老年高血压“络病”与动脉僵硬度相关性的预试验
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摘要
目的:观察203例老年人高血压病中络病的分布特点及其与baPWV(脉搏波传导速度)的相关性,评价老年高血压络病与动脉僵硬度的关联度。方法:入选203例老年高血压病人,按照络病和血瘀证的诊断标准分为4组:2个单一病证组(络病组、血瘀证组)、1个复合病证组(络病+血瘀证组)和无病证组(非络病+非血瘀证组)。统一完成中医证候及有关病史资料的完整采集,采用日本colin全自动动脉硬化测定仪测定baPWV(脉搏波传导速度)。观察老年高血压病中络病的分布情况以及其与动脉僵硬度的相关性。结果:1.各组构成比不等,络病+血瘀证组的构成比(0.429)最高;非络病组和络病组组间比较,BMI、WHR(肥胖)、吸烟例数、舒张压、平均动脉压、危险分层的差异均无显著性(P>0.05);年龄、性别、收缩压、脉压的差异有显著性(P<0.05或<0.01);与非络病组相比,络病组的年龄、男性性别、收缩压、脉压和baPWV均较高(P<0.05或<0.01)。2.年龄、性别、收缩压、脉压、baPWV是老年络病的预测因子,而吸烟、BMI、舒张压、平均动脉压与络病的发生无关;年龄、脉压、baPWV(P<0.001)为三个独立预测老年高血压“络病”发生的危险因子,其中对络病影响最大的变量是baPWV(β=1.122)。结论:1.在老年高血压病中,络病及其与血瘀证相关的复合证型较为常见。2.老年高血压病络病与动脉僵硬度可能存在相关性,鉴于样本量相对不足,尚不能建立非条件Logistic回归模型,充分校正年龄、高收缩压和危险分层等对络病患者的影响。为此,扩大样本量,深入分析年龄、高收缩压和危险分层等可能危险因素,以及病程、男性性别等潜在危险因素对上述初步结论影响的相关临床流行病学研究正在进行中。
Objective:To observe the distribution characteristic of meridian pattern in senile hypertension of 203 cases patients and their correlation with baPWV and to evaluate the relational grade of meridian pattern to arterial stiffness. Method:203 cases hypertension patients were divided into four groups according to diagnostic criteria of meridian pattern and blood stasis pattern: meridian pattern group, blood stasis group, meridian pattern group plus blood stasis group and normal group. And full collection of TCM syndromes and relative records were completed in unity. The baPWV (pulse wave velocity) was measured by colin automatic arteriosclerosis determinator made by Japan. The distribution characteristic of meridian pattern in hypertension and their relational grade of meridian pattern to arterial stiffness were observed. Result:1. The constituent ratio of these groups were different. The constituent ratio of meridian pattern group plus blood stasis group was the highest (0.429). Comparison between meridian pattern groups and non-meridian pattern groups showed no significant difference in BMI, WHR number of smoking cases, diastolic pressure and mean arterial pressure(P>0.05).While there were significant difference in Age, gender, systolic pressure, and pulse pressure between these two groups (P<0.05). Age, male gender, systolic pressure, pulse pressure and baPWV of meridian pattern groups were relative higher than those of non-meridian pattern group(P<0.05 or <0.01). 2. Age, gender, systolic pressure, pulse pressure and baPWV predictive factor for meridian pattern, while smoking, BMI, diastolic pressure and mean arterial pressure had no relationship with the onset of meridian pattern. Age, pulse pressure and baPWV were three risk factors which predicted the onset of meridian pattern in hypertension respectively. The most influential factor was baPWV among these. Conclusion: 1.Meridian pattern and the compound patterns integrated with blood stasis were relative common in senile hypertension. 2.There was possible correlation between meridian pattern in senile hypertension and arterial stiffness. Non-conditional logistic regression model was not able to be built due to relative insufficient sample size. As a result, clinical epidemiology research on possible risk factors like enlarging sample size, deeper analysis in age, high systolic pressure and risk stratification and potential risk factors like course and male gender, which could influence the conclusion mentioned above had been undertaking.
