【作者】 安礼；

【导师】 吉中强；

【作者基本信息】 山东中医药大学 ， 中医内科学， 2012， 博士

【摘要】 目的：目前，我国高血压病患病人数已上升至2亿，每年还有相当数量的新发病例，提示在正常人群中预防高血压病的发生是当前的迫切任务。但是，由于其影响因素多，辨证复杂，不同级（期）患者证候分布有何特点、靶器官损伤有何规律，在不同节气病情加重是否存在规律性，既往研究尚未给出明确答案。因此，本研究以3级高血压病为切入点，探讨3级高血压病证候与症状分布特点、病情加重与节气关系、患病时间与靶器官损伤、以及靶器官器损伤与血压水平之间的关系，从而发现其证候症状分布特点，主要致病因素及损伤病位，部分揭示患病时间与靶器官损伤规律，以及病情加重与节气关系，为临床和现代医学预防和治疗该病提供第一手临床证据和理论依据。方法：1.采用文献梳理与分析方法，探讨中医学对高血压病病名、病因病机、证候分型、病位的认识。2.应用临床病历回顾性研究方法，使用自行设计的《一般情况问卷》和《高血压病案回顾性调查表》对青岛海慈医院中医心内科1592份病历资料进行调查。使用SPASS17.0统计分析软件对录入的病历进行统计分析，采用探索性因子分析研究3级高血压病证候和症状分布特点，采用生存分析Kaplan-Meier方法探索该病靶器官损伤与患病时间关系，应用描述性统计分析研究3级高血压患者的主诉、致病因素、病位、中医病名、血压水平及节气等。结果：纳入总病例数876例，平均年龄66.64±11.58。其中，男352例，平均年龄65.51±11.70，占40.18%；女524例，平均年龄67.40±11.439，占59.82%。血压水平：收缩压194.85±22.30，舒张压110.77±15.89，脉压差84.16±22.60。3级高血压病在中医心内科主要见于眩晕、胸痹、心悸、头痛等4个病，分别占44.18%、41.78%、7.76%、6.28%。主诉通常为眩晕、胸闷、憋气、头痛、心慌和胸痛等6个症状。现病史常见以下20个症状：胸闷、头晕、憋气、乏力、眠差、心慌、口干、头痛、胸痛、大便干、纳呆、汗出、咳嗽、恶心、尿频、耳鸣、口苦、头胀、咳痰、水肿。3级高血压证侯分布以痰瘀互结、气阴两虚、血瘀阻络、肝阳上亢等四个证侯为主，分别占33.56%、28.42%、13.93%和12.10%;致病因素以痰、瘀血、气虚、阴虚为主，分别占49.23%、27.69%、22.71%、20.80%；病位以络脉及肾、心、脾、肺、肝五脏为主，分别占26.31%、24.29%、16.61%、11.73%、10.95%、9.17%。3级高血压病情加重一年当中呈现一定的时间规律，高峰为每年10月初至11月底。3级高血压病与靶器官损害之间呈现一定的时间相关性，随着高血压患病时间的增长，患冠心病、糖尿病、脑梗塞的几率增大，从发现患高血压病到疾病进展至3级约为14年，患病年龄平均53岁。结论：3级高血压病病情加重与节气关系密切，痰、瘀血、虚是其重要致病因素，证候及其分布有一定特点，靶器官损伤规律呈现一定的时间规律。研究结果将从病因病机角度为3级高血压病及其发病机制提供相关理论依据和数据支持，深化中西医学对3级高血压病因病机及证候分型特点及其靶器官损伤的原有认识。中西医学可能将依据本研究结果寻找出针对3级高血压病有效干预方式和途径，为提高该病早期防治水平提供理论依据。更多还原

