摘要
目的：本临床研究调查高血压人群认知功能,高敏C反应蛋白(Hs-CRP)及中医证候,分析认知功能损伤与血管内皮损伤指标高敏C反应蛋白(Hs-CRP)及中医证候之间的关系,进一步探讨高血压认知损伤的病理机制,从而获得对中西医结合临床诊疗血管性认知功能损害有指导意义的结论。
方法：采用横断面调查方法,选取127例高血压病患者,应用中医四诊信息量表进行中医症状及证候调查。用Folstein简易精神状态检查(Mini-mental state examination, MMSE)中文版评价患者的总体认知功能,并用于痴呆的筛选。采用中国科学院心理研究所编制的临床记忆量表(Clinical memory scale, CMS)甲套评估记忆功能,并结合画钟实验(clock drawing test CDT)、字色干扰测验(STROOP TEST)、数字广度记忆测验(DS)、以及连线实验进一步评估认知功能。高血压诊断标准参照2005年中国高血压病防治指南诊断标准,Hs-CRP水平采取重点学科实验室的生化乳胶增强免疫比浊法测定。
结果：
1健忘、口干、头昏沉出现频率在80%以上,可以把它们归为本研究的核心症状。对出现频率在50%以上的症状进行聚类分析后,参照相关文献及导师经验,对聚类分析的结果进行综合分析,最终得出高血压人群认知功能障碍的常见证型。本研究中高血压人群认知功能障碍的常见证型依次为肾虚证、痰火证、痰浊证、气虚血瘀证、气血亏虚证。
2经双变量相关分析,高敏C反应蛋白与肾虚证出现频率存在极显著正相关(P<0.01),经卡方检验,痰浊证、气虚血瘀证出现频率在高敏C反应蛋白正常组与异常组比较差异显著(P<0.05)。
3肾虚证与实物认知、书写力、画钟试验、指向记忆、年龄量表总分经相关性分析有显著意义(P<0.05),与执行力、联想学习、总分连线实验存在极显著相关(P<0.01)；痰火证与指向记忆存在显著相关(P<0.05)；痰浊证与阅读力、画钟试验、联想学习存在显著相关(P<0.05)；气虚血瘀证与执行力、绘图能力存在显著相关(P<0.05)；气血亏虚证与执行力、联想学习存在显著相关(P<0.05)。
4经t检验,肾虚证有与无组之间时间定向、空间定向、实物认知、书写能力、数字广度、STROOP TEST1、指向记忆、联想学习存在显著差异(P<0.05),与执行力、记忆商(MQ值)存在极显著差异(P<0.01)；在痰火证有与无组之间指向记忆存在显著差异(P<0.05)；在痰浊证有与无组之间阅读力、画钟试验、联想学习、记忆商(MQ)存在显著差异(P<0.05)；在气虚血瘀证有与无组之间执行力、绘图能力存在显著差异(P<0.05)；在气血亏虚证有与无组之间执行力、联想学习存在显著差异(P<0.05)。
5经t检验,在肾虚／痰火证组合证候有无组之间实物认知、图像自由回忆存在显著差异(P<0.05),与语言重复、执行力、书写能力存在极显著差异(P<0.01)；在肾虚／痰浊证组合证候有无组之间联想学习存在显著差异(P<0.05),与时间定向、空间定向、实物认知、语言重复、执行力、阅读能力、书写能力、绘图能力、STROOP TEST1存在极显著差异(P<0.01)；在痰浊／痰火证组合证候有无组之间阅读力存在显著差异(P<0.05),与瞬时记忆、执行力、绘图能力存在极显著差异(P<0.01)；在肾虚／痰浊／痰火证组合证候有无组之间时间定向、瞬时记忆、MQ值存在显著差异(P<0.05),与空间定向、实物认知存在极显著差异(P<0.01)。
6高血压患者高敏C反应蛋白与患者数字广度、STROOP TEST2、记忆商(MQ值)之间经相关性分析有显著意义(P<0.05),与图像自由回忆存在极显著相关(P<0.01)。在HsCRP正常组与异常组间比较,计算力、语言重复、阅读力、图像自由回忆存在显著差异(P<0.05),在年龄量表总分、MQ值、字色干扰测验1(STROOP TEST1)存在极显著差异(P<0.01)。
7经t检验,高脂血症有无两组之间比较,认知功能测评中瞬时记忆、书写能力、绘图能力存在显著差异(P<0.05),字色干扰测验1 (STROOP TEST1)存在极显著差异(P<0.01)。在高脂血症合并高敏C反应蛋白异常组和无二者合并组间比较,认知功能测评中瞬时记忆、MQ值、STROOP TEST 2存在显著差异(P<0.05),空间定向、执行力、年龄量表总分、STROOP TEST 1存在极显著差异(P<0.01)。
结论：本研究发现,健忘、口干、头昏沉是出现频率最高的症状,为高血压人群认知功能障碍的核心症状。本研究采用了聚类的方法结合相关文献及导师经验对高血压人群认知功能障碍证型划分进行了研究,发现肾虚证、痰火证、痰浊证、气虚血瘀证、气血亏虚证是认知功能障碍的常见证型。中医证候如：肾虚证、痰火证、痰浊证与血管内皮损伤标志物HsCRP存在联系,而认知功能损害也与这些证候相关。本研究还运用血清HsCRP水平对认知功能及中医证候的微观实质做了初步的探讨,发现HsCRP水平异常与其认知功能水平下降之间存在一定关系；肾虚证、痰浊证、气虚血瘀证高血压患者HsCRP水平更高,脑内炎症反应更重,认知功能得分更低。由此说明虚、痰、瘀、火病邪在认知损害的发展过程中起着重要作用,可能是导致认知功能损害的病因,因此推测“毒”邪的产生,可能是秽浊如：虚、痰、瘀、火等病理因素由量变到质变的结果,而“毒损脑络”是病情加重发展的关键。
