慢性肾脏病患者24h动态血压与中医辨证分型的相关性研究

目的探讨慢性肾脏病（chronic kidney disease，CKD）患者动态血压变化与中医辨证分型的相关性。方法收集湖北省中医院符合CKD2～4期诊断标准的门诊及住院患者145例。对入组患者进行24h动态血压监测，根据血压变化情况，分为昼夜平均血压正常组（血压≤130／80mrnHg），昼夜平均血压升高组（血压≥131／81mmHg），日间平均血压升高组（血压〉135／85mmHg），夜间平均血压升高组（血压〉125／75mmHg）；并根据临床表现，对患者进行中医辨证，分为本虚证及邪实证。观察中医各证型在血压正常组和血压升高组中的分布情况。结果①昼夜平均血压正常组的本虚证型分布以脾肾阳虚为主，邪实证型以血瘀证为主；昼夜平均血压升高组的本虚证型以气阴两虚为主，邪实证型以湿浊证为主；②在动态血压从日间升高到夜间升高的过程中，本虚证型中阴阳两虚证型逐渐上升，邪实证型中浊毒证型逐渐上升；③随着24h动态血压升高，本虚证型中，阴阳两虚证型逐渐上升；邪实证型中，浊毒证逐渐上升。结论动态血压变化在一定程度上反映中医正虚邪实的证候变化规律。

Correlation between changes of ambulatory blood pressure and syndrome differentiation of TCM in chronic kidney disease patients

Objective To investigate the correlation between the dynamic changes of blood pres- sure （BP） and the syndrome differentiation of TCM in patients with chronic kidney disease （CKD）. Methods 145 patients from the Hubei Hospital of TCM, who were in line with the diagnostic criteria pf stage 2-4 of CKD, were selected. The patients were divided into normal day-night mean BP group （BP~131/81 rnm Hg）, elevated day-night mean BP group （BP~131/81 mm Hg）, elevated day-time mean BP group （BP）135/85 mm Hg）, and elevated night-time mean BP group （BP~ 125/75 mm Hg）, according to the monitoring of 24-h dynamic BP changes. According to the clinical manifes- tations, patients were divided into a deficiency of Ben type and an excess of Xie type. The distribution of different type＇s o{ syndromes o{ TCM in the normal BP group and the elevated BP groups was ob- served. Results （1） In normal day-night mean BP group, the deficiency syndrome type distribution was given priority to spleen and kidney Yang deficiency, and the empirical model was given priority to blood stasis. In elevated day-night mean BP group, the deficiency syndrome model was given priority to qi and Yin deficiency, and the empirical model was given priority to damp heat syndrome~ （2） Dur- ing the process of ambulatory BP increased from day to night, the deficiency syndrome type in Yin de- ficiency type was gradually increased, and empirical type in turbidity toxin type was gradually in- crease; （3） with the increase in 24-h ambulatory BP, Yin deficiency type in the deficiency syndrome type was increased gradually, and in the empirical model, turbid poison was gradually decreased. Con- clusions Dynamic changes in BO to a certain extent reflect the regulation of deficiency and excess syn- dromes of TCM.