| Objective:To explore the correlation between TCM syndrome types,Hcy level and Left Ventricular structure changes in patients with H-type hypertension,and analyze the influencing factors of Left Ventricular Hypertrophy(LVH),so as to provide reference for TCM treatment.Methods:From June 2018 to December 2019,179 patients with H-type hypertension who were hospitalized in the first affiliated hospital of tianjin university of traditional Chinese medicine and underwent color doppler echocardiography during the menstrual period were collected.Statistical materials of patients were collected,including clinical data acquisition in patients with general,past medical history,medication history,blood biochemical examination,with cysteine,homocysteine and the related parameters of echocardiography,refer to the release of China association of Chinese medicine of the vertigo disease(primary hypertension)in TCM diagnosis and treatment plan(trial edition)2017 divided into liver fire syndrome,phlegm and blood stasis syndrome,Yin deficiency and Yang hyperactivity and kidney qi deficiency syndrome.the general condition,left ventricular structure and functional index,and left ventricular geometry of the four groups were compared.then,according to the left ventricular quality index,LVH group was divided into LVH group and non-LVH group.Binary Logistic regression analysis was used to compare the indicators of the two groups and select independent variables.Finally,LVH was taken as the dependent variable,and eight variables with single factor significance were substituted into the regression model.Results:1.Comparison of Hcy levels in various blood pressure grades of h-induced hypertension:There was no significant difference in age and course of disease between different genders(P >,0.05).Hcy levels increased with the increase of blood pressure grades,and Hcy levels of grade3 hypertension increased significantly compared with those of grade 1 and 2 hypertension(P< 0.01).2.The distribution trend of TCM syndrome type in 179 patients with H type hypertension was as follows:72 cases(40.2%)in the phlegm and blood stasis group,63 cases(35.2%)in the Yin deficiency and Yang hyperactivity group,33 cases(18.4%)in the kidney qi deficiency group,and 11 cases(6.2%)in the liver fire excess group.3.Comparison of general information between the four groups:(1)The ages of the four groups were as follows: kidney qi deficiency group > phlegm and blood stasis group > Yin deficiency and Yang hyperactivity group > liver fire excess group,kidney qi deficiency group significantly increased compared with the other three groups(P < 0.01).(2)The Body Mass Index(BMI)among the four groups was as follows:sputum and blood stasis mutual aggregation group > Yin deficiency and Yang hyperactivity group > kidney qi deficiency group > liver fire excess group,the sputum and blood stasis mutual aggregation group and Yin deficiency and Yang hyperactivity group were significantly larger than the irascibility hyperactivity group(P < 0.05).(3)The course of hypertension among the four groups was as follows:kidney qi deficiency group > sputum and blood stasis mutual aggregation group > Yin deficiency and Yang hyperactivity group > liver fire excess group.Compared with the other three groups,the course of hypertension in liver fire excess group was significantly reduced(P < 0.05).(4)Comparison of blood pressure classification between the four groups:the proportion of grade 1 hypertension in irascibility-hyperactivity group was significantly higher than that in the other three groups(P <0.01),while the proportion of grade 3 hypertension in the phlegm-blood stasis interchange group was significantly higher than that in the other three groups(P <0.01).(5)Comparison of other general conditions between the four groups:compared with the irascibility-hyperactivity group,TC level in the phlegm-blood stasis interjunction group was significantly increased(P < 0.01).Between the four groups of gender,history of smoking,drinking,past medical history(diabetes,coronary heart disease,cerebrovascular disease,family history of hypertension,medications,and course of hypertension,systolic blood pressure,diastolic blood pressure,heart rate,TG,HDL-C,LDL-C,fasting blood glucose,Alt,aspertate aminotransferase,creatinine,there was no statistically significant difference(P >0.05).4.The Hcy levels of the four groups were as follows:sputum and blood stasis mutual aggregation group > kidney qi deficiency group and > Yin deficiency and Yang hyperactivity group and > liver fire excess group.Compared with the other three groups,the Hcy level in the sputum and blood stasis mutual junction group was significantly increased(P < 0.01).5.Comparison of left ventricular structure among the four groups:LVEDD,IVST,LVPWT and LVM in the sputum and blood-stasis interaction group were significantly higher than those in the yin-deficiency,yang-hyperactivity and irascibility-hyperactivity groups(P<0.01).The LVMI value of the sputum and blood stasis combined group was significantly higher than that of the other three groups(P < 0.01).6.Comparison of left ventricular function between the four groups:LVEF value of liver fire excess group was significantly higher than that of kidney qi deficiency and phlegm and blood stasis intergroup(P < 0.05).The E/A value of phlegm and blood stasis,kidney qi deficiency and asthenia group was significantly lower than that of irascibility and Yin deficiency and Yang hyperactivity group(P < 0.05).7.Comparison of the incidence of LVH among the four groups:the incidence of LVH in the sputum and blood stasis interaction group was significantly higher than that in the other three groups,while the incidence of LVH in the kidney-qi deficiency group was significantly higher than that in the Yin deficiency and Yang hyperactivity group(all P < 0.01).8.Correlation analysis between Hcy and left ventricular structure and function:Hcy level was positively correlated with LVEDD,IVST,LVPWT,LVM and LVMI,and negatively correlated with E/A(P < 0.05).9.Factors influencing LVH were analyzed based on regression results:TCM syndrome type,Hcy level,duration of hypertension,age,gender,smoking history and TCM syndrome type were all risk factors for LVH.Among the four syndromes of h-type hypertension,phlegm-blood stasis mutual syndrome has the most significant influence on LVH,and the risk of LVH in phlegm-blood stasis mutual syndrome is 15.350 times higher than that in hyperigneous syndrome.For every 1 ? mol/L increase in Hcy level,the risk of LVH was increased by45.8%.The risk of LVH increased by 4.5% for each additional year of hypertensive course.For each year of increase in age,LVH increased the risk by 4.1 percent.The risk of LVH was 0.159 times higher in women than in men.The risk of LVH in smokers was 3.020 times higher in non-smokers.Conclusions:1.Type H hypertension is mostly characterized by phlegm-blood stasis syndrome,and the Hcy level of the group with phlegm-blood stasis syndrome is the highest;In addition,Hcy level was positively correlated with changes in left ventricular structure(IVST,LVM,LVMI)and negatively correlated with left ventricular diastolic function(E/A).2.The syndrome of mutual phlegm-blood stasis is closely related to the occurrence of LVH,which significantly affects the structure and diastolic function of the left ventricle.It may be a high-risk syndrome of H-type hypertension resulting in LVH. |
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