Objective:This clinical study investigated cognitive function in people with hypertension, high sensitivity C-reactive protein (Hs-CRP) and TCM syndrome of cognitive impairment and vascular endothelial damage index of high sensitivity C-reactive protein (Hs-CRP) and between TCM syndrome relations, to further explore the pathogenesis of hypertension in cognitive impairment, in order to obtain Integrative Medicine Clinical Diagnosis of vascular cognitive impairment are instructive conclusions.
Methods:A cross-sectional survey method, select the 127 cases of hypertensive patients, the application of information scale TCM four diagnostic symptoms and syndromes of Chinese medicine practitioners investigation.Compiled by the Chinese Academy of Sciences Institute of Psychology of Memory Scale (Clinical memory scale, CMS) A package used to assess memory function, interference-term test (STROOP TEST), breadth of digital memory test (DS),painted bell Experiment (clock drawing test CDT), connected with the overall assessment of cognitive function. Diagnosis of hypertension refers to 2007 China Hypertension Prevention Guide diagnostic criteria. The biochemical laboratory disciplines latex enhancing immune turbidity measure Hs-CRP levels.
Results:
1 Forgetfulness, dry mouth, head and dazed frequency above 80%, they could be owned by the core symptoms of this study. On the frequency of occurrence of 50% or more of the symptoms of cluster analysis, the reference to the relevant literature and teacher experience, clustering analysis, a comprehensive analysis of the results, concluded that cognitive impairment in high-risk groups a common card types. In this study of cognitive dysfunction in high-risk groups commonly followed by Shenxu, Tanhuo, Tanzhuo, Qixuxueyu, Qixuekuixu.
2 By Spearman, high-sensitivity C-reactive protein and the frequency of Shenxu there is a very significant positive correlation (P<0.01),by chi-square test, Tanzhuo, Qixuxueyu frequency of deficiency in high-sensitivity C-reactive protein in normal and abnormal group difference was extremely significant.