Objective:To observe the distribution characteristic of meridian pattern in senile hypertension of 203 cases patients and their correlation with baPWV and to evaluate the relational grade of meridian pattern to arterial stiffness. Method:203 cases hypertension patients were divided into four groups according to diagnostic criteria of meridian pattern and blood stasis pattern: meridian pattern group, blood stasis group, meridian pattern group plus blood stasis group and normal group. And full collection of TCM syndromes and relative records were completed in unity. The baPWV (pulse wave velocity) was measured by colin automatic arteriosclerosis determinator made by Japan. The distribution characteristic of meridian pattern in hypertension and their relational grade of meridian pattern to arterial stiffness were observed. Result:1. The constituent ratio of these groups were different. The constituent ratio of meridian pattern group plus blood stasis group was the highest (0.429). Comparison between meridian pattern groups and non-meridian pattern groups showed no significant difference in BMI, WHR number of smoking cases, diastolic pressure and mean arterial pressure(P>0.05).While there were significant difference in Age, gender, systolic pressure, and pulse pressure between these two groups (P<0.05). Age, male gender, systolic pressure, pulse pressure and baPWV of meridian pattern groups were relative higher than those of non-meridian pattern group(P<0.05 or <0.01). 2. Age, gender, systolic pressure, pulse pressure and baPWV predictive factor for meridian pattern, while smoking, BMI, diastolic pressure and mean arterial pressure had no relationship with the onset of meridian pattern. Age, pulse pressure and baPWV were three risk factors which predicted the onset of meridian pattern in hypertension respectively. The most influential factor was baPWV among these. Conclusion: 1.Meridian pattern and the compound patterns integrated with blood stasis were relative common in senile hypertension. 2.There was possible correlation between meridian pattern in senile hypertension and arterial stiffness. Non-conditional logistic regression model was not able to be built due to relative insufficient sample size. As a result, clinical epidemiology research on possible risk factors like enlarging sample size, deeper analysis in age, high systolic pressure and risk stratification and potential risk factors like course and male gender, which could influence the conclusion mentioned above had been undertaking.
引文
[1]中国高血压防治指南修订委员会.2004年中国高血压防治指南(实用本).高血压杂志,2004, 12( 6):483-486.
[2]国际心脏病学会和协会及WHO临床命名标准化联合专题组1979年报告.缺血性心脏病的命名及诊断标准.中华心血管病杂志,1981,9(1)∶75-76.
[3]王吉耀,廖二元.全国高等医药教材内科学2003,12(1):255.
[4]《中药新药临床研究指导原则》.第2版.北京:中国医药科技出版社,2002.73.
[5]徐宗佩,张伯礼.“久病入络”患者舌象(舌底)观察与分析天津中医1992, 4(2):43-45.
[6]中国肥胖问题工作组数据原总分析协作组.我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究.中华流行病学杂志,2002, 23 (1): 5-10.
[7]吴以岭.“脉络-血管系统病"新概念及其治疗探讨.疑难病杂志,2005,4(5):285-287.
[8]王筠,张军平.从中医络病学说认识血管新生.中国中医基础医学杂志,2005,11(7):493-494.
[9]朱迪.络病的中医临床研究进展.中国现代实用医学杂志,2005,4(7):42-43.
[10]雷燕.络病理论探微.北京中医药大学学报,1998,21(2):18-23.
[11]雷燕,黄启福,王永炎.论瘀毒阻络是络病形成的病理基础.北京中医药大学学报,1999,22(2):8-10.
[12]吴以岭.络病学概论.疑难病杂志,2004,3(1):37-39.
[13] Sugiyarna T,Lee JD,Shimizu ti,et a1.Influence of treated bloodpressure on progression of slient cerebral infarction.Hypertents,1999.17(5):679-684.
[14] Gohlke P,Lamberty V,Kuwer I ,et a1.Vascular remodeling in systemic hypertension.Am J Cardiol,1993,71:28-78.
[15]粱民里.增龄对血瘀及血浆血栓素B2和6-酮-前列腺素Fla水平的影响.中西医结合杂志,l994,12(12):725.
