| Purposes:We was to analyze the difference and correlation about the indexes of early renal damage between the patients with essential hypertension (EH) in different TCM constitutional types, explore the influencing factors of early renal damage caused by EH, provide the basis for prevention and diagnosis of early renal damage caused by EH, seek objective basis and explore new thoughts for the treatment of it by individualization of TCM at the same time.Methods:We screened patients with EH according to the relevant inclusion and exclusion criteria in the ward and outpatient of Dongzhimen Hospital, signed informed consent form, gathered the general information and condition relevant to hypertension, measured blood pressure (BP), filled the form of TCM constitution and then classified the type of him according to 《The classified standard of TCM constitution》.His morning urine specimens was sent to the clinical laboratory of Dongzhimen Hospi tal where the four urinary protein indexes (MALB、 TRF、β2-MG、α1-MG)with early nephropathy were tested, at the same time the morning fasting venous blood was tested of blood glucose, insulin, creatinine,urea nitrogen, triglyceride,cholesterol at the clinical biochemical laboratory. Finally,we analyzed the statistics about all the collected data.Results:1Basic Information:450cases with EH were collected into the study, ages18to80years, mean age68.42±14.78years. There were240cases (53.3%) of men whose mean age was66.86±16.39years old and210cases (46.7%) of women whose mean age was70.20±12.48years old. The course of hypertension was from0.1to60years averaged16.60±14.22years. The case from primary school was the most, junior and senior high school in turn. Women were older than men on average age. Women were lower11.73cm than men on average height. The BMI of men was slightly bigger than women, but there was no statistically significant dif-ference. Smoking and drinking rates of men were significantly higher than women.2The correlation between BMI and fasting blood glucose (FBG), fasting insulin (FINS), insulin resistance index (HOMA-IR). FINS and HOMA-IR of group BMI>26were all higher than the groups of BMI<24and24≤BMI<26. There were no statistically significant differences in FINS and HOMA-IR between the groups of BMI<24and24≤BMI<26. There was no statistically significant overall difference between the three groups in FBG.3Condition about antihypertensive drugs took and BP.354cases (78.7%) were taking antihypertensive drugs and96cases (21.3%) were not. There were321cases (90.68%) taking antihypertensive drugs regularly, but33cases (9.32%) er-ratically. The rate of reaching the standard in the patients of taking an- tihypertensive drugs was significantly higher than the patients who were not taking antihypertensive drugs. The rate of BP reaching the standard in the patients of taking antihypertensive drugs regularly was significantly higher than the patients who were taking ant ihypertens ive drugs erratically. There were120times of ARB classes,27times of ACE I classes,252times of CCB classes,78times of β-blockers,69t imes of diuretics in all ant ihypertens ive drugs took. The taking frequency of CCB classes was highest and ARB classes secondly. The taking rate of CCB classes was significantly higher than other four classes. There was significantly positively correlation in taking antihypertensive drugs of CCB classes and BP reaching the standard, so they were still the first choices to control BP.4Condition of TCM constitution in hypertension. There were48cases of Normal-constitution in450patients with EH, Yin-deficiency constitution which had55cases(12.2%) was the most in the single lopsided constitutions, Blood stasis and Damp-heat constitutions were the second both40cases (8.9%) Special-constitution had only3cases (0.7%).2types combined constitutions which had76cases (16.9%) was the most type in combined constitutions.3types combined constitutions had43cases (9.6%) and6types combined constitutions had only2(0.4%).The turn of appearing frequency from more to less in lopsided constitutions was:Qi-deficiency constitution, Blood stasis constitution, Yin-deficiency constitution, Phlegm-dampness constitution, Damp-heat con-stitution, Qi-stagnation constitution, Yang-deficiency constitution and Special-constitution. There was difference between men and women in the composing of TCM constitution.5The correlations between all kinds of TCM constitutions and various factors. Normal-constitution had a negative correlation wi th coronary heart disease (CHD), positive correlation with the condition of BP control. Qi-deficiency con-stitution had a positive correlation with CHD. Yang-deficiency constitution had negative correlations with age, smoking and family history of hypertension. Yin-deficiency constitution had a positive correlation with cerebrovascular disease. Blood stasis constitution had negative correlations with body mass index (BMI) and smoking; positive correlations with drinking, CHD and cere-brovascular disease. Phlegm-dampness constitution had positive correlations with smoking, CHD and cerebrovascular disease; negative correlation with condition of BP control. Damp-heat constitution had positive correlations with education level, BMI, smoking. Qi-stagnation constitution had negative cor-relations with abnormal lipid metabolism and condition of BP control, positive correlation with taking antihypertensive drugs. 