The Study On Traditional Chinese Medicine Syndromes Of Hypertension With Carotid Atherosclerosis

Objective:By syndrome differentiation in clinic, to observe the correlation of carotid artery intima-media thickness(IMT) and plaque of hypertensive patients and traditional Chinese medicine(TCM) syndromes, to explore TCM syndromes of hypertension with atherosclerosis (AS), to provide a basis for standardization of clinical TCM syndromes of hypertension with atherosclerosis, to guide the early diagnosis and treatment of the disease.Methods:150 patients with hypertension were selected in the outpatient department and hospital ward of the Second Guangdong Provincial Hospital of Traditional Chinese Medicine from July 2008 to December 2009, including 67 men and 83 women, the average age of them is (64.09±5.40) years old. We Collected each patient's medical history and objective datas with the four examination, then filled the dates in the surveying tables accurately. The TCM syndrome types and Conclusions were obtained from referring to the guidelines for TCM Studies. All the objects of study accepted carotid ultrasound inspection, were divided into three groups according to the degree of atherosclerosis, the normal carotid artery group (IMT<0.9mm and no plaque), the intima thicking group (0.9mm≤IMT<1.2mm and no plaque), the plaque shaping group(IMT≥1.2mmand/or plaque). Total cholesterol(TC), triglyceride(TG), high density lipoprotein chole-sterol (HDL-C), low density lipoprotein cholesterol(LDL-C), uric acid, fibrinogen, etc. are tested from collecting patient's venous blood samples. The results were obtained by using the SPSS17.0 statistical software to carry on statistical processing. The measurement datas of normal distribution and homogeneity of variance are expressed by mean addition and subtraction standard deviation(x±S). Mean differences in the three groups are used one-way analysis of variance. The measurement datas of non-normal distribution and non-homogeneity of variance are expressed by median and quartile range. The comparison in the three groups is used Kruskal-Wallis signed rank test. The count datas are used chi-square test. The correlation between the two factors is analyzed using Pearson or Spearman correlation. The relationship between Carotid IMT and various risk factors is analyzed by multiple regression analysis. When P≤0.05, the difference has the statistics significant.Results:(1) In clinic, they, qi-dificiency and phlegm-stasis, qi-dificiency and blood-stasis, are the most important syndromes for CAS of hypertensive patients. .Secondly, including qi stagnation induced blood stasis syndrome, qi-dific iency and phlegm-stagnancy syndrome, yin-deficiency syndrome phlegmy-heat syndrome. When carotid artery IMT increased, qi-dificiency and blood-stasis is the major syndrome. When plaque shaped, qi-dificiency and phlegm-stasis is the major syndrome.(2)The positive rate of qi-dificiency and phlegm-stasis was 81.13%, it was the highest among these TCM syndromes. The second was qi-dificiency and blood-stasis, its positive rate was 59.52%. However, the positive rate of qi-dificiency and phlegm-stagnancy syndrome and phlegmy-heat syndrome was 33.33%, it was the lowest. Compared with qi-dificiency and phlegm-stagnancy group, The positive rate of qi-dificiency and blood-stasis plaque was increased(P<0.05), the positive rate of qi-dificiency and phlegm-stasis plaque was significantly increased (P<0.01), the differences had the statistics significant. Compared with qi-dificiency and blood-stasis group, the positive rate of qi-dificiency and phlegm-stasis plaque was increased(P<0.05), the difference had the statistics significant. All the differences had no statistics significant in carotid artery IMT, TG, TC, HDL-C, LDL-C, UA and FIB with these TCM syndromes (P>0.05).(3)Carotid artery IMT values and arterial stiffness index(ASI) of the intima thicking group and plaque group were significantly higher than the normal carotid artery group, the differences had the statistics significance (P<0.01). Compared with the intima thicking group, IMT values of the plaque group was higher(P<0.05),ASI was increased significantly(P<0.01), the differences had the statistics significance.(4) Compared with the normal carotid artery group, the levels of LDL-C, UA and FIB with the intima thicking group were raised(P<0.05), the levels of course of disease and TC with the intima thicking group were raised significantly (P<0.01), the level of HDL-C with the intima thicking group was lower sign-ificantly (P<0.01). The levels of course of disease, TC, LDL-C, UA and FIB with the plaque group were increased significantly than the normal carotid artery group (P<0.01), the level of HDL-C with the plaque group was lower significantly than the normal carotid artery group(P<0.01), the differences had the statistics significance. It was the relationship between the factors, which were course disease, TC, LDL-C,HDL-C, UA and FIB, and the advanced of CAS. Compared with the intima thicking group, the levels of LDL-C and UA with the plaque group were increased(P<0.05), the levels of course of disease, TC and FIB with the plaque group were increased significantly (P<0.01), the level of HDL-C with the plaque group was significantly lower (P<0.01), the differences had the statistics significance.(5)The positive relation between CAS and TC, LDL-C, UA and FIB was demon-strated. The adverse relation between CAS and HDL-C was corroborated. CAS and the raised level of TC, LDL-C and UA were related, CAS and the lower level of HDL-C was associated using multiple regression analysis(P<0.05).Conclusion:(1)There are six kinds of clinical TCM syndromes of hypertension with ath-erosclerosis, including Qi-dificiency and phlegm-stasis, qi-dificiency and blood-stasis, qi stagnation induced blood stasis, qi-dificiency and phlegm-stagnancy, yin-deficiency, phlegmy-heat. It will provide a basis for stand-ardization of clinical TCM syndrome and TCM treatment for hypertension and atherosclerosis.(2)Hypertension with carotid atherosclerosis has different clinical TCM syndromes in different stages of development. In Lingnan area, when carotid artery IMT increased, qi-dificiency and blood-stasis is the major syndrome. With the development of the disease, when plaque shaped, qi-dificiency and phlegm-stasis become the major syndrome.(3)The course of hypertensive patient is more longer, the artery intima is more thicker significantly. Gradually, artery emerges plaque, atherosclerosis is formed. It leads to the damage of heart, brain and kidney.