高血压脑小血管病中医证型与靶器官损伤因素的相关性分析＊

目的 观察高血压脑小血管病（Hypertensive cerebral small vessel disease,HT-CSVD）患者中医证型分布规律,分析其与靶器官损伤因素的相关性。方法 选取2020年6月至2021年6月在湖南中医药大学第一附属医院确诊的215例HT-CSVD患者,根据《中药新药临床研究指导原则（试行）》和《中医临床诊疗术语?证候部分》中相关证候分型标准对其中医四诊信息进行辨证分型,采集其年龄、性别、体质指数（BMI）、血压等一般资料,并检测血脂、血糖、凝血功能、肾功能、同型半胱氨酸（HCY）等相关指标。结果 215例HT-CSVD患者中医证型的构成比从高到低依次排序为痰湿壅盛证>气血亏虚证>阴虚阳亢证>肝火亢盛证>瘀血阻络证。五组证型中,痰湿壅盛证BMI水平最高,与肝火亢盛证、阴虚阳亢证比较差异有统计学意义（P < 0.05）;其肌酐（Cr）、血尿酸（UA）水平较其余四组证型偏高,与气血亏虚证比较差异有统计学意义（P < 0.05）。气血亏虚证HCY水平与痰湿壅盛证、瘀血阻络证比较差异有统计学意义（P < 0.05）;其甘油三酯（TG）水平与阴虚阳亢证比较差异有统计学意义（P < 0.05）。二分类Logistic分析结果显示,TG、BMI与阴虚阳亢证存在相关性,HCY与气血亏虚证存在相关性（P < 0.05）。结论 痰、虚、风、火与瘀是HT-CSVD的主要发病因素与病理枢机;BMI、Cr、UA、TG、HCY水平与各中医证型有一定的相关性,可将其作为HT-CSVD中医证型分型客观化的参考指标。

Analysis of Correlation between TCM Syndrome Types and Target Organ Injury Factors of Hypertensive Cerebral Small Vessel Disease

Objective To observe the distribution of TCM syndromes in patients with hypertensive cerebral small vessel disease (HT-CSVD) and analyze the correlation between TCM syndromes and biochemical indexes of target organ damage.Methods 215 HT-CSVD subjects were diagnosed and included in the First Hospital of Hunan University of Chinese Medicine from June 2020 to June 2021. The syndrome types were differentiated according to Guiding Principle of Clinical Research on New Drugs of Traditional Chinese Medicine (for Trial Implementation) and Clinic Terminology of Traditional Chinese Medical Diagnosis. Age, gender, body mass index (BMI), blood pressure and other general data were collected. The related indicators such as blood lipid, blood glucose, coagulation function, renal function and homocysteine were measured.Results The constituent ratio of TCM syndrome types of 215 cases with HT-CSVD from high to low was phlegm dampness syndrome, Qi and blood deficiency syndrome, Yin deficiency and yang hyperactivity syndrome, liver fire hyperactivity syndrome, blood stasis obstructing collaterals syndrome. Compared with liver fire hyperactivity syndrome and Yin deficiency and yang hyperactivity syndrome, the BMI of phlegm dampness syndrome was the highest (P < 0.05). The Cr and UA of phlegm dampness syndrome were highest, and the difference between phlegm dampness syndrome and Qi and blood deficiency syndrome was statistically significant (P < 0.05). The HCY of Qi and blood deficiency syndrome was significantly different than that of phlegm dampness syndrome and blood stasis obstructing collaterals syndrome (P < 0.05), and the TG of Qi and blood deficiency syndrome was significantly different than that of Yin deficiency and yang hyperactivity syndrome (P < 0.05). Binary logistic regression analysis showed that TG and BMI levels were correlated with Yin deficiency and yang hyperactivity syndrome, HCY was negatively correlated with Qi blood deficiency syndrome (P < 0.05).Conclusion Phlegm, deficiency, wind, fire and blood stasis are the important pathogenic factors and axis of HT-CSVD. BMI, Cr, UA, TG and HCY are closely related to syndromes, which can be used as the objective reference index of TCM syndrome classification of HT-CSVD.