原發性高血壓中期腎損害患者的中醫臟腑辨證特點及臨床意義

張南龍 江丹娜 陳磊

[摘要]目的 探討原發性高血壓中期腎損害患者的中醫臟腑辨證特點及臨床意義，為患者臨床診療提供相關指導。方法 選取2019年9月至2020年8月我院接收診治的320例原發性高血壓患者為研究對象。根據其腎損害情況，將所有患者分為對照組（無腎損害，172例）和研究組（中期腎損害，148例）。對比兩組患者中醫臟腑辨證特點，并比較研究組患者不同年齡段、不同高血壓級別的中醫臟腑辨證特點。 結果 對照組患者的肝臟證候積分為（3.51±0.64）分，明顯高于研究組的（1.97±0.43）分，研究組患者的腎臟、脾臟證候積分分別為（2.97±0.62）分、（2.77±0.57）分，均明顯高于對照組的（2.34±0.54）分、（2.25±0.54）分，差異均有統計學意義（P<0.05）;對照組患者的陽亢證證候積分為（2.43±0.47）分，明顯高于研究組的（1.28±0.31）分，研究組患者的氣虛證、陰虛證證候積分分別為（2.72±0.55）分、（1.93±0.41）分，均明顯高于對照組的（2.21±0.47）分、（1.35±0.32）分，差異均有統計學意義（P<0.05）;>70歲患者的腎臟證候積分為（4.28±0.76）分，氣虛證、陰虛證、血瘀證證候積分分別為（4.05±0.71）分、（2.33±0.45）分、（1.87±0.35）分，均明顯高于其他三個年齡段，差異均有統計學意義（P<0.05）;3級高血壓患者的腎臟、脾臟證候積分分別為（4.63±0.77）分、（3.15±0.39）分，氣虛證、陰虛證、血瘀證證候積分分別為（4.33±0.75）分、（2.94±0.37）分、（1.59±0.18）分，均明顯高于1級和2級高血壓患者，差異均有統計學意義（P<0.05）。 結論 原發性高血壓中期腎損害患者的中醫臟腑辨證病位為腎臟、脾臟，病性為氣虛證、陰虛證及血瘀證;患者年齡越大、高血壓級別越高，其腎臟、脾臟損害越嚴重，氣虛證、陰虛證及血瘀證程度加重。

[關鍵詞] 原發性高血壓;中期腎損害;中醫證候;臟腑辨證

[中圖分類號] R256? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）24-0156-04

The characteristics and clinical significance of TCM viscera syndrome differentiation in patients with renal damage in the middle stage of essential hypertension

ZHANG Nanlong? ?JIANG Danna? ?CHEN Lei

Department of Cardiology， Ningbo Hospital of Traditional Chinese Medicine， Ningbo? ?315000， China

[Abstract] Objective To explore the characteristics and clinical significance of TCM viscera syndrome differentiation in patients with primary hypertension with mid-stage renal damage， and to provide relevant guidance for clinical diagnosis and treatment of patients. Methods A total of 320 patients with essential hypertension who were diagnosed and treated in our hospital from September 2019 to August 2020 were selected as the research objects. According to their renal damage， all patients were divided into the control group（no renal damage， 172 cases）and the study group（mid-stage renal damage， 148 cases）. The characteristics of TCM viscera syndrome differentiation between the two groups of patients were compared. And the TCM viscera syndrome differentiation characteristics of patients in the study group at different ages and different levels of hypertension were compared. Results The liver syndrome score of the control group was（3.51±0.64）points， which was significantly higher than（1.97±0.43）points of the study group. The kidney and spleen syndrome scores of the study group were（2.97±0.62）points and（2.77±0.57）points respectively， which were significantly higher than（2.34±0.54）points，（2.25±0.54）points of the control group， and the differences were statistically significant （P<0.05）. The Yang hyperactivity syndrome score of the control group was（2.43±0.47） points， which was significantly higher than（1.28±0.31）points of the study group. The scores of Qi deficiency and Yin deficiency syndromes of the study group were（2.72±0.55）points，（1.93±0.41）points， respectively， which were significantly higher than（2.21±0.47）points，（1.35±0.32）points of the control group， and the differences were statistically significant（P<0.05）. The score of renal syndromes in patients >70 years old was（4.28±0.76）points. The scores of Qi deficiency syndrome， Yin deficiency syndrome， and blood stasis syndrome were（4.05±0.71）points，（2.33±0.45）points，（1.87±0.35）points， respectively， which were significantly higher than other three age groups， and the differences were statistically significant（P<0.05）. The scores of kidney and spleen syndromes in patients with grade 3 hypertension were（4.63±0.77）points and（3.15±0.39）points. The scores of Qi deficiency syndrome， Yin deficiency syndrome， and blood stasis syndrome were（4.33±0.75）points， （2.94±0.37）points， and（1.59±0.18）points， which were significantly higher than those of patients with grade 1 and grade 2 hypertension， and the differences were statistically significant（P<0.05）. Conclusion The lesion sites of TCM viscera syndrome differentiation in patients with primary hypertension with mid-stage renal damage are kidney and spleen， and the disease nature is Qi deficiency， Yin deficiency and blood stasis syndrome. The older the patient， the higher the level of hypertension， the more severe the kidney and spleen damage. The degree of Qi deficiency， Yin deficiency and blood stasis syndrome is aggravated.