Research assessment of white matter lesions in hypertensive patients with different traditional Chinese medicine syndromes

HE Yanhu; JIN Hua; JIN Limei; LIU Minke; LIU Zhijun; SU Lili; SI Meilong; YE Luliang; HOU Tiantian

doi:10.3969/j.issn.1006-2157.2023.06.013

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Research assessment of white matter lesions in hypertensive patients with different traditional Chinese medicine syndromes

Clinical Studies | 更新时间：2023-07-05

- Research assessment of white matter lesions in hypertensive patients with different traditional Chinese medicine syndromes
- Journal of Beijing University of Traditional Chinese Medicine Vol. 46, Issue 6, Pages: 826-835(2023)
- 作者机构：
  
  1.甘肃中医药大学中医临床学院　兰州　730099
  2.甘肃中医药大学附属医院
  3.敦煌医学与转化教育部重点实验室
- 作者简介：
  
  Prof.JIN Hua, Ph.D., Chief Physician, Doctoral Supervisor. Clinical College of Chinese Medicine, Gansu University of Chinese Medicine, No.35, Dingxi East Road, Chengguan District, Lanzhou 730099.E-mail: lanzhoujinhua@126.com
- 基金信息：
  
  National Natural Science Foundation of China(82160886;81860832);Traditional Chinese Medicine Research Project of Gansu Province(GZK-2019-24);Natural Science Foundation of Gansu Province(20JR10RA315;22JR5RA579);Youth Science and Technology Foundation of Gansu Province(21JR11RA156);Health Industry Research Project of Gansu Province(GSWSKY2022-35)
- DOI：10.3969/j.issn.1006-2157.2023.06.013
  CLC： R259.441
- Received：17 December 2022，
  
  Published Online：06 May 2023，
  
  Published：30 June 2023
- 稿件说明：
移动端阅览
HE Yanhu, JIN Hua, JIN Limei, et al. Research assessment of white matter lesions in hypertensive patients with different traditional Chinese medicine syndromes[J]. Journal of beijing university of traditional chinese medicine, 2023, 46(6): 826-835.
DOI：

HE Yanhu, JIN Hua, JIN Limei, et al. Research assessment of white matter lesions in hypertensive patients with different traditional Chinese medicine syndromes[J]. Journal of beijing university of traditional chinese medicine, 2023, 46(6): 826-835. DOI： 10.3969/j.issn.1006-2157.2023.06.013.

摘要

目的

评估并预测高血压不同中医证候患者脑白质病变(WMLs)的危险性，探讨高血压不同中医证候与脑白质病变间的相互关系及其影响因素。

方法

2019年9月—2021年12月，根据纳入、排除标准选择甘肃中医药大学附属医院心血管科等相关科室就诊患者309例，辨证分为痰瘀互结证、肾气亏虚证、肝火亢盛证、阴虚阳亢证4种证候，检测患者舒张压(DBP)、同型半胱氨酸(Hcy)、尿酸(UA)、血清胱抑素C(Cys C)，并运用Fazekas与ARWMC量表评估各证候高血压患者WMLs部位、量表评分、危险程度(低危、中危、高危)，归纳并总结不同证候与各危险因素间的相关性。

结果

不同中医证候患者间舒张压、Hcy、UA、Cys C差异具有统计学意义(

0.05)。经Fazekas、ARWMC量表评估，各证候间WMLs部位分布差异无统计学意义；各证候间WMLs Fazekas量表评分差异无统计学意义，ARWMC量表评分差异具有统计学意义(

