Research On The Syndrome Principle And Metabonomics Of Essential Hypertension Complicated With Hyperuricemia

Objective:Syndrome is the core of syndrome differentiation and treatment in TCM, the research explored the symptoms and signs, tongue and pulse, distribution rules of manifestations. Through the research on the syndrome of essential hypertension complicated with hyperuricemia, finding out the key pathogenesis of this disease, and so as to provide guidance and reference for TCM intervention and treatment of hypertension complicated with hyperuricemia.On the other hand, the research also study the changes of small molecule metabolites in serum metabolic profile of hypertension complicated with hyperuricemia patients, and explore the possible pathogenesis of essential hypertension complicated with hyperuricemia.Methods:The study adopted the questionnaire and physical examination for 465 essential hypertension complicating hyperuricemia patients(observation group)and 386 hyperuricemia patients(control group). We used general conditions collection table and four diagnostic methods information scale to collect general situation and four diagnostic information. We used modern statistical methods to analyse symptom,tongue picture,pulse, syndrome elements and syndrome factors of hypertension complicated with hyperuricemia.We also selected 11 essential hypertension complicated with hyperuricemia patients, 12 hyperuricemia patients and 7 healthy cases. We collected the clinical biochemical data in each group, using hydrogen nuclear magnetic resonance(1H-NMR) to detect small molecular substances in serum of patients, then obtained metabolic profiling of serum, using partial least squares discriminant analysis(PLS-DA) and orthogonal partial least-squares discriminant analysis(OPLS-DA) to identify the differences of small molecule metabolism serum of each group, to find out the characteristics of metabolites of disease.Results:Hypertension complicated with hyperuricemia and hyperuricemia group showed no significant difference in terms of gender, but the age, body weight, serum uric acid, past medical illness, life habit(preference for meat, seafood, salt, pungency), fasting blood glucose, low density lipoprotein and kidney function between two groups had significant differences(P < 0.05 or P < 0.01).The high symptom frequency distribution of observation group were dizziness, dry mouth, sticky mouth, body weight of heavy legs, heavy head as if wrapped, forgetful, irritability, chest tightness, vomiting phlegm, lips cyanosis etc; The high symptom frequency distribution of control group included: fear the heat, mouth sticky, spontaneous perspiration, stool sticky, fatigue, insomnia, dry mouth, body weight of heavy legs, vomiting phlegm, heavy wrapped etc. The high tongue picture frequency distribution of observation group were greasy moss, moss white, red tongue, thick moss, moss yellow, pale tongue, white; The high frequency of control group were yellow, greasy fur, thick moss, moss white, red tongue, tongue fat etc. The high pulse frequency distribution of observation group included: wiry pulse, rapid pulse, slippery pulse, full pulse, deep pulse, thready pulse, sluggish pulse; the high frequency pulse of control group were: wiry pulse, rapid pulse, slippery pulse, deep pulse etc.Through cluster analysis, basic symptom types of observation group were: blood stasis, kidney qi deficiency, lung and spleen deficiency syndrome, liver kidney yin deficiency, qi deficiency and dampness, dampness and phlegm syndrome, hyperactivity of liver fire stagnation and phlegm heat syndrome. The basic symptom types of control group were: kidney yang deficiency, spleen dampness syndrome, blood stasis syndrome, spleen kidney two falsely phlegm syndrome, damp heat retention.Through factor analysis, the symptom factors of disease character of observation group were fire(heat), yin deficiency, phlegm, qi deficiency, yang deficiency, blood deficiency, dampness, blood stasis, qi not solid. The higher frequency were fire(heat), yin deficiency, qi deficiency, phlegm wet. The symptom factors of disease location were liver, stomach, lung, spleen, kidney, heart and mind. The higher frequency wre liver, heart, spleen, kidney, stomach. The symptom factors of disease character of control group were qi deficiency, phlegm, wet, fire(heat), blood stasis, deficiency of blood, qi not solid, fire(heat), yin deficiency. The higher frequency were qi deficiency,, dampness, phlegm, fire(heat). The symptom factors of disease location were spleen, stomach, kidney, liver, lung, heart and mind. The higher frequency were spleen, kidney and stomach.The study on metabonomic find that, metabolic profiling of hypertension complicated with hyperuricemia group, hyperuricemia group and healthy control group could be well distinguished. Compared with hyperuricemia group, the content of lipid(-CH3), lipid(-CH2), elevated CH2CH2 CO, pyruvate, lactate, unsaturated fatty acid, triglyceride, histidine, tyrosine, phenylalanine were higher in hypertension complicated with hyperuricemia group, the content of valine, alanine were reduced.Compared with healthy control group, the content of lipid(-CH3), 3-hydroxybutyric acid, lipid(-CH2), increased CH2CH2 CO, CH2C=C, glucose, lactate, acetoacetic acid, unsaturated fatty acid, triglyceride were higher in hypertension complicated with hyperuricemia group, the content of valine, alanine, O-acetyl-glycoprotein, glutamine, pyruvate, creatine, histidine, phenylalanine wre reduced.Compared with healthy control group, the content of lipid(-CH3),3- hydroxybutyric acid, lipid(-CH2), pyruvate, elevated alanine, aspartic acid, unsaturated fatty acid, triglyceride were higher in hyperuricemia group, the content of acetate, N-acetyl- glycoprotein, tyrosine were reduced.Conclusion:The common syndrome types of essential hypertension complicated with hyperuricemia are excessive accumulation of phlegm dampness syndrome, hyperactivity of liver fire and phlegm heat, qi deficiency and stagnation of dampness, blood stasis, yin deficiency of liver and kidney. The common syndrome types of hyperuricemia are: dampness due to spleen deficiency, spleen and kidney deficiency syndrome, two phlegm stagnation of damp heat, blood stasis, deficiency of kidney yang. Hypertension complicated with hyperuricemia and hyperuricemia are both with phlegm, hyperactivity of liver fire, yin deficiency of liver and kidney are more obvious in the patients with hypertension and hyperuricemia, the accumulation of damp heat and spleen deficiency are more significantly in hyperuricemia group.The study on metabolomics showed that, 1HNMR spectroscopy combined with pattern recognition analysis technology can effectively distinguish metabolites of essential hypertension complicated with hyperuricemia, hyperuricemia and healthy control group, revealing the disorders of lipid metabolism, glucose metabolism, amino acid metabolism in essential hypertension complicated with hyperuricemia, laid the foundation for further study of mechanism and prevention strategy in essential hypertension complicated with hyperuricemia.