Study On The Relationship Between TCM Syndrome Types And Endothelia Dysfunction In Essential Hypertension

Background: Essential hypertension normally leads to endothelial dysfunction distur-bance,cardiovascular remodeling,metabolic disturbance,and so on. Vascular endothelial cellplays an important role in the process of essential hypertension,and it is the carrier in thechain of "endothelial-hypertension-cardiovascular events".So investigating the correlationbetween the traditional Chinese medicine(TCM) syndrome types and e-endothelial dysfunction will contribute to revealing the substance in syndrome and g-uiding precautionary and clinical therapy.Objective: To investigate the correlation between the TCM syndrome types and endothelialdysfunction.Method:1. Patients-selection:Hypertension was diagnosed according to the diagnostic standard of《Guildline of Chinese hypertensive precautionary and therapy》(1999). All the subj-jectwith essential hypertension were selected from Wuxi City hospital of TCM from August2006 to March 2007.There were 184 cases in total,including 83 males and 101 females.2. Syndrome types differentiated standard: According to the different syndrome typesstandard of《The guildline of clinical researchon new Chinese traditional medicine trea-ted hypertension》(2003),the cases were differentiated as hyperactivity of yang due to yindeficiency(HYYD)group(75 subjects), hyperactivity of liver yang(HLY) group (21 subjects),excessive phlegm and damp(EPD) group (81 subjects),deficiency of yin and yang(DYY) gr-oup (7 subjects).3. Related targets:①Estimating symptomatic integration.②. Height and body mass weremeasured with standardized method.Index of body mass(BMI) was calculated.③.Detectio-n of blood glucose, blood lipids, insulin, insulin resistance was calculate.④.Detection o-f nitrogen monoxide(NO),nitric oxide synthase(NOS),inducible nitric oxide synthase(iNOS),endothelin(ET);⑤Color duplex blood flow imaging technique was used to assessthe carotid artery intima-media thickness(IMT),⑥Color duplex blood flow imaging techniq-ue was used to assess the left ventricular dimensions during diastolic phase(LVDd),depthof posterior wall in left ventricle(PWT),the interventricular septum thickness (IVST),the left ventricular mass index(LVMI) was calculated.4. Statistical analysis: Measurement data, expr-essed as Mean±SD.Comparison between eachgroups was conducted by F-test.SPSS for Windows was used. p＜0.05 was taken to definestatistical significance.Results:1. Age spread of different syndrome types in essential hypertension: The age of the patient inthe HLY group was lower than other groups(P＜0.05), and in the EPD group was lower thanthe DYY group.2. Symptomatic integration of different syndrome types in essential hypertension:There wasobvious difference in each groups.3. Endothelial dysfunction of different syndrome types in essential hypertension:There wasno obvious difference in NO,NOS,ET.The iNOS in hyperactivity of liver yang group wasthe highest in all group (P＜0.05), The iNOS in HLY group was higher than the EPD grou-p (P＜0.05).4. Metabolic disturbance of different syndrome types in essential hypertension: The BMI,TC and LDL-C in the EPD group was higher than the DYY group, insulin resistance in diff-erent syndrome types had no obvious difference.5. IMT of different syndrome types in essential hypertension: There was no obvious differen-ce in each groups.6. LVMI of different syndrome types in essential hypertension: The DYY group was the hig-hest of all groups (P＜0.05).7. Endothelial dysfunction of different syndrome types in essential hypertension with leftventricular hypertrophy: There was no obvious difference in NO,ET, AngⅡThe iNOS andNOS in the EPD group was lower than the HLY group(P＜0.05).iNOS in the HLY was high-er than the DYY group.8. Endothelial dysfunction of different syndrome types in essential hypertension withmetabolic disturbance: There was no obvious difference in NO and AngⅡ.The iNOS andNOS in the HLY group were higher than the HYYD group and the excessive phlegm anddamp group (P＜0.05). iNOS in the EPD group was higher than the HYYD group(P＜0.01). ET in the EPD group was lower than the HYYD group.Conclusions:1. The changes of the levels of endothelium function markers detected from all the chosen EH patientswith different TCM groups were characteristic respectively. It was not find that NO,NOS nor ET level was relative with EH TCM groups. But iNOS value of HLY group EH patients was remarkablyhigher than that of the other three TCM groups, while AngⅡlevel of HLY group EHpatients was significantly higher than that of EPD group EH patients. It shows that iNOSand AngⅡcould be two helpful markers in HLY group decision.2. In EH patients with LVH, iNOS level was an important marker when differentiate EPDgroup from all the four EH TCM group, and NOS level was helpful for distinguishingbetween HLY group and EPD/HYYD group.3. In EH patients with abnormal serum lipid levels, ET, NOS and iNOS could besignificative guides when evaluating their TCM group. INOS values of EPD group patientswere significantly higher than that of HYYD group patients, while both NOS and iNOSlevels of HLY group patients were remarkably higher than that of EPD group patients andHYYD group patients, and HYYD group patients’ ET values were significantly higher thanthat of EPD group patients.The regular pattern of iNOS levels is HLY group＞EPD group＞HYYD group.4. Compare with HLY, EPD and HYYD, left ventricle remodeling of DYY group EHpatients was more obvious, promoting that the left wentricular mass index could beregarded as a reference when decide EH patients’ TCM group and evaluate their states ofillness.5. It seems that lipid metabolic disturbance in EPD group patients was more familiar thanthat of DYY group patients.6. The TCM group distribution of EH was HLY, EPD, HYYD and DYY in turn, Alongwith ages and patients self-symptom-assess degree.