高血压病左室肥厚中西医诊断和活血方药逆转左室肥厚的初步研究

【作者】 谢连娣；

【导师】 陈立新； 王硕仁；

【作者基本信息】 北京中医药大学 ， 中西医结合内科， 2002， 硕士

【摘要】 高血压病是我国目前非传染性疾病中患病率最高，心脑血管并发症最严重的疾病。而高血压病左室肥厚是高血压病最严重的靶器官损害之一，高血压病左室肥厚（LVH）可以造成心脏舒张功能障碍，收缩功能异常，进而出现充血性心力衰竭，还可以造成心律失常，加重或诱发原先存在的冠心病，所以如果早期对高血压病左室肥厚进行诊治，则会对改善患者的预后，提高生存质量有重要的意义。目前我国在高血压病左室肥厚的诊断、治疗中存在的问题有：高血压病左室肥厚的中医证型特点尚待总结;对于高血压病左室肥厚的超声心动图诊断标准还没有完全统一;心电图的诊断标准较多而不统一，而我国目前普遍使用的惠普心电图机所给予的心电图LVH诊断，其可靠性如何，都有待研究;中医药逆转左室肥厚的疗效还缺少大样本、多中心、随机、对照、盲法的临床研究。本论文针对以上问题，对高血压病左室肥厚的中西医诊断和治疗进行了初步研究。1.惠普心电图机诊断LVH和重修改的纽约心脏学会（NYHAC）标准的特异性、敏感性研究。目的：对惠普心电图机诊断LVH和重修改NYHAC标准的特异性敏感性进行研究。方法:1.对178例高血压病人，以超声心动图诊断LVH的左室重量指数（LVMI）和左室后壁厚度、室间隔厚度、左室舒张末内径异常为标准，筛选出左室肥厚病人55例；2。分别以惠普HPPagewriter100型心电图机内定标准和美国重修改NYHAC标准进行敏感性和特异性的比较研究。 结果：1.惠普HPPagewriter100型心电图机对LVH的报告不是确诊性诊断而是一个可能性诊断；2.惠普内定标准的敏感性高，但是特异性低；3.如果以LVMI异常为准，重修改NYHAC标准的敏感性、特异性和正确性都很高。4.惠普内定标准的敏感性很高，但是在室间隔肥厚，左室后壁肥厚，以及左室舒张未期内径增大的IVH患者中阳性率特别低。5.LVMI升高的检出率不随着病程的增加而增加，也不随着高血压程度的加重而增加。但是重修改NYHAC标准的LVH检出率却随着高血压程度的增加而增加，而且病程>20年时，检出率明显增加。讨论与结论：1.惠普内定标准由于其是可能性的诊断，所以惠普心电图机所报告的LVH只能做参考；2.超声心电图中LVMI是基层医院诊断高血压病左室肥厚的最重要指标。3.重修改NYHAC标准是诸多心电图标准中诊断LVH的最理想的标准。4.超声心动图可以比较早期的诊断高血压病左室肥厚。而NYHAC标准阳性时出现的比较晚。2.高血压病及左室肥厚患者的中医证候学研究目的：对高血压病及左室肥厚患者的中医证候学进行研究方法:本研究应用中西医结合会有关虚证和血瘀证的全国诊断标准对133例<WP=5>高血压病门诊患者进行中医证候学的临床流行病学研究。结果：1.原发性高血压病患者，无论有无左室肥厚，其心虚证都多于肝虚证、肾虚证患者，经卡方检验，有显著性差异；2.原发性高血压病患者无论有无左室肥厚，其血瘀证都远多于气虚证、阴虚证、阳虚证患者，经卡方检验，有显著性差异；3.高血压病左室肥厚的中医证型特点仍然以心气虚和血瘀证为主。但是符合血瘀证诊断的条件数比非左室肥厚组的条件数多，有显著性差异。讨论与结论：1.在高血压病中医诊断与治疗中，心系辨证与肝肾辨证具有同等重要的地位，心主神明和心主血脉异常是高血压病的中医病机之一；2.血瘀证普遍存在于高血压病患者中，而且高血压病左室肥厚血瘀证的程度要比非左室肥厚组严重。3高血压病左室肥厚患者药物疗效的观察。目的：对高血压病左室肥厚患者进行中医药药物逆转治疗的研究。方法：将14例高血压病左室肥厚患者随机分为中药组（7例）和对照组（7例），分别给予了降压通脉方和洛汀新或开博通治疗6个月。治疗前后进行超声心动图检查和心电图检查。 结果：1.降压通脉方组与血管紧张素素转换酶抑制剂（ACEI）组均可以降压并能够改善症状，疗效相近；2.LVMI异常时，中药组对左室后壁厚度、左室舒张末期内径、左室重量、左室重量指数都有所减小。而西药组对左室肥厚所有相关指标也都有所减少；3.在室间隔厚度，左室后壁厚度、左室舒张末期内径异常而LVMI正常时，中药组和西药组对左室肥厚所有相关指标均有一定的改善作用；4.中药和西药都对左室的收缩功能的EF和D%有所升高，对左室舒张功能有所改善。讨论与结论：疗程半年的降压通脉方组与ACEI组均有一定降压并能够改善症状的作用，并且疗效相近；中药组和西药组均有一定的改善舒张功能和收缩功能以及改变左室结构的作用。但治疗前后的统计学比较未作出显著性差异，其原因有血液动力学因素和/或非血液动力学药理作用的缺陷以及样本量少、服药时间偏短。更多还原