0.05)；WMLs Fazekas与ARWMC量表危险度分级，不同中医证候间WMLs差异有统计学意义(

0.05)。高血压患者与WMLs Fazekas量表相关的危险因素经

Spearman

秩相关分析，痰瘀互结证组患者WMLs程度与年龄、Hcy、UA、Cys C呈正相关(

＝0.22、0.23、0.18、0.24，

0.05)，与高尿酸血症(HUA)、高同型半胱氨酸血症(HHcy)呈负相关(

＝－0.19、－0.21，

0.05)；肝火亢盛证组患者WMLs程度与UA呈正相关(

＝0.48，

0.05)，与HUA呈负相关(

＝－0.47，

0.05)；阴虚阳亢证组患者WMLs程度与HUA、年龄、Cys C呈正相关(

＝0.27、0.37、0.27，

0.05)，与UA呈负相关(

＝－0.32，

0.05)；肾气亏虚证组患者WMLs程度与Hcy呈正相关(

＝0.33，

0.05)，与HHcy、舒张压呈负相关(

＝－0.32、－0.30，

0.05)；痰瘀互结证组相比于肝火亢盛证组、阴虚阳亢证组、肾气亏虚证组，差异有统计学意义(

0.05)的危险因素最多。WMLs经ARWMC量表评估，各证型间WMLs存在差异(

0.05)，高血压患者与WMLs ARWMC量表相关的危险因素经

Spearman

秩相关分析，阴虚阳亢证组患者WMLs程度与UA呈正相关(

＝0.57，

0.05)，与HUA呈负相关(

＝－0.58，

0.05)；肝火亢盛证组患者WMLs程度与UA呈正相关(

＝0.34，

0.05)，与HUA呈负相关(

＝－0.44，

0.05)；肾气亏虚证组患者WMLs程度与Cys C呈正相关(

＝0.26，

0.05)，与糖尿病、HUA呈负相关(

＝－0.30、－0.28，

0.05)；肾气亏虚证组相比于痰瘀互结证组、肝火亢盛证组、阴虚阳亢证组，差异有统计学意义(

0.05)的危险因素最多。

结论

痰瘀互结证和(或)肾气亏虚证可能是高血压病患者WMLs发病率较高的中医证候。

Abstract

Objective

We aimed to analyze and predict the risk of white matter lesions (WMLs) in hypertensive patients with different traditional Chinese medicine (TCM) syndromes

and to explore the relationship and influencing factors between them.

Methods

From September 2019 to December 2021

309 patients were enrolled from the cardiovascular departments of the Affiliated Hospital of Gansu University of Traditional Chinese Medicine according to the inclusion and exclusion criteria

and they were divided into four syndromes: phlegm and blood stasis syndrome

kidney qi deficiency syndrome

liver fire hyperactivity syndrome

and yin deficiency and yang hyperactivity syndrome. Diastolic blood pressure (DBP)

homocysteine acid (Hcy)

uric acid (UA)

and serum cystatin C (Cys C) were measured. The ARWMC and Fazekas scales were used to assess the site

score

and the degree of WMLs (mild

moderate

or severe) in hypertensive patients with different syndromes

and the correlation between risk factors and different syndromes was summarized.

Results

There were significant differences in DBP

Hcy

and Cys C among different TCM syndrome types (

0.05). WMLs were assessed by the Fazekas and ARWMC scales

and there was no significant difference in the distribution of WMLs sites among different syndrome types. There was no significant difference in the Fazekas scores of WMLs

but there was a significant difference in the ARWMC ratings among different syndrome types (

0.05). The WMLs Fazekas and ARWMC risk classification analysis of different TCM syndrome types were significantly different (

0.05). According to the Fazekas scale assessment

there were differences in WMLs among all of the syndrome types (

0.05).

Spearman

rank correlation analysis showed that the WMLs degree was positively correlated with age

Hcy

Cys C

and UA in the phlegm and blood stasis syndrome group (

=0.22

0.23

0.18

0.24

0.05). The WMLs degree was negatively correlated with HUA and HHcy (

=-0.19

-0.21

0.05). The degree of WMLs was positively correlated with UA (

=0.48

0.05)

and negatively correlated with HUA (

=-0.47

0.05). The degree of WMLs in yin deficiency and yang hyperactivity syndrome group was positively correlated with age

HUA

and Cys C (

=0.37

0.27

0.05)

and negatively correlated with UA (

=-0.32

0.05). The degree of WMLs in the kidney qi deficiency syndrome group was positively correlated with Hcy (

=0.33

0.05)

but negatively correlated with HHcy and DBP (

=-0.32

-0.30

0.05). The phlegm and blood stasis syndrome had more risk factors with a statistically significant difference (

0.05) compared with the liver fire hyperactivity syndrome

yin deficiency and yang hyperactivity syndrome

and kidney qi deficiency syndrome. According to the ARWMC rating

there were differences in WMLs among all syndrome types (

0.05). Spearman rank correlation analysis showed that the WMLs degree was positively correlated with UA (

=0.57

0.05) and negatively correlated with HUA (

=-0.58

0.05) in patients with hypertension and the ARWMC rating. The degree of WMLs was positively correlated with UA (

=0.34

0.05)

and negatively correlated with HUA (

=-0.44

0.05). The degree of WMLs in the kidney qi deficiency syndrome group was positively correlated with Cys C (

=0.26

0.05)

and negatively correlated with diabetes mellitus and HUA (

=-0.30

-0.28

0.05).There were more risk factors with statistically significant differences (

0.05) in the kidney qi deficiency syndrome compared with phlegm and blood stasis syndrome

liver fire hyperactivity syndrome

and yin deficiency and yang hyperactivity syndrome.

