摘要
目的:进行原发性高血压患者中医证型与心理情绪表现的评分调查,以发现原发性高血压患者认知功能在不同中医证候间的差异。方法:选择2003-05/2005-01在营口市中心医院心内科门诊就诊或住院治疗的原发性高血压患者251例,男148例,女103例;年龄36～77岁,平均(55±19)岁;病程1个月～17年,平均(3.2±1.2)年。纳入患者均愿意接受量表测查。参照1993年卫生部《中药新药临床研究指导原则》关于治疗高血压病的临床研究指导原则所确定的辨证标准,并结合临床实际,将高血压患者分为4个证型,分别为肝火亢盛证、阴虚阳亢证、痰湿壅盛证、阴阳两虚证。中医辨证诊断需经两名中医师进行辨证,并获得一致结论后入选,辨证诊断时间在开始治疗前1周内。评估4种证型高血压患者认知功能采用中国韦氏成人智力量表犤包括语言量表测验(包括6个分量表,为知识、领悟、算术、相似性、数字广度、词汇,有的项目通过时记1分,未通过时记0分;另一些项目按回答质量记0,1或2分),操作量表测验(包括5个分量表,为数字符号、图画填充、木块图案、图片排列、图形拼凑,每种操作结果都按质记分)。有时间限制的项目,超过规定时间即使通过也记0分;提前完成的按提前时间的长短记奖励分。一个分测验中的各项目的得分相加,称该分测验的粗分(或称原分)。粗分按手册上相应用表换算成量表分犦。将测得认知水平与正常人常模比较。结果:按意向处理分析,原发性高血压患者251例均进入结果分析,并规范完成量表填写。①语言智测成绩结果:知识分量表评分:痰湿壅盛证、阴阳两虚证高血压患者明显低于正常人常模(t=2.14,3.61,P<0.05,0.05);算术分量表评分:肝火亢盛证、阴阳两虚证高血压患者明显低于正常人常模(t=2.24,3.89,P<0.05,0.01);相似性分量表:阴阳两虚证高血压患者明显低于正常人常模(t=2.56,P<0.05);数字广度分量表:痰湿壅盛证高血压患者明显低于正常人常模(t=3.57,P<0.01);词汇分量表:阴阳两虚证高血压患者明显低于正常人常模(t=4.54,P<0.01)。②操作智测成绩结果:肝火亢盛证、阴虚阳亢证、痰湿壅盛证、阴阳两虚证高血压患者与正常人常模接近(P>0.05)。结论:阴阳两虚证原发性高血压患者存在语言智测认知功能障碍,而操作智能测试认知功能在各证型间水平基本接近。
AIM：To investigate the syndromes of traditional Chinese medicine and scores of psychological emotional manifestation in essential hypertensive patients, so as to find out the differences of cognitive function in essential hypertensive patients with different syndromes of traditional Chinese medicine.METHODS： Totally 251 essential hypertensive patients （148 males and 103 females） at 36 to 77 years of age [mean age was （55±19） years] with disease course of 1 month to 17 years [averagely （3.2±1.2） years], who were treated or hospitalized in the Department of Cardiology, Yingkou Central Hospital from May 2003 to January 2005, were voluntarily investigated with the scale. According to the standards for differentiating syndromea bout the clinical research instructive principles in the treatment of hypertension defined in the principle of clinical research for new traditional herbs set by the Ministry of Health in 1993, and combined with the clinical status,the hypertensive patients were divided into 4 types：liver-fire hyperactivity,hyperactivity of yang due to yin deficiency,excessive accumulation of phlegm-dampness,deficiency of both yin and yang.The diagnosis of traditional Chinese medicine syndromes was performed by two Chinese physicians within one week pre-treatment,and selected after the coincident conclusion was obtained.The cognitive function of hypertensive patients with 4 syndromes was evaluated with the Chinese Weehsler adult intelligence scale, which was divided into language scale test （including 6 suhseales of knowledge,insight,arithmetics,similarity, digit span, vocabulary; Some items were marked as 1 or 0 if it was passed or not; Others were marked as 0,1 or 2 according to the quality of the answer）, operation measurement test （including 5 suhscales of digital sign, picture completion, block pattern, picture arrangement and figure put together, each operation was marked according to the quality）.The item with time limitation was marked as 0 if it was not finished within the provided duration although it was passed; and it was marked as the rewarded score according to the ahead duration if it was finished in advance. The summation of each item in one suhscale was taken as the raw score （or original score） of this suhscale, and then the raw .score was transformed into scale score according to the corresponding tables in the manual. The measured cognitive levels were compared with those of normal subjects.RESULTS： According to intention-to-treat analysis, all the 251 patients with essential hypertension were involved in the analysis of results, and finished the completion of scale as required. ① The results of language intelligence test： the score of knowledge subscale was obviously lower in the hypertensive patients with the syndromes of excessive accumulation of phlegm-dampness and deficiency of both yin and yang. than in normal subjects （t=2.14,3.61,P 〈 0.05,0.05）： The score of arithmetics subscale was markedly lower in the hypertensive patients with the syndromes of liver-fire hyperactivity and deficiency of both yin and yang than in normal subjects（t=2.24, 3.89, P 〈 0.05, 0.01）, The score of similarity subscale was obviously lower in the hypertensive patients with syndrome of deficiency of both yin and yang than in normal subjects （t=2.56,P 〈 0.05）; The score of digit span was remarkably lower in the hypertensive patients with excessive accumulation of phlegm-dampness than in normal subjects （t=3.57,P 〈 0.01）;The score of vocabulary subscale was obviously lower in the hypertensive patients with deficiency of both yin and yang than in normal subjects（t=4.54, P 〈 0.01）. ② The results of operation intelligence test： The results in the hypertensive patients with the syndromes of liver-fire hyperactivity,hyperactivity of yang due to yin deficiency, hypertension due to excessive accumulation of phlegm-dampness and deficiency of both yin and yang were close to those in normal subjects （P 〉 0.05）.CONCLUSION： The essential hypertensive patients with the syndrome of deficiency of both yin and yang have cognitive dysfunction in the language intelligence test, hut the levels of cognitive function in the operation intelligence test are almost the same among the patients with different syndromes.
出处
《中国临床康复》
CSCD
北大核心
2005年第20期63-65,共3页
Chinese Journal of Clinical Rehabilitation