[16]颜德馨.气虚血瘀是人体衰老的主要机制.中国医药学报。1989,4(2):10.
[17]王永炎,常富业,杨宝琴.病络与络病对比研究.北京中医药大学学报,2005,28(3):1-6.
[18] Shargorodsy M,Leibovitz E,Lubimov L,et a1.Am J Hypenens,2002,15:1087一1091.
[19]陶军,靳亚非,王礼春,等.冠心病患者血管内皮功能障碍与动脉弹性关系的研究中华心血管病杂志,2003,31:250-254.
[20]李丽秋.长效二氢吡啶类钙拮抗剂治疗老年人高血压的疗效观察.中国民康医学,2006,03:173.
[21] Hozawa A, OhkuboT, NagaiK, et al. Prognosis of isolated systolic and isolated diastolic hypertension as assessed by self-measurement of blood pressure at home: the Ohasama study. Arch Intern Med, 2000, 160:3301-3306.
[22] European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. Hypertens, 2003,21:1011-1053.
[23] Verdecchia P, Schillaci G,Borgioni C,et al. Ambulatory pulse pressure apotent predictor of total cardiovascular risk in hypertension.Hypertension, 1998,32: 983-988.
[24] Cemvolo R,Maio R,Pujia,e t al.Pulse pressure and endothelial dysfunction in never-treated hypertension patients,JACC,2003, 4:1759-1760.
[25]张海锋,李新立.无创性动脉顺应性的评估方法及其临床意义心血管病学进展2003,24(6):426-427.
[26] Asmar R,Benetos A ,Topouchian,et a1.Assessment of arterial distensibility by automatic pulse wave velocity measurement. Hypertension,1995;26;485—490.
[27] K hder Y ,Bray—Desboscs L ,Allot E ,et a1.Effects of blood pressurecontrol on radial artery diameter and compliance in hypertensivepatients.Am J Hypertens,1997;10;269—274.
[28]胡大一,马长生.心脏病学实践2003-新进展与临床案例.北京:人民卫生出版社,2003.497-505.
[29] Avolio A,jones D,Tafazzoli-Shadpour M.Quantification of alterations in structure and function of elastin in the arterial media. Hypertension, 1998,32:170-175.
[30]王宏宇,倪永斌.老年高血压患者大动脉弹性研究.中国老年学杂志,2003,1(23):10-11.
[31]马虹,陶军.年龄对血管弹性和内皮细胞功能的影响.中华心血管病杂志,2003,3:250-254.
[32] Mitchen GF,Moye LA,Bratmwald E,et a1.SphygmomanometricaUy deter mined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function.Circulation,1997,96:42-54.
[33] Black HR. The paradigm has shifted to systolic blood pressure. Hypertension, 1999, 34:386-387.
[34] Verdecchia P, Schillaci G,Borgioni C,et al. Ambulatory pulse pressure apotent predictor of total cardiovascular risk in hypertension.Hypertension,1998,32:983-988.
[35] Cemvolo R,Maio R,Pujia,e t al.Pulse pressure and endothelialdysfunction in never-treated hypertension patients,JACC,2003,4:1759-1760.
[36] BlatherJ,Staessen JA, Gired X,et al Pulse prssure determines cardiovascular risk in older hypertensive patients.Arch Intern Med, 2000,160(8):1085-1089.
[1]陈家旭,薛飞飞.“微观辨证”的产生及其发展.中西医结合学报.2005.9(3):342-346.
[2]张臣,邢之华,刘卫平,等.不同中医证型高血压病血浆ET和血清NO的变化.实用中医内科杂志.2004.18(6):508-509.
[3]吴亦强,罗治华,唐荣德.高血压病血液流变学变化与中医辨证分型的关系.新中医,1994,26(3):10-11.
[4]毛莉娜,祝炜,喻荣辉,等.高血压病中医证型与血液流变学及胰岛素抵抗的相关性研究.湖北中医学院学报.2007.6(9):24-25.
[6]顼志兵,梁知,徐辉,等.血浆同型半胱氨酸水平与高血压中医证型的相关性研究.中华现代中西医杂志,2003.1(5):394-395.