【Abstract】 Essential Hypertension (EH), of which the cardiac and mental vascular complications are the most severe, has the highest prevalence rate in our country. Being one of the most serious target-organs damages of hypertension ,left ventricular hypertrophy(LVH), can lead to heat distal dysfunction and contractility dysfunction. At last It will lead to heat failure. It can also lead to arrhythmia and coronary heat disease or aggravate coronary heat disease. If we diagnose and cure LVH earlier. We can amelioration the prognosis and improve the quality of life of EH patients. How to diagnose The LVH of EH . At present, the standard of LVH have not been unificated completely by echocardiogram. There are several standards to diagnose LVH with electrocardiography. Huipu cardiofax often give a English report LVH. But we don’t know the reliability. There are many studies of inversio LVH of EH. But we don’t know whether the effect of the traditional Chinese medicine is better than west medicine or not.This study have a research of the diagnosis of the LVH of EH and the effect in the LVH of EH of west medicine and traditional Chinese medicine .1. The study of symptomatology of compare the diagnostic capacity for left ventricular in patient of hypertrophy of NYHAC standard with huipu standard.Purpose : Compare the diagnostic capacity for left ventricular in patient of hypertrophy of NYHAC standard with huipu standard.Method:We research the diagnosis of LVH using ultrasonic cardiography (UCG) and electrocardiography .we also compared the diagnostic capacity for left ventricular in patient of hypertrophy of NYHAC standard with huipu standard.Result:1.The LVH diagnosis standard of huipu is not a final diagnosis .2. The sensitivity of the NYHAC standard is low, but the specificity and the accuracy of it are high. 3.The sensitivity of the huipu standard is high, but the specificity and the accuracy of it are low. 3. If we take the LVMI as a gold standard, the sensitivity, the specificity and the accuracy of NYHAC standard are both high. 4. Although the sensitivity of huipu criteria is great, only one electrocardiography which are identified according to Septal thickness of the ventricle ,the thickness of the posterior wall of the left ventricle and the Diameter of the short-axis left ventricle in end diastole is positive. 5.The positive rate of LVMI criteria is not increase with the course elongation <WP=7>or the blood pressure level increase. But the positive rate of NYHAC criteria is increase with the blood pressure level increase, and the positive rate of NYHAC criteria is higher than other when the progress longer than 20 years.Conclusion : 1Huipu criteria is only a reference criteria. 2.The LVMI criteria in ultrasonic cardiography criteria is the most impontant standard in foot layer hospital. 3. NYHAC criteria is the most ideal criteria in all electrocardiography criteria. 4. Ultrasonic cardiography can identified LVH earlier, and NYHAC identified LVH later.2.The study of symptomatology of essential hypertension patients and the EH patients with LVHPurpose: To study the symptomatology of essential hypertension patients and the EH patients with LVHMethod: We investigated 133 EH outpatients, taking syndrome-differentiation of deficiency-syndrome and blood-stasis-syndrome. Result: 1. EH patients’ heart-deficiency-syndrome is more than liver—deficiency—syndrome and kidney--deficiency—syndrome.2. EH patients’ blood-stasis-syndrome is more than qi--deficiency--syndrome and yin--deficiency--syndrome and yang-deficiency -syndrome.3.The EH patients with LVH have the same result. And the blood-deficiency-syndrome is more severe than other EH patient. Conclusion : 1. Heart acts the same important status as the liver and kidney in the diagnosis and cure of EH; 2.Heart host soul and heart host blood vessel are the mechanism of Chinese medicine science.3 Blood-stasis-syndrome is prevalence in EH patients. 3. the blood-- deficiency-syndrome of the EH patients with LVH is more severe than other EH patient.更多还原