老年高血压病中医证型分布规律及相关因素分析

目的探讨老年高血压病的中医证型分布规律及各证型动态血压曲线、颈动脉粥样硬化、年龄分布。方法选择全国七省市1 311例老年高血压病患者，观察老年高血压病症候特点、分级分布、证型分布规律，比较各证型动态血压曲线分布、颈动脉硬化分布、年龄分布。结果中医辨证共4个主要证型，共736例（56.15%），分别为痰湿壅盛（210例，16.02%）、阴虚阳亢（177例，13.50%）、肝肾阴虚（79例，6.03%）和气阴两虚型（252例，19.22%），另有瘀血阻络和痰瘀互阻两个亚型。211例患者完成24 h动态血压检测， 152例（72.38%）患者血压昼夜节律异常，以阴虚阳亢、痰湿壅盛和气阴两虚兼夹瘀血阻络型多见；660例主要证型患者行颈动脉彩超检测，痰湿壅盛和气阴两虚兼夹瘀血阻络和痰瘀互阻型，颈动脉粥样硬化发病率较高，分别为182例（27.58%）和322例（48.79%）；60～79岁的患者以阴虚阳亢型为主，而80岁以上患者以气阴两虚和肝肾阴虚型为主。结论痰湿壅盛、阴虚阳亢、肝肾阴虚和气阴两虚是老年高血压病的主要证型，不同中医证型血压昼夜节律变化、颈动脉粥样硬化和年龄分布有一定差异。

Distribution Laws of Chinese Medical Syndrome Types and Analyses of Risk Factors in Senile Hypertension Patients： a Clinical Study

Objective To explore the distribution laws of TCM syndrome types and to analyze the distribution of dynamic blood pressure curve, atherosclerosis, and age in senile hypertension patients. Methods Totally 1 131 senile hypertension patients were recruited from 7 provinces and municipal cities. Features of TCM syndromes, classification and distribution curves, and syndrome distribution laws were observed. The distribution curves of dynamic blood pressure, carotid atherosclerosis, and age were compared in each TCM syndrome types. Results There were four main syndrome types in 736 cases （56.15%）, i.e., excessive accumulation of phlegm-dampness syndrome （210 cases, 16.02% ）, yin deficiency and hyperactivity of yang syndrome （177 cases, 13.50%）, Gan-Shen yin deficiency syndrome （79 cases, 6.03%）, and deficiency of qi and yin syndrome （252 cases, 19.22%）. Besides, there were two more sub-types, i.e., collateral obstruction by blood stasis syndrome and collateral obstruction by phlegm and stasis. Circadian blood pressure monitor was completed in 211 cases. Of them, abnormal circadian blood pressure occurred in 152 cases （accounting for 72.38% ） ; yin deficiency and hyperactivity of yang syndrome, excessive accumulation of phlegm-dampness syndrome, deficiency of qi and yin syndrome plus collateral obstruction by blood stasis syndrome were most often seen. Color ultrasound of carotid artery was performed in 660 patients of main syndromes. The incidence was quite higher in those of excessive accumulation of phlegm-dampness syndrome （182 cases, 27.58%）, deficiency of qi and yinsyndrome plus collateral obstruction by blood stasis syndrome or collateral obstruction by phlegm and stasis （322 cases, 48.79%）. Yin deficiency and hyperactivity of yang syndrome was dominant in patients 60 -79 years old, while deficiency of qi and yin syndrome and Gan-Shen yin deficiency syndrome were dominant in patients older than 80 years. Conclusions Excessive accumulation of phlegm-dampness syndrome, yin deficiency and hyperactivity of yang syndrome, Gan-Shen yin deficiency syndrome,and deficiency of qi and yin syndrome were main syndrome types in senile hypertension patients. There was statistical difference in the distribution curves of blood pressure, atherosclerosis, and age of various TCM syndrome types.