[7]辛效毅,张绚邦,周铭心.高血压病中医证型与血浆ET、AⅡ关系研究.山东中医药大学学报,2002.26(2):123-124.
[8]王晓凤,杨关林,辛世勇.老年原发性高血压患者动态脉压与中医辨证分型的研究.实用中医内科杂志.2006.20(6):637-638.
[9]李建松,林树乔,朱艺成.高血压病中医证型与血压变化相关性分析研究.中华中医医学杂志.2005.3(1):96-97.
[10]张臣,邢之华,刘卫平,等.高血压病中医证型与血浆内皮素及血压的相关性研究.辽宁中医杂志.2005.32(1):6-7.
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[12]龚一萍,陈海燕,卜佳俊,等.常见病理舌形的定量研究及与高血压病和证型相关性的分析.中华中医药杂志.2005.20(12):730-731.
[13]朱国强.高血压病的证型与心脏收缩舒张功能的关系.实用中医内科杂志.2003.17(6):475-476.
[14]刘泽银.高血压不同中医证型与左室肥厚的关系.中华医学研究杂志.2003.3(8):715-720.
[15]刘劲松,吴晓宏,胡金花,等.高血压左室肥厚与中医证型关系的探讨.中国中医基础医学杂志.2003.9(11):807-808.
[16]郭磊磊,周英,郑本德.高血压患者左心室重量指数与中医分型的关系.浙江中西医结合杂志,2002,12(4):2l1-212.
[17]唐靖一,王英杰,胡婉英.不同中医证型老年高血压患者动脉弹性变化的研究.深圳中西医结合杂志.2004.14(2):144-146.
[18]王英杰,胡婉英.原发性高血压病病人血管重构与中医证型相关关系的研究.中西医结合心脑血管病杂志.2007.5(1):11-12.
[19]张文云,李徽.高血压动脉弹性功能的研究进展.河北医药2005,27(9):698-699
[20] Safar MF.Siche.IP,Malllon JM.et a1.Arterial mechanics predict risk in hypertension.Hypertens.1997,15:1605-1611.
[21]郭蕾,王永炎.论中医证候中的复杂现象及相应的研究思路.中国中医基础医学杂志,2004,10(2):3-5.
[2]国际心脏病学会和协会及WHO临床命名标准化联合专题组1979年报告.缺血性心脏病的命名及诊断标准.中华心血管病杂志,1981,9(1)∶75-76.
[3]王吉耀,廖二元.全国高等医药教材内科学2003,12(1):255.
[4]《中药新药临床研究指导原则》.第2版.北京:中国医药科技出版社,2002.73.
[5]徐宗佩,张伯礼.“久病入络”患者舌象(舌底)观察与分析天津中医1992, 4(2):43-45.
[6]中国肥胖问题工作组数据原总分析协作组.我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究.中华流行病学杂志,2002, 23 (1): 5-10.
[7]吴以岭.“脉络-血管系统病"新概念及其治疗探讨.疑难病杂志,2005,4(5):285-287.
[8]王筠,张军平.从中医络病学说认识血管新生.中国中医基础医学杂志,2005,11(7):493-494.
[9]朱迪.络病的中医临床研究进展.中国现代实用医学杂志,2005,4(7):42-43.
[10]雷燕.络病理论探微.北京中医药大学学报,1998,21(2):18-23.
[11]雷燕,黄启福,王永炎.论瘀毒阻络是络病形成的病理基础.北京中医药大学学报,1999,22(2):8-10.
[12]吴以岭.络病学概论.疑难病杂志,2004,3(1):37-39.
[13] Sugiyarna T,Lee JD,Shimizu ti,et a1.Influence of treated bloodpressure on progression of slient cerebral infarction.Hypertents,1999.17(5):679-684.
[14] Gohlke P,Lamberty V,Kuwer I ,et a1.Vascular remodeling in systemic hypertension.Am J Cardiol,1993,71:28-78.
[15]粱民里.增龄对血瘀及血浆血栓素B2和6-酮-前列腺素Fla水平的影响.中西医结合杂志,l994,12(12):725.
