TCM Syndrome Characteristics Of Patients With Hypertension Combined With Target Organ Damage And Its Correlation With Objective Indexes Of Target Organ Damage

Purpose1.To study the distribution characteristics of TCM syndromes of target organ damage in hypertension.2.To explore the correlation between TCM symptoms of hypertensive patients with target organ damage and indicators of target organ damage(ventricular septal thickness,left ventricular posterior wall thickness,left ventricular end-diastolic diameter,left ventricular mass index,ejection fraction,estimated glomerular filtration rate,creatinine,uric acid,carotid intima media thickness).MethodStudy 1.Characteristics of TCM syndrome distribution of target organ damage in hypertensionData were collected from 303 patients who met the diagnostic criteria and inclusion criteria for target organ damage in hypertension,and questionnaires were filled in,including general information such as name,gender,age,height,weight,BMI,blood pressure in the clinic,history of hypertension,etc.Observation indexes such as the interventricular septum thickness,left ventricular posterior wall thickness,left ventricular end-diastolic diameter,left ventricular mass index(bmi),troponin T,brain natriuretic peptide,ejection fraction,electrocardiogram(ecg),dynamic electrocardiogram,brain CT/MRI,estimated glomerular filtration rate and serum creatinine,blood uric acid,24 hours urinary protein,urinary albumin/creatinine,quantitative carotid intima-media thickness,and presence of plaques,etc.;four diagnostic data.Combination with four diagnostic data according to the syndrome factor scale and objective index for the diagnosis of TCM syndrome factor and target-organ damage assessment,statistical merge different target organ damage of hypertension patients the frequency and composition of TCM syndrome factor distribution ratio,summarizes characteristics of target organ damage in patients with TCM syndrome distribution and compare the different blood pressure classification of hypertension with target organ damage in patients with disease syndrome factor,the distribution of target organ damage.Study 2.Correlation between TCM syndrome and damage index of target organ damage in hypertensionExtraction in patients with ventricular septal thickness,left ventricular posterior wall thickness,left ventricular end-diastolic diameter,left ventricular mass index(bmi),ejection fraction and estimated glomerular filtration rate,serum creatinine,blood uric acid and carotid intima-media thickness data analysis into the target organ damage of hypertension patients in TCM syndrome factor and reflect the correlation of target-organ damage inspection and laboratory test index.ResultStudy 1.Characteristics of TCM syndrome distribution of target organ damage in hypertension1.Distribution characteristics of disease location and syndrome elements(1)General distribution characteristicsA total of 6 disease location syndromes were extracted from 303 patients: liver,heart,spleen,lung,kidney,and meridian.The distribution characteristics were: liver(71.29%)>heart(20.46%)> spleen(19.47%)> lung(12.21%)> meridian(6.27%)> kidney(4.62%).(2)Single-position syndromeA total of 216 patients with single disease location syndrome factor,accounting for71.29% of the total,were distributed as follows: liver(47.85%)> heart(9.57%)> lung(6.27%)> spleen(5.61%)> meridian(1.65%)> kidney(0.33%).(3)Two-position syndromeThere were 71 patients with the combination of two syndromes,accounting for 23.43%of the total,and the distribution of the combination of two syndromes was liver + spleen(8.58%),> liver + heart(5.61%),> liver + meridian(2.64%),> liver + lung(1.65%),> heart+ spleen(1.32%).There were 3 cases of liver + kidney,3 cases of heart + lung,2 cases of heart + meridian,2 cases of lung + spleen,and 1 case of heart + kidney.(4)Multiple-position syndromeThe distribution of multiple disease location syndrome elements was as follows: among the 15 patients with the combination of three disease location syndrome elements,3 cases were liver + spleen + heart,lung + heart + kidney,2 cases were liver + spleen + kidney,liver+ spleen + lung,liver + kidney + meridian,only 1 case was liver + spleen + meridian,liver +kidney + lung,lung + spleen + meridian.There was only one patient with the combination of four syndromes: liver + spleen + lung + kidney.2.Distribution characteristics of disease syndromes(1)General distribution characteristicsA total of 12 disease syndromes were extracted from 303 patients,which were divided into 4 deficiency syndromes(qi deficiency,blood deficiency,Yin deficiency and Yang deficiency)and 8 solid syndromes(Yang and kang,phlegm,dampness,heat,qi stagnation,blood stasis,dynamic wind and cold).The distribution characteristics of syndrome elements were as follows: phlegm(74.26%)> qi deficiency(37.62%)> blood deficiency(37.29%)>dampness(28.71%)>-positive hyperactivity(11.92%)> heat(7.92%)> Yin deficiency(7.59%)> Yin deficiency(6.93%)> blood stasis(5.61%)> dynamic wind(1.65%)> qi stagnation(1.32%),and cold only 1 case.