Conclusion

The phlegm and blood stasis syndrome and kidney qi deficiency syndrome may be TCM syndrome types with higher incidences of WMLs in hypertensive patients.

关键词

Keywords

references

HACHINSKI VC ， POTTER P ， MERSKEY H ． Leukoaraiosis [J]. Arch Neurol ， 1987 ， 44 ( 1 )： 21 － 23 .

OKAMURA T ， HASHIMOTO Y ， HAMAGUCHI M ， et al . Metabolically healthy obesity and risk of leukoaraiosis：a population based cross-sectional study [J]. Endocr J ， 2018 ， 65 ( 6 )： 669 － 675 .

GROSU S ， ROSPLESZCZ S ， HARTMANN F ， et al . Associated factors of white matter hyperintensity volume：a machine-learning approach [J/OL]. Sci Rep ， 2021 ， 11 ( 1 )： 2325 [ 2022－12－06 ]. https：//10.1038/s41598－021－81883－4 http://doi.org/10.1038/s41598－021－81883－4 .

赵曼丽，玄飞，魏洪玉，等．动态血压与缺血性脑白质病变关系的研究进展 [J]. 中国老年学杂志， 2016 ， 36 ( 10 )： 2557 － 2559 .

张小峰，徐文灯，武剑．急性缺血性脑卒中患者脑白质病变与血压变异性的相关性 [J]. 中华脑血管病杂志(电子版) ， 2021 ， 15 ( 3 )： 153 － 156 .

黄世敬，王永炎．缺血性脑白质病变“虚气留滞”病机探讨 [J]. 北京中医药大学学报， 2011 ， 34 ( 8 )： 513 － 516 .

KONG Q ， MA X ， WANG C ， et al . Total atherosclerosis burden of baroreceptor-resident arteries independently predicts blood pressure dipping in patients with ischemic stroke [J]. Hypertension ， 2020 ， 75 ( 6 )： 1505 － 1512 .

YAN B ， PENG LY ， HAN DG ， et al . Blood pressure reverse-dipping is associated with early formation of carotid plaque in senior hypertensive patients [J/OL]. Medicine (Baltimore) ， 2015 ， 94 ( 10 )： e604 [ 2022－12－06 ]. https：//www.ncbi.nlm.nih.gov/pmc/articles/PMC4602459/ https：//www.ncbi.nlm.nih.gov/pmc/articles/PMC4602459/ .

CUSPIDI C ， TADIC M ， SALA C ， et al . Reverse dipping and subclinical cardiac organ damage：a meta-analysis of echocardiographic studies [J]. J Hypertens ， 2021 ， 39 ( 8 )： 1505 － 1512 .

TAN X ， SUNDSTRÖM J ， LIND L ， et al . Reverse dipping of systolic blood pressure is associated with increased dementia risk in older men：a longitudinal study over 24 years [J]. Hypertension ， 2021 ， 77 ( 4 )： 1383 － 1390 .

冯千伟，吴小坤，刘斌，等．短暂性脑缺血发作患者血压变异性与颅外段颈动脉狭窄及狭窄程度的相关性 [J]. 中华老年心脑血管病杂志， 2018 ， 20 ( 8 )： 836 － 839 .

刘玉洁，谭华．脑白质疏松发病机制及临床研究进展 [J]. 中国老年学杂志， 2018 ， 38 ( 18 )： 258 － 260 .

BROOCKS G ， KNIEP H ， KEMMLING A ， et al . Effect of intravenous alteplase on ischemic lesion water homeostasis [J]. Eur J Neurol ， 2019 ， 81 ( 17 )： 215 － 216 .

KYNAST J ， LAMPE L ， LUCK T ， et al . White matter hyperintensities associated with small vessel disease impair social cognition beside attention and memory [J]. J Cerebr Blood F Met ， 2018 ， 38 ( 6 )： 996 － 1009 .

DUPONT PS ， BOCTI C ， JOANNETTE M ， et al . Amyloid burden and white matter hyperintensities mediate age-related cognitive differences [J]. Neurobiol Aging ， 2020 ， 86 ： 16 － 26 .

高芳，陈志刚，王少杰，等．不同程度脑白质疏松轻度认知障碍患者的MoCA评估分析 [J]. 北京中医药大学学报(中医临床版) ， 2012 ， 19 ( 3 )： 1 － 4 .

