张南龙 江丹娜 陈磊

[摘要]目的 探讨原发性高血压中期肾损害患者的中医脏腑辨证特点及临床意义，为患者临床诊疗提供相关指导。方法 选取2019年9月至2020年8月我院接收诊治的320例原发性高血压患者为研究对象。根据其肾损害情况，将所有患者分为对照组（无肾损害，172例）和研究组（中期肾损害，148例）。对比两组患者中医脏腑辨证特点，并比较研究组患者不同年龄段、不同高血压级别的中医脏腑辨证特点。 结果 对照组患者的肝脏证候积分为（3.51±0.64）分，明显高于研究组的（1.97±0.43）分，研究组患者的肾脏、脾脏证候积分分别为（2.97±0.62）分、（2.77±0.57）分，均明显高于对照组的（2.34±0.54）分、（2.25±0.54）分，差异均有统计学意义（P<0.05）;对照组患者的阳亢证证候积分为（2.43±0.47）分，明显高于研究组的（1.28±0.31）分，研究组患者的气虚证、阴虚证证候积分分别为（2.72±0.55）分、（1.93±0.41）分，均明显高于对照组的（2.21±0.47）分、（1.35±0.32）分，差异均有统计学意义（P<0.05）;>70歲患者的肾脏证候积分为（4.28±0.76）分，气虚证、阴虚证、血瘀证证候积分分别为（4.05±0.71）分、（2.33±0.45）分、（1.87±0.35）分，均明显高于其他三个年龄段，差异均有统计学意义（P<0.05）;3级高血压患者的肾脏、脾脏证候积分分别为（4.63±0.77）分、（3.15±0.39）分，气虚证、阴虚证、血瘀证证候积分分别为（4.33±0.75）分、（2.94±0.37）分、（1.59±0.18）分，均明显高于1级和2级高血压患者，差异均有统计学意义（P<0.05）。 结论 原发性高血压中期肾损害患者的中医脏腑辨证病位为肾脏、脾脏，病性为气虚证、阴虚证及血瘀证;患者年龄越大、高血压级别越高，其肾脏、脾脏损害越严重，气虚证、阴虚证及血瘀证程度加重。

[关键词] 原发性高血压;中期肾损害;中医证候;脏腑辨证

[中图分类号] R256          [文献标识码] B          [文章编号] 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.