990．10(6)：366
17．郑济国．诺迪康治疗低血压48例疗效观察．中原医刊．1997．24(10)：46
18．郑小璞，马爱群，刘治全等．小剂量美多心安对24例原发性低血压的临床疗效观察．西北药学杂志．1994：9(4)：179
19. Shutov-AA. Role of cerebral mechanisms in the development of arterial hypotension. Zh-Nevropatol Psikhiatr.1983:83(10):1509
20. Man Shikov.Functional state of the cortical and medullary layers of the adrenals in primary hypotension.mardiogiia.1976;16(11)78
21. Ziegler M.The sympathetic nervous system defect in primary othostatic hypotension.New Engl J Med 1997;293～296
22. Kaloeva-ZD,Indicators of the kallikrein-kinin system in children With Primary arterial hypotension.Pediatria 1989;4:43
23. Leont'eva-Ⅳ. Characteristics of the cardio-vascular system in children with Primary arterial hypotension.Pediatria 1991;3:23
24．李绍芝．心气虚证研究近况．湖南中医学院学报．1989；9(2)：103
25．柳文仪．心气虚证的心功能表述．实用中医内科杂志．1991；5(3)：9