6The difference comparisons between different TCM const i tut ions in HOMA-IR.159patients’ FBG, FINS were tested and then HOMA-IR were calculated by formula. There was statistically significant overall difference between different TCM con-stitutions in HOMA-IR. The HOMA-IR of pure Yang-deficiency constitution was significantly higher than pure Phlegm-dampness constitution and pure Damp-heat constitution hot.7The difference comparisons between each lopsided constitutions (Spe-cial-constitution excepted) and Normal-constitution in the four indexes of early renal damage. The all four indexes of early renal damage had no correlation with gender, but had significant overall differences between different types of TCM constitutions. Each lopsided constitutions (Special-constitution ex-cepted) compared with Normal-constitution in the four indexes. The MALB of all lopsided constitutions were higher than Normal-constitution and had statistical differences, especially Qi-deficiency constitution’s was the highest. The β2-MG of all lops ided constitutions were higher than Normal-constitution, but only the Damp-heat constitution had a statistical difference compared with Nor-mal-constitution, and the other lopsided constitutions had no statistical difference with Normal-constitution. The TRF of all lopsided constitutions were higher than Normal-constitution and had statistical differences except Blood stasis constitution, especially Phlegm-dampness constitution’s was the highest. The α1-MG of all lopsided constitutions were higher than Normal-constitution and had statistical differences except Yang-deficiency constitution and Yin-deficiency constitution, especially Qi-stagnation constitution’s was the highest.8Logistic regression between the four indexes of early renal damage and various factors. MALB had a positive correlation with education level; negative correlations with abnormal lipid metabolism and condition of BP control. β2-MG had a positive correlation with BMI. TRF had posi tive correlations with education level and taking antihypertensive drugs, negative correlations with abnormal lipid metabolism and condition of BP control. α1-MG had positive correlations with smoking and the times of night urination, negative correlations with taking antihypertensive drugs and condition of BP control.9The correlations between four indexes of early renal damage and the five types of taking antihypertensive drugs. MALB had no correlation with taking any five antihypertensive drugs. The rise of β2-MG had a negative correlation with taking ACEI drugs, that was to say ACEI drugs can reduce β2-MG. The rise of TRF had a negative correlation with taking ARB drugs, that was to say ARB drugs can reduce TRF. The rise of TRF had a positive taking CCB drugs,that was to say CCB drugs can increase TRF. The rise of α1-MG had negative correlations with taking ARB and CCB drugs, that were to say ARB and CCB drugs can reduce α1-MG.10Regression analyses between the four indexes of early renal damage and HOMA-IR. There was no correlation between the four indexes of early renal damage and HOMA-IR.Conclusions:1Yin-deficiency constitution is the most in the types of TCM constitutions in the patients with EH, but the frequency of Qi-deficiency constitution is the most in the8lopsided constitutions. There is difference between men and women in the composing of TCM constitution.2The difference comparisons between each lopsided constitutions (Spe-cial-constitution excepted) and Normal-constitution in the four indexes of early renal damage. The degree of early renal damage caused by hypertension in8lopsided constitut ions are more serious than Normal-constitution, especially in Phlegm-dampness constitution. Damp-heat constitution and Qi-deficiency constitution. The damage of glomerulus is most special in Qi-deficiency constitution and Phlegm-dampness constitution, however the kidney tubules are more easily damaged by hypertension in Damp-heat constitution.3ACE I drugs can reduce (β2-MG; ARB drugs can reduce TRF; ARB and CCB drugs can reduce α1-MG. CCB drugs can increase TRF.4The HOMA-IR of pure Yang-deficiency constitution is higher than pure Phlegm-dampness constitution and pure Damp-heat constitution hot. There is no correlation between the four indexes of early renal damage and HOMA-IR. |
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