芦波 韩亚楠 周训杰 桂明泰 姚磊 李建华 符德玉

摘要：目的 探索中心性肥胖高血压患者中医证型分布特点，并分析不同证型与尿微量白蛋白/尿肌酐（尿MA/Cr）水平的相关性，为中西医结合有效控制肥胖高血压及防治早期肾脏损伤提供一定的依据。方法 采用流行病学横断面调查研究，采集上海地区359例中心性肥胖高血压患者年龄、性别、身高、体质量、腹围、血压、相关病史及中医症状，结合四诊情况进行中医辨证，并检测尿MA/Cr、空腹血糖、空腹胰岛素、超敏C反应蛋白（hs-CRP）水平。结果 上海地区中心性肥胖高血压人群中，尿MA/Cr升高检出率为33.4%（120/359），其中男性占56%（67例），女性占44%（53例）。微量白蛋白尿组患者胰岛素抵抗指数和hs-CRP较正常组明显升高（P<0.05）。359例中心性肥胖高血压患者中，痰湿壅盛证140例（39%），肝阳上亢证108例（30%），阴阳两虚证61例（17%），阴虚阳亢证50例（14%），4种证型例数构成比差异有统计学意义（P<0.05）。痰湿壅盛证患者尿MA/Cr明显高于肝阳上亢证、阴阳两虚证及阴虚阳亢证（P<0.05）。结论 上海地区中心性肥胖高血压患者早期肾损害发生率高，且早期肾损害者伴有明显的胰岛素抵抗和炎症反应。中心性肥胖高血压的中医证型以痰湿壅盛证及肝阳上亢证居多，且痰湿壅盛证患者更易发生早期肾脏损伤。

关键词：原发性高血压；中心性肥胖；中医证型；尿微量白蛋白/尿肌酐

DOI：10.3969/j.issn.1005-5304.2016.06.006

中图分类号：R259.871；R259.892.5 文献标识码：A 文章编号：1005-5304（2016）06-0019-04

Abstract： Objective To explore the TCM syndrome distribution characteristics of central obesity hypertension patients； To analyze its correlation with urinary microalbumin/creatinine （MA/Cr） ratio； To provide some proof for an efficient way to control central obesity hypertension and prevent and cure its early renal injury with integrated TCM and Western medicine. Methods It was performed in a cross-sectional epidemiological study. The age， gender， height， weight， waist circumference， blood pressure， medical history and symptoms of 359 central obesity hypertension patients were collected in Shanghai. Then according to the four diagnostic methods， TCM syndromes were recorded. The urinary MA/Cr ratio， fasting blood glucose， fasting insulin and hs-CRP levels were detected. Results The urinary MA/Cr detectable rate in Shanghai among central obesity hypertension was 33.4% （120/359）， men accounting for 56% and women 44%. Among central obesity hypertension patients， the HOMA-IR and hs-CRP level of urinary albumin group were significantly higher than those of normal group， with statistical significance （P<0.05）. Among 359 central obesity hypertension patients， 140 people had phlegm-dampness syndrome， accounting for 39%， the largest part； 108 had liver-yang hyperactivity syndrome， accounting for 30%； 61 had yin-yang deficiency syndrome， accounting for 17%； 50 had yin-deficiency and yang-hyperactivity syndrome， accounting for 14%； the number of four TCM syndromes had statistical difference （P<0.05）. Urinary MA/Cr ratio of the patients with phlegm-dampness syndrome was significantly higher than that of other three syndromes （P<0.05）. Conclusion The incidence rate of early renal damage with central obesity hypertension patients is high in Shanghai area， and the early stage of renal damage is associated with insulin resistance and inflammatory reaction. Among central obesity hypertension， phlegm-dampness syndrome and liver-yang hyperactivity account for the majority， and patients with phlegm- dampness syndrome are more likely to have early kidney damage.

Key words： primary hypertension； central obesity； TCM syndromes； urinary MA/Cr ratio

随着生活水平的提高，全球超重及肥胖人群从1980年的8.57亿增长至2013年的21亿[1]，成为全世界重大的公共卫生问题。流行病学调查显示，我国高血压患病率为29.6%，患者已达3亿[2]，中心性肥胖患者已经高达2.59亿[3]。肥胖和高血压常相伴而生，预防和控制肥胖高血压的靶器官损害是亟待解决的重大健康问题。回归分析进一步发现肥胖是高血压微量白蛋白尿（MAU）的重要预测因子[4]，尤其是中心性肥胖患者，由于体脂异常及胰岛素抵抗、肾素-血管紧张素系统功能亢进因素的存在[5]，与肾脏损伤有显著相关性，MAU反过来又显著增加肥胖及高血压患者的病死率。本研究通过分析中心性肥胖合并高血压人群的中医证型分布及主要证候特点，研究不同证型与MAU的相关性，为中西医结合有效控制血压及防治早期肾损害提供一定的依据。……