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| 高血压合并脑血管受损患者中医证型分布特征及其血流动力学相关性研究 |
| Study on the distribution characteristics of TCM Syndrome Types and their hemodynamic correlation in patients with hypertension and cerebrovascular damage |
| 投稿时间：2025-06-13 修订日期：2025-06-13 |
| 中文关键词: 高血压 脑血管损伤 中医证型 分布规律 血流动力学 脑血管功能积分 |
| 英文关键词: Hypertension Cerebrovascular injury TCM syndrome type Distribution law Hemodynamics Cerebrovascular function score |
| 基金项目:2022浙江省 卫生健康科技计划2022KY1363 |
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| 中文摘要: |
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目的: 探讨高血压合并脑血管功能受损患者中医证型的分布特点,并分析不同证型患者双侧脑血管血流动力学指标的差异。方法: 采用横断面研究方法,纳入2022年1月至2024年12月本院收治的600例高血压合并脑血管功能受损患者。依据《高血压中医诊疗专家共识》进行中医辨证分型(肝阳上亢、痰饮内停、瘀血内停、肾阴亏虚)。收集患者性别、年龄信息,并应用GT3000型脑血管功能检测仪定量测定左侧与右侧脑血管的平均血流量(Qmean)、平均血流速度(Vmean)、特性阻抗(Zcv)、外周阻力(RV)及动态阻力(DR),计算脑血管功能积分。结果:证型分布:总体证型构成比排序为:肾阴亏虚证> 肝阳上亢证> 痰饮内停证> 瘀血内停证。男性患者中肾阴亏虚与肝阳上亢比例较高；女性患者中痰饮内停和瘀血内停更为常见,但性别间证型分布差异无统计学意义(P> 0.05)。年龄演变:不同年龄段主导证型不同:40-50岁以肝阳上亢证为主,51-60岁以肾阴亏虚证为主,61-70岁以痰饮内停证突出,>70岁以肾阴亏虚证显著。随年龄增长,肾阴亏虚证比例呈递增趋势(P<0.01),肝阳上亢证比例呈递减趋势(P<0.05)。血流动力学特征: 各证型均存在显著的脑血管左右侧血流动力学差异(P<0.05):肝阳上亢证: 左侧Qmean、Vmean、Zcv、RV、DR值均优于右侧。痰饮内停证: 左侧Qmean、Zcv、RV、DR值显著优于右侧。肾阴亏虚证: 脑血管功能积分最低(27.11±16.28)。瘀血内停证: 呈现双侧血流不对称特征。脑血管功能积分: 各证型脑血管功能积分排序为:肾阴亏虚证 < 瘀血内停证 < 痰饮内停证 < 肝阳上亢证(P<0.001),差异具有高度统计学意义。结论: 高血压合并脑血管功能受损患者以肾阴亏虚证和肝阳上亢证最为常见,痰饮内停证与瘀血内停证在女性中比例更高。肾阴亏虚证患病率随年龄增长而上升,肝阳上亢证则下降。无论何种证型,患者右侧脑血管均表现出相对较差的弹性、更高的血液黏稠度及较低的血流速度。中医证型与脑血管功能状态显著相关,功能积分由差到好依次为肾阴亏虚证、瘀血内停证、痰饮内停证、肝阳上亢证。 |
| 英文摘要: |
| Objective: To explore the distribution characteristics of TCM Syndrome Types in patients with hypertension complicated with impaired cerebrovascular function, and to analyze the differences of bilateral cerebrovascular hemodynamic indexes in patients with different syndrome types. Methods: a cross-sectional study was conducted to include 600 patients with hypertension and impaired cerebrovascular function treated in our hospital from January 2022 to December 2024. According to the consensus of TCM diagnosis and treatment experts on hypertension, TCM syndrome differentiation was carried out (hyperactivity of liver Yang, stagnation of phlegm and drink, stagnation of blood stasis, deficiency of kidney yin). The sex and age information of patients were collected, and the mean blood flow (qmean), mean blood flow velocity (vmean), characteristic impedance (Zcv), peripheral resistance (RV) and dynamic resistance (DR) of left and right cerebral vessels were measured quantitatively by gt3000 cerebrovascular function tester, and the cerebrovascular function score was calculated. Results: distribution of syndrome types: the overall composition ratio of syndrome types is as follows: kidney yin deficiency syndrome > liver yang hyperactivity syndrome > phlegm retention syndrome > blood stasis retention syndrome. The proportion of kidney yin deficiency and liver yang hyperactivity was higher in male patients; Phlegm retention and blood stasis retention were more common in female patients, but there was no significant difference in the distribution of syndrome types between sexes (p>0.05). Age evolution: the dominant syndrome types of different ages are different: the syndrome of hyperactivity of liver Yang at the age of 40-50, the syndrome of deficiency of kidney Yin at the age of 51-60, the syndrome of phlegm retention within the body at the age of 61-70, and the syndrome of deficiency of kidney Yin at the age of > 70. With the increase of age, the proportion of kidney yin deficiency syndrome increased (p<0.01), and the proportion of liver yang hyperactivity syndrome decreased (p<0.05). Hemodynamic characteristics: there were significant differences in hemodynamics between the left and right sides of cerebral vessels in each syndrome type (p<0.05): the left qmean, vmean, Zcv, RV, Dr values were better than the right in liver yang hyperactivity syndrome. Phlegm retention syndrome: the left qmean, Zcv, RV, Dr values were significantly better than the right. Kidney yin deficiency syndrome: cerebrovascular function score was the lowest (27.11 ± 16.28). Stagnation of blood stasis: bilateral blood flow is asymmetric. Cerebrovascular function score: the order of cerebrovascular function score of each syndrome type is: kidney yin deficiency syndrome < blood stasis syndrome < phlegm retention syndrome < liver yang hyperactivity syndrome (p<0.001). The difference is highly statistically significant. Conclusion: kidney yin deficiency syndrome and liver yang hyperactivity syndrome are the most common syndromes in patients with hypertension complicated with cerebrovascular dysfunction, and the proportion of phlegm retention syndrome and blood stasis retention syndrome is higher in women. The prevalence of kidney yin deficiency syndrome increased with age, while that of liver yang hyperactivity syndrome decreased. Regardless of the syndrome type, the right cerebral vessels of the patients showed relatively poor elasticity, higher blood viscosity and lower blood flow velocity. The TCM syndrome types were significantly correlated with the cerebrovascular functional status. The functional scores from poor to good were kidney yin deficiency syndrome, blood stasis syndrome, phlegm retention syndrome and liver yang hyperactivity syndrome. |
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