[16]颜德馨.气虚血瘀是人体衰老的主要机制.中国医药学报。1989,4(2):10.
[17]王永炎,常富业,杨宝琴.病络与络病对比研究.北京中医药大学学报,2005,28(3):1-6.
[18] Shargorodsy M,Leibovitz E,Lubimov L,et a1.Am J Hypenens,2002,15:1087一1091.
[19]陶军,靳亚非,王礼春,等.冠心病患者血管内皮功能障碍与动脉弹性关系的研究中华心血管病杂志,2003,31:250-254.
[20]李丽秋.长效二氢吡啶类钙拮抗剂治疗老年人高血压的疗效观察.中国民康医学,2006,03:173.
[21] Hozawa A, OhkuboT, NagaiK, et al. Prognosis of isolated systolic and isolated diastolic hypertension as assessed by self-measurement of blood pressure at home: the Ohasama study. Arch Intern Med, 2000, 160:3301-3306.
[22] European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. Hypertens, 2003,21:1011-1053.
[23] Verdecchia P, Schillaci G,Borgioni C,et al. Ambulatory pulse pressure apotent predictor of total cardiovascular risk in hypertension.Hypertension, 1998,32: 983-988.
[24] Cemvolo R,Maio R,Pujia,e t al.Pulse pressure and endothelial dysfunction in never-treated hypertension patients,JACC,2003, 4:1759-1760.
[25]张海锋,李新立.无创性动脉顺应性的评估方法及其临床意义心血管病学进展2003,24(6):426-427.
[26] Asmar R,Benetos A ,Topouchian,et a1.Assessment of arterial distensibility by automatic pulse wave velocity measurement. Hypertension,1995;26;485—490.
[27] K hder Y ,Bray—Desboscs L ,Allot E ,et a1.Effects of blood pressurecontrol on radial artery diameter and compliance in hypertensivepatients.Am J Hypertens,1997;10;269—274.
[28]胡大一,马长生.心脏病学实践2003-新进展与临床案例.北京:人民卫生出版社,2003.497-505.
[29] Avolio A,jones D,Tafazzoli-Shadpour M.Quantification of alterations in structure and function of elastin in the arterial media. Hypertension, 1998,32:170-175.
[30]王宏宇,倪永斌.老年高血压患者大动脉弹性研究.中国老年学杂志,2003,1(23):10-11.
[31]马虹,陶军.年龄对血管弹性和内皮细胞功能的影响.中华心血管病杂志,2003,3:250-254.
[32] Mitchen GF,Moye LA,Bratmwald E,et a1.SphygmomanometricaUy deter mined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function.Circulation,1997,96:42-54.
[33] Black HR. The paradigm has shifted to systolic blood pressure. Hypertension, 1999, 34:386-387.
[34] Verdecchia P, Schillaci G,Borgioni C,et al. Ambulatory pulse pressure apotent predictor of total cardiovascular risk in hypertension.Hypertension,1998,32:983-988.
[35] Cemvolo R,Maio R,Pujia,e t al.Pulse pressure and endothelialdysfunction in never-treated hypertension patients,JACC,2003,4:1759-1760.
[36] BlatherJ,Staessen JA, Gired X,et al Pulse prssure determines cardiovascular risk in older hypertensive patients.Arch Intern Med, 2000,160(8):1085-1089.
[1]陈家旭,薛飞飞.“微观辨证”的产生及其发展.中西医结合学报.2005.9(3):342-346.
[2]张臣,邢之华,刘卫平,等.不同中医证型高血压病血浆ET和血清NO的变化.实用中医内科杂志.2004.18(6):508-509.
[3]吴亦强,罗治华,唐荣德.高血压病血液流变学变化与中医辨证分型的关系.新中医,1994,26(3):10-11.
[4]毛莉娜,祝炜,喻荣辉,等.高血压病中医证型与血液流变学及胰岛素抵抗的相关性研究.湖北中医学院学报.2007.6(9):24-25.
[6]顼志兵,梁知,徐辉,等.血浆同型半胱氨酸水平与高血压中医证型的相关性研究.中华现代中西医杂志,2003.1(5):394-395.
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