3 Shenxu and physical knowledge, writing ability, Clock Drawing test, point to memory, age, total score by the correlation was significant (P<0.05), and the execution, associative learning, there is a very experimental Total Connection significant correlation (P<0.01);Tanhuo and point to significant correlation (P<0.05); Tanzhuo and reading ability, clock drawing test, associative learning, there was significant correlation (P＜0.05); Qixuxueyu and execution, graphics significant correlation (p<0.05);Qixuekuixu and the execution, associative learning, there was significant correlation (P＜0.05).
4 The t test, Shenxu between the groups with and without time orientation, spatial orientation, physical awareness, writing ability, digit span, STROOP TEST1, point to memory, associative learning were significantly different (P＜0.05), and MQ had significant differences (P＜0.01); Tanhuo between groups with and without memory were significantly different (P<0.05); Tanzhuo between groups with and without reading ability, clock drawing test, associative learning, MQ were significantly different (P<0.05); Qixuxueyu between the groups with and without executive power, graphics capabilities were significantly different (P＜0.05);Qixuekuixu with and without executive power between groups, associative learning, there are significant differences (P＜0.05).
5 The t test, the Shenxu/Tanhuo between groups with or without physical awareness, image free recall were significantly different (P＜0.05), and the language repeat, execution, writing ability had significant difference (P＜0.01); Shenxu/Tanzhuo between the groups with or without combination of associative learning were significantly different (P＜0.05), and time orientation, spatial orientation, physical cognitive, language repetition, executive ability, reading ability, writing skills, drawing ability, STROOP TEST1 had significant differences (P＜0.01); in Tanhuo/ Tanzhuo combination of syndromes with or without evidence of reading ability between the groups were significantly different (P<0.05),And immediate memory, executive ability, drawing skills had significant differences (P＜0.01); in Shenxu /Tanhuo/Tanzhuo portfolio syndrome between groups with or without time orientation, immediate memory, MQ were significantly different (P＜0.05), and spatial orientation, the physical existence of significant differences in cognition (P＜0.01).
6 Hypertension's hs-crp and digit span, STROOP TEST2, MQ between the correlation was significant (P＜0.05), and image free recall had significant correlation (P＜0.01). In HsCRP normal and abnormal groups were compared, calculating ability, language repetition, reading ability, image free recall were significantly different (P＜0.05), total score of age, MQ, STROOP TEST1 There were significant differences (P＜0.01).
7 The t test, with or without hyperlipidemia between the two groups, cognitive testing in transient memory, writing ability, drawing skills were significantly different (P＜0.05), STROOP TEST1 had significant differences (P＜0.01). In Hyperlipidemia abnormal hs-crp in both group and non-merger between the two groups, cognitive testing in transient memory, MQ, STROOP TEST 2 were significantly different (P＜0.05), space orientation, execution, age, total score, STROOP TEST 1 had significant differences (P＜0.01).
Conclusion:The study found that forgetfulness, dry mouth, head and dazed is the highest frequency of symptoms, high blood pressure groups for the core symptoms of cognitivedysfunction. This study used clustering methods in the literature and instructors of the experience of cognitive impairment among people with hypertension were studied divided Syndrome and found that Shenxu, Tanhuo, Tanzhuo, Qixuxueyu, Qixuekuixu is a common cognitive dysfunction syndrome types. TCM such as:Shenxu, Tanhuo card, Tanzhuo and vascular endothelial injury markers HsCRP there is a link, but also cognitive impairment associated with these syndromes. This study also used serum HsCRP levels on cognitive function and essence of TCM Syndromes made preliminary microscopic study, found that the level of abnormal Hs-CRP decline of cognitive function with a certain relationship exists between; Shenxu,Tanzhuo,QixuxueyuHs-CRP higher levels of hypertension,brain inflammation is more important, lower cognitive function scores. It showed true, Xu, Tan,Yu, Huopathogenic factor in the development of cognitive impairment may play an important role, might be the cause of cognitive impairment, suggesting that "poison" evil generation, may be dirty cloud, such as:Xu, Tan,Yu, Huo and other pathological findings from the quantitative to qualitative changes,The " damaged brain Toxinluo " is the key to the development of exacerbations.
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