盐敏感性高血压肾素血管紧张素系统及心脏功能形态学与证候学关系研究
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摘要
目的:探讨盐敏感性高血压不同中医证候间肾素血管紧张素系统(RAS)及心脏功能形态学差异。方法:入选131例盐敏感性高血压患者,酶联免疫法测定患者血清血管紧张素I(AngI)、血管紧张素II(AngII)、醛固酮(ALD)、肾素(PRA),超声学评价其心脏功能形态学情况。结果:AngII:脾肾阳虚、水饮内停>痰湿壅盛>阴虚阳亢,且二者比较差异有统计学意义;ALD:脾肾阳虚、水饮内停>痰湿壅盛>阴虚阳亢,且二者比较差异有统计学意义,AngI、ALD、PRA组间比较差异不显著。脾肾阳虚、水饮内停组患者左室后壁、室间隔厚度显著高于其他2组,脾肾阳虚、水饮内停组患者EF、E/A、FS显著低于其他2组。结论:盐敏感性高血压脾肾阳虚、水饮内停证RAS激活最为显著,同时伴有更严重的心脏功能损害。
Objective: To investigate the difference of rennin-angiotensin system(RAS) and cardiac function between salt-sensitive hypertension and different TCM syndromes. Methods: 131 patients with salt-sensitive hypertension were enrolled in this study. Serum angiotensin I(AngI), angiotensin II(AngII), aldosterone(ALD) and renin(PRA) were measured by enzyme-linked immunosorbent assay morphology. Results: AngII: spleen and kidney Yang deficiency, water fluid retention>phlegm dampness>Yin deficiency and Yang hyperactivity, and significant differences between the two groups were significant; ALD: spleen and kidney yang deficiency, water fluid retention>phlegm dampness> Yin deficiency Yang hyperactivity, and any significant difference between the two groups; AngI, ALD, PRA was no significant difference between groups. Spleen and kidney Yang, water fluid retention group of patients with interventricular septum, left ventricular posterior wall thickness was significantly higher than the other two groups; spleen and kidney Yang, water fluid retention group EF, FS, E/A was significantly lower than the other two groups. Conclusion: Salt-sensitive hypertensive rats with spleen-kidney-Yang deficiency and water fluid retention are the most prominent RAS activators, accompanied by more severe cardiac dysfunction.
Objective: To investigate the difference of rennin-angiotensin system(RAS) and cardiac function between salt-sensitive hypertension and different TCM syndromes. Methods: 131 patients with salt-sensitive hypertension were enrolled in this study. Serum angiotensin I(AngI), angiotensin II(AngII), aldosterone(ALD) and renin(PRA) were measured by enzyme-linked immunosorbent assay morphology. Results: AngII: spleen and kidney Yang deficiency, water fluid retention>phlegm dampness>Yin deficiency and Yang hyperactivity, and significant differences between the two groups were significant; ALD: spleen and kidney yang deficiency, water fluid retention>phlegm dampness> Yin deficiency Yang hyperactivity, and any significant difference between the two groups; AngI, ALD, PRA was no significant difference between groups. Spleen and kidney Yang, water fluid retention group of patients with interventricular septum, left ventricular posterior wall thickness was significantly higher than the other two groups; spleen and kidney Yang, water fluid retention group EF, FS, E/A was significantly lower than the other two groups. Conclusion: Salt-sensitive hypertensive rats with spleen-kidney-Yang deficiency and water fluid retention are the most prominent RAS activators, accompanied by more severe cardiac dysfunction.
引文
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[17] 崔爽.有关高血压病中医不同证型心脏结构及功能变化比较的研究[J].中医临床研究,2013,5(21):5-7.
[18] 褚瑜光,宋庆桥,胡元会,等.不同中医证候盐敏感性高血压病人24 h动态血压及心率变异性差异研究[J].中西医结合心脑血管病杂志,2018,16(5):532-535.
[19] 褚瑜光. 盐敏感性高血压患者血清“Ghrelin-生长激素信号系统”蛋白表达与中医证候学相关性研究[D].北京:中国中医科学院,2017.
[2] 汪新良,何兆初,曾昭华,等.安体舒通对感觉神经损伤性盐敏感性高血压大鼠血管重构及RAAS的影响[J].中国心血管病研究杂志,2006,4(10):773-776.
[3] RJ JOHNSON,KL GORDON,C GIACHELLI,et al.Tubulointerstitial injury and loss of nitric oxide synthases parallel the development of hypertension in the Dahl-SS rat[J].Journal of Hypertension,2000,18(10):1497-505.
[4] 汪洋,牟建军,刘富强,等.高盐喂食对Dahl盐敏感大鼠肾小管上皮向间质转化和肾脏纤维化的影响[J].中华高血压杂志,2015,23(3):238-244.
[5] 黄帝内经素问[M].田代华,整理.北京:人民卫生出版社,2005:20-22.
[6] 刘力生.中国高血压病防治指南2010[J].中华高血压病杂志,2011,19(8):703-743.
[7] 李玉明,刘治全,杨鼎颐,等.盐敏感者在高血压人群中的分布及盐敏感性标志的筛选研究[J].中华心血管病杂志,1994(2):89.
[8] 国家技术监督局.中华人民共和国国家标准·中医临床诊疗术语证候部分[M].北京:中国标准出版社,1997:6-33.
[9] 朱文峰.中医诊断学[M].北京:中国中医药出版社,2007:139-203.
[10] 张树林.心肌病的表现.超声心动图学[M].北京:北京医科大学中国协和医科大学联合出版社,1996:90.
[11] 唐一平,薛颖,余振球,等.男性高血压合并阻塞性睡眠暂停综合征患者动脉弹性与血浆肾素-血管紧张素-醛固酮活性改变的研究[J].心肺血管病杂志,2014,33(5):683-687.
[12] 赵利群,李旭光,谢力俊,等.血管紧张素Ⅱ和醛固酮对原发性高血压患者心房颤动的诊断价值[J].上海交通大学学报:医学版,2016,36(12):1732-1735.
[13] 李泓,张济颖,胡宪蕴,等.肾素-血管紧张素-醛固酮、血浆心钠素水平在原发性高血压中医分型的研究[J].天津中医,1989,6(3):12-15.
[14] 王爱珍,蔡治宾,吴罗杰,等.原发性高血压病中医辨证分型与肾素、血管紧张素初探[J].中国现代医学杂志,1998,8(5):43-44.
[15] 高扬,胡元会,禇瑜光,等.高血压病患者中医证候与血清AngⅠ、AngⅡ、ALD相关性研究[J].北京中医药,2012,31(1):20-22.
[16] 龚乃鹃,李青,陈婕,等.高血压病中医证型与心脏结构功能的关系初探[J].天津中医药,2010,27(1):19-20.
[17] 崔爽.有关高血压病中医不同证型心脏结构及功能变化比较的研究[J].中医临床研究,2013,5(21):5-7.
[18] 褚瑜光,宋庆桥,胡元会,等.不同中医证候盐敏感性高血压病人24 h动态血压及心率变异性差异研究[J].中西医结合心脑血管病杂志,2018,16(5):532-535.
[19] 褚瑜光. 盐敏感性高血压患者血清“Ghrelin-生长激素信号系统”蛋白表达与中医证候学相关性研究[D].北京:中国中医科学院,2017.
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