中国高血压防治指南修订委员会，高血压联盟(中国) ，中华医学会心血管病学分会，等．中国高血压防治指南(2018年修订版) [J]. 中国心血管杂志， 2019 ， 24 ( 1 )： 24 － 56 .

国家中医药管理局医政司 . 24个专业105个病种中医诊疗方案(合订本试行版) [A]. 2011 .

王博，申抗抗，李静，等．脑白质病变患者临床特征及其发病影响因素分析 [J]. 山东医药， 2018 ， 58 ( 26 )： 52 － 54 .

WANG ZW ， CHEN Z ， ZHANG LF ， et al . Status of Hypertension in China：Results From the China Hypertension Survey，2012－2015 [J]. Circulation ， 2018 ， 137 ( 22 )： 2344 － 2356 .

WAHLUND LO ， BARKHOF F ， FAZEKAS F ， et al . A new rating scale for age-related white matter changes applicable to MRI and CT [J]. Stroke ， 2001 ， 32 ( 6 )： 1318 － 1322 .

FAZEKAS F ， CHAWLUK JB ， ALAVI A ， et al . MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging [J]. AJR Am J Roentgenol ， 1987 ， 149 ( 2 )： 351 － 356 .

张子轩，黄晶．超声消融去肾交感神经术治疗高血压的研究现状 [J]. 心血管病学进展， 2021 ， 42 ( 6 )： 503 － 507 .

王博，窦志杰，申抗抗，等．合并高血压脑白质病变相关影响因素分析 [J]. 中国神经免疫学和神经病学杂志， 2018 ， 25 ( 1 )： 52 － 56 .

中华医学会老年医学分会老年神经病学组，脑小血管病认知功能障碍诊疗指南中国撰写专家组 . 脑小血管病相关认知功能障碍中国诊疗指南(2019) [J]. 中华老年医学杂志， 2019 ， 38 ( 4 )： 345 － 354 .

王志鹏，高仲磊，卫孟佳．脑小血管疾病磁共振成像表现与血管性认知功能障碍 [J]. 中国临床医生杂志， 2019 ， 47 ( 7 )： 814 － 817 .

张薇，刘会，张亚岚，等．脑小血管病致认知障碍的危险因素研究进展 [J]. 解放军医学院学报， 2021 ， 42 ( 2 )： 235 － 238 .

秦艳霞，刘再高，郑杰，等．脑复康方联合高压氧治疗脑小血管病致认知功能障碍疗效及对血清VEGF、BDNF、hs-CRP的影响 [J]. 现代中西医结合杂志， 2018 ， 27 ( 19 )： 2099 － 2102 .

LIU Y ， DONG YH ， LYU PY ， et al . Hypertension-induced cerebral small vessel disease leading to cognitive impairment [J]. Chin Med J(Engl) ， 2018 ， 131 ( 5 )： 615 － 619 .

DE HEUS RAA ， REUMERS SFI ， VAN DER HAVE A ， et al . Day-to-day home blood pressure variability is associated with cerebral small vessel disease burden in a memory clinic population [J]. J Alzheimers Dis ， 2020 ， 74 ( 2 )： 463 － 472 .

JIMENEZ-BALADO J ， RIBA-LLENA I ， ABRIL O ， et al . Cognitive impact of cerebral small vessel disease changes in patients with hypertension [J]. Hypertension ， 2019 ， 73 ( 2 )： 342 － 349 .

ARBOIX A ， PARRA O ． Hypertension and small vessel disease：a dangerous association for cognitive impairment over time [J]. J Clin Hypertens(Greenwich) ， 2018 ， 20 ( 9 )： 1266 － 1267 .

LI T ， LIU XY ， DIAO SS ， et al . H-Type Hypertension Is a Risk Factor for Cerebral Small-Vessel Disease [J/OL]. Biomed Res Int ， 2020 ， 2020 ： 6498903 [ 2022－12－06 ]. https：//doi.org/ 10.1155/2020/6498903 http://doi.org/10.1155/2020/6498903 .

KARGER AB ， STEFFEN BT ， NOMURA SO ， et al . Association between homocysteine and vascular calcification incidence，prevalence，and progression in the MESA cohort [J/OL]. J Am Heart Assoc ， 2020 ， 9 ( 3 )： e013934 [ 2022－12－06 ]. https：//doi.org/10.1161/JAHA.119.013934 http://doi.org/10.1161/JAHA.119.013934 .

冯丽，叶娜，贾伟丽，等．脑白质病变评价量表在认知功能障碍中的作用 [J]. 中国医刊， 2018 ， 53 ( 7 )： 730 － 734 .

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