【Abstract】 Objectives: At present, Hypertensive patients the number of patients in China hadrisen to200million, there were a considerable number of new cases each year,Prompted the prevention of hypertension occurred is an urgent task for the current inthe normal population. But factors of hypertension were more, and its syndromes werecomplex, what are the characteristics of different level of patients with syndromedistribution, which regular patter do displayed target organ damage? There was not a clear answerwhether do the regularity of invasion exist in different solar. In this study, we explore the threegrade hypertension the relationship between the syndrome and characteristics of symptomsdistribution,between invasion and solar terms, between duration of disease and target organdamage,and between target organ damage and blood pressure levels. Thus, we could findthe characteristics of symptoms distribution,the major etiological factor and the site ofinjury. At the same time,we could reveal the relationship between duration of disease andtarget organ damage and between invasion and solar terms.So,we can provid first-handclinical evidence and theoretical basis for the clinical and modern medicine.Methods:1.We explored recognition on hypertension nonaggressive, etiology andpathogenesis, syndrome type,and the site of disease in traditional Chinese medicine byusing a literature review and analysis methods.2.We investigated1552medical records byusing 《Ggeneral Qquestionnaire》and《Hhypertension Medical Rrecord RetrospectiveQuestionnaire》in Qingdao Hai Ci Hospital TCM Department of Cardiology.we analyzedthe characteristics of symptoms distribution,the major etiological factor, the characteristicsof target organ damage and relationship between invasion and solar terms of thehypertension patients. To use SPASS17.0Statistical Analysis Software added entry records.Using test and variance analysis which explored syndrome features, Using survival analysismethods to explore the characteristics of target organ damage in present time.Count data used frequency statistics or t-test, measurement data used least squares analysis.Result: The number of total case is876,its average age is66.64±11.58. Of whichThe number of the male is352, its average age is65.51±11.70, the ratio of it is40.18%.Of which The number of female is524, its average age is67.40±11.439, the ratio of itis59.82%. Level of blood pressure: their systolic pressure is194.85±22.30, theirdiastolic blood pressure110.77±15.89, their pulse differential pressure is84.16±22.60.The main illnesses of the three grade hypertension were mainly dizziness, Chest,heart palpitations, headache in the Traditional Chinese Medicine Department ofCardiology.The proportion of these four symptoms are44.18%,41.78%,7.76%,6.28%.The patients’ chief complaint is usually dizziness, chest tightness, suffocation, headache,palpitation and chest pain,et al. The common symptoms in history of present illness wereas following: chest tightness, dizziness, breath holding, fatigue, poor sleep, palpitation, drymouth, headache, chest pain, dry stools, poor appetite, sweating, cough, nausea, frequenturination, ringing in the ears, mouth pain, headinflation, sputum, and edema. The mainsyndromes of the three grade hypertension were phlegm-blood stasis mutu-stagnation,Qi-Yin dual-Xu、blood stasis–obstructs-luo、Gan-Yang up-hyper function-ing，accounting for33.56%、28.42%、13.93%and12.10%. The main factors of the pathogenicwere phlegm, blood stasis, deficiency of vital energy, yin asthenia, accounting for26.31%,24.29%,16.61%,11.73%,10.95%,9.17%.The main disease locations were collaterals andsubcollaterals, Shen, Xin,Pi,Fei,Gan, accounting for26.31%、24.29%、16.61%、11.73%、10.95%、9.17%. The sick time of the three grade hypertension showed a certain regularitythat the time of peak incidence was from early October to the end of November each year.A certain time correlation exists between the three grade hypertension and target organdamage. With the growth of the prevalence of hypertension, risk of suffering fromcoronary heart disease, diabetes, cerebral infarction increased.From the discovery ofhypertension to the disease divided into three grades was approximately14years. Theaverage age of patients suffering from hypertension was53years old.Conlusion:3the stage of hypertension were closely related with solar terms,Phlegm,blood stasis, deficiency is important pathogenic factor, Syndromes and target organdamage have showed regularity. research results will provide related theoretical basis anddata to support from the perspective of etiology for3the stage of hypertension and itspathogenesis, intensified the original understanding of the climate sub-typecharacteristics and target organ damage of3the stage of hypertension for traditional Chinese Medicine and western medicine. Traditional Chinese medicine, western medicine may lookfor external factors of triggering3the stage of hypertension of ways and means ofeffective psychological intervention of emotional stimulus, and support theoretical basisfor enhancing level of early prevention and treatment of it.更多还原