(2)Single disease syndromeThere were 136 patients with single syndrome element,accounting for 44.88% of the total.Among them,phlegm syndrome accounted for the largest 54 cases(17.82%),followed by qi deficiency syndrome(28 cases,9.24%),blood deficiency syndrome(28 cases,9.24%),Yang and kang syndrome(11 cases,3.63%),wet syndrome(4 cases,1.32%),heat syndrome(4 cases,1.32%),Yin deficiency syndrome(3 cases,0.99%),blood stasis syndrome(3 cases,0.99%),and dynamic wind syndrome(1 case,0.33%).(3)Two disease syndromeThere were 85 patients with the combination of two syndromes,accounting for 28.05%of the total.Phlegm + dampness syndrome(26 cases,8.58%),qi + blood deficiency syndrome(21 cases,6.93%),phlegm + blood deficiency syndrome(8 cases,2.64%),phlegm + Yang &kang syndrome(6 cases,1.98%),phlegm + qi deficiency syndrome(5 cases,1.65%),phlegm+ blood stasis syndrome(4 cases,1.32%),phlegm + blood stasis syndrome(3 cases,0.99%),followed by phlegm + blood deficiency syndrome(1 case,each).(4)Three disease syndromeAmong the 53 patients with syndrome combination of three diseases,qi deficiency +blood deficiency + phlegm syndrome was the most(10 cases,3.30%),blood deficiency +phlegm + dampness syndrome(5 cases,1.65%),qi deficiency + blood deficiency + Yin deficiency syndrome(4 cases,1.32%),qi deficiency + Yang deficiency + phlegm syndrome(4cases,1.32%),followed by qi deficiency + blood deficiency + Yin deficiency syndrome(4cases,1.32%).Qi deficiency + blood deficiency + Yang deficiency syndrome,qi deficiency +phlegm + dampness syndrome,2 cases respectively,qi deficiency + blood deficiency +dampness syndrome,phlegm + dampness + blood stasis syndrome,Yin deficiency +yangkang + phlegm syndrome,blood deficiency + dynamic wind + phlegm syndrome,blood deficiency + phlegm + blood stasis syndrome less,1 case each.(5)Four disease syndromeThere were a total of 19 patients with the combination of four syndromes,including 6patients with qi deficiency + blood deficiency + phlegm + wet syndrome,4 patients with qi deficiency + Yang deficiency + phlegm + wet syndrome,3 patients with qi deficiency + blood deficiency + Yang deficiency + phlegm syndrome,and 1 other patients.(6)Five disease syndromeThe proportion of patients with multiple syndromes was the least,with a total of 10 cases,most of which were combined with some syndromes on the basis of phlegm + dampness + qi deficiency/blood deficiency(7 cases,2.31%).3.Damage distribution of target organs(1)Overall distributionThe number of cases < 10 in the classification of syndromes was not included in the statistics,and the analysis data showed that patients with hyperactivity had the most vascular and heart damage,followed by Yin deficiency.There were more brain damage in patients with Yin deficiency.Yang deficiency patients with kidney,heart damage more.Patients with heat syndrome had the least renal damage.(2)Distribution of cardiac damageLeft ventricular hypertrophy was the most common in patients with Yin deficiency,followed by Yang deficiency.Blood stasis patients with angina pectoris is the most;Yang deficiency patients with myocardial infarction,heart failure is the most;Patients with qi deficiency with arrhythmia were the most.(3)Distribution of brain damagePatients with cerebral infarction and cerebral hemorrhage had the most phlegm,followed by blood deficiency and qi deficiency.(4)Distribution of kidney damageKidney damage was the most in patients with qi deficiency and blood stasis.Hypopuricemia was the most common complication in patients with hypopuricemia,followed by phlegm and Yang deficiency.(5)Distribution of vascular damageThe most of the patients with Yang deficiency were combined with carotid artery plaque,and the least of the patients with wet syndrome were combined with carotid artery plaque.Patients with heat syndrome had the least thickening of the medial carotid membrane.4.Distribution of disease syndromes and target organ damage in different blood pressure grades(1)Distribution of disease syndromesThe first grade hypertension qi deficiency syndrome was the most,followed by phlegm syndrome.The phlegm syndrome of grade 2 hypertension was the most,followed by blood deficiency syndrome.The phlegm syndrome of grade 3 hypertension was the most,followed by qi deficiency syndrome.