陈允

【摘要】 目的 探讨原发性高血压危险因素和预后相关情况， 为原发性高血压发病危险因素预测提供可靠的理论依据。方法 对200例原发性高血压患者进行调查， 包括生化检验血脂、血糖等；血管功能评估包括颈部血管彩超等， 并对调查结果进行分析。结果 ①原发性高血压危险因素的分布表现出危险分层越高， 其聚集程度越明显， 尤以糖代谢异常、血脂异常和超敏C反应蛋白（hs-CRP）增高明显；②在传统危险因素回归分析中， 显著影响心血管事件的变量为高甘油三酯（TG）血症、糖代谢异常、低高密度脂蛋白胆固醇（HDL-C）血症、hs-CRP分层、运动量减低和早发家族史6个危险因素；③对发生心血管事件与否的中医证候Logistic回归分析结果中， 反映对发生心血管事件的贡献度指标Wald的最高值是痰证的25.033， 次高值是风阳上扰证7.615。④脂质代谢与糖代谢、炎性反应和血小板聚集对发生心血管事件都存在着交互效应。结论 ①中医“毒”的内涵是：多重并且聚集在一起的心血管病危险因素；②将心血管每一易损成分与多重危险因素定量评估与痰证、中医风证、血瘀证诊断相结合有助于对心血管病的个体临床事件和近期事件的预示诊断。

【关键词】 心血管病；多重危险因素；中医证候；诊断

DOI：10.14163/j.cnki.11-5547/r.2016.15.212

【Abstract】 Objective To investigate risk factors and prognosis related condition of coronary heart disease， in order to provide reference for risk factor prediction. Methods A total of 200 coronary heart disease patients received examination， including blood lipid， blood glucose， vascular function， and carotid duplex ultrasound. Their research outcomes were analyzed. Results ① Primary hypertension had higher risk factors degree along with higher aggregation extent， especially with abnormal glucose metabolism， dyslipidemia and increased high sensitivity C-reactive protein （hs-CRP）. ② Traditional regression analysis of cardiovascular events risk factor showed hypertriglyceridemia， abnormal glucose metabolism， low high-density lipoprotein cholesterol （HDL-C）， hs-CRP delamination， reduced amount of exercise， and early family history. ③ Logistic regression analysis of traditional Chinese medicine syndrome showed phlegm syndrome had the highest Wald value as 25.033， followed by wind yang interference as 7.615. ④Lipid metabolism， glycometabolism， inflammatory reaction and platelet aggregation all showed interaction effects on occurrence of cardiovascular diseases. Conclusion ① Poison in traditional Chinese medicine stands for multiple aggregation of cardiovascular risk factors. ② Combination of vulnerable components， multiple risk factor evaluation and phlegm syndrome， wind syndrome and stasis syndrome is helpful for predictive diagnosis of individual clinical cardiovascular event and short-term event.

【Key words】 Cardiovascular disease； Multiple risk factors； Traditional Chinese medicine syndrome； Diagnosis

近年来， 随着生活节奏的加快， 工作压力的增大使得原发性高血压等严重心血管事件的发生几率也不断增大。心血管事件的概念最早是由著名学者Dzau和Braunwald提出的， 是指多种危险因素如高血压、高脂血症、糖尿病等导致动脉内皮损害、左心室肥厚和动脉粥样硬化， 最终演变成原发性高血压、心力衰竭和死亡的严重后果。……