(2)Target organ damage distributionPatients with grade 1 hypertension had the most heart damage,patients with grade 2 and3 hypertension had the most blood vessel damage,followed by heart damage.With the increase of blood pressure level,the proportion of kidney damage and blood vessel damage increased.Study 2.Correlation between TCM syndrome and damage index of target organ damage in hypertension1.Qi deficiency syndrome and target organ damage indexIVST,EF were negatively correlated with qi-deficiency syndrome(P < 0.05).For each increase in IVST level,the "qi-deficiency syndrome" was 0.588 times higher than before,and for each increase in EF level,the "qi-deficiency syndrome" was 0.591 times higher than before.EGFR was positively correlated with qi deficiency syndrome(P < 0.05).For every increase in e GFR level,the syndrome differentiation of "qi deficiency syndrome" was 2.102 times higher than before.2.Blood deficiency syndrome and target organ damage indexThere was a negative correlation between LVEDd and UA and the syndrome of blood deficiency(P < 0.05).For each increase in LVEDd level,the syndrome differentiation of "blood deficiency" was 0.489 times of the original level,while for each increase in UA level,the syndrome differentiation of "blood deficiency" was 0.584 times of the original level.3.Yin deficiency syndrome and target organ damage indexUA was negatively correlated with Yin deficiency syndrome(P < 0.05),and the syndrome differentiation of "Yin deficiency syndrome" was 0.361 times as much as before with each increase of UA level.4.Yang deficiency syndrome and target organ damage indexThere was a positive correlation between LVEDd and UA and Yang deficiency syndrome(P < 0.05).For each increase of LVEDd level,the syndrome differentiation of "Yang deficiency syndrome" was 4.210 times of the original level,while for each increase of UA level,the syndrome differentiation of "Yang deficiency syndrome" was 3.053 times of the original level.There was a negative correlation between EF and Yang deficiency syndrome(P< 0.05),and the syndrome differentiation of "Yang deficiency syndrome" increased by 0.220 times for each grade of EF.5.Sputum syndrome and target organ damage indicatorsThere was a positive correlation between UA and sputum syndrome(P < 0.05),and the "sputum syndrome" was 2.040 times more than the original for every UA grade increased.6.Yang kang syndrome and target organ damage indexThere was a positive correlation between IMT and hyperactivity syndrome(P < 0.05),and the syndrome differentiation of "hyperactivity syndrome" was 2.384 times of the original for each grade of IMT.Conclusion1.In patients with target organ damage of hypertension,the main syndromes are liver,heart and spleen,the deficiency syndromes are qi deficiency and blood deficiency,and the solid syndromes are phlegm,dampness and hyperactivity.Single element was the most common combination of disease syndromes,followed by double syndrome element,threesyndrome element,four syndrome element and five syndrome element.The top three components of mononitone were phlegm,blood deficiency and qi deficiency,and the combination of syndrome elements accounting for more than 2.0% were phlegm + dampness,phlegm + yangkang,deficiency and syndrome elements were qi deficiency + blood deficiency,and deficiency and syndrome elements were qi deficiency + blood deficiency,phlegm + blood deficiency,qi deficiency + blood deficiency,qi deficiency + phlegm + blood deficiency,qi deficiency + phlegm + qi deficiency,phlegm + blood deficiency,qi deficiency + phlegm +dampness.2.The blood vessels and heart damage were the most in patients with hyperactivity;The patients with Yin deficiency had the most brain damage.Patients with Yang deficiency had the most kidney.Left ventricular hypertrophy was the most common in patients with Yin deficiency.Blood stasis patients with angina pectoris is the most;Yang deficiency patients with myocardial infarction,heart failure is the most;Patients with qi deficiency with arrhythmia were the most.Patients with qi deficiency and blood stasis complicated with kidney damage were the most.Hyperuricemia was the most common complication in patients with wet syndrome.3.Qi deficiency syndrome of grade 1 was the most,phlegm syndrome of grade 2 and grade 3 were the most.Patients with grade 1 hypertension had the most heart damage,patients with grade 2 and 3 hypertension had the most blood vessel damage,followed by heart damage.With the increase of blood pressure level,the proportion of kidney damage and blood vessel damage increased.4.EGFR is an independent predictor of qi deficiency syndrome,and IVST and EF are protective factors for qi deficiency syndrome;LVEDd and UA are protective factors of blood deficiency;UA is the protective factor of Yin deficiency syndrome.LVEDd and UA were independent predictors of Yang deficiency syndrome,while EF was the protective factor.UA was an independent predictor of sputum syndrome.IMT is an independent predictor of hyperactivity.