| Objective:To investigate the relationship between the traditional Chinese medicine(TCM)evidence pattern of hypertension combined with carotid atherosclerosis and the general data and clinical examination-related indexes,and to provide reference for the TCM identification and clinical treatment of hypertension combined with carotid atherosclerosis.Methods:Using a retrospective study design,case data of 253 patients with hypertension combined with carotid atherosclerosis who met the nadir criteria among inpatients in the cardiovascular department of Xiyuan Hospital,Chinese Academy of Traditional Chinese Medicine from January 2019 to January 2022 were collected in this study.Using the information from the four TCM consultations in the admission records as the basis for identification,and referring to the Expert Consensus on the Treatment of Hypertension in Chinese Medicine and the Expert Consensus on the Prevention and Treatment of Atherosclerosis in Chinese and Western Medicine(2021)released in 2019,the included patients were divided into four evidence groups:hyperactivity of liver and yang,phlegm and blood stasis,qi deficiency and blood stasis,and liver and kidney yin deficiency.General case data,laboratory test indexes,ambulatory blood pressure examination indexes,carotid ultrasound examination indexes,and cardiac ultrasound examination indexes were collected for statistical analysis in each group.For univariate analysis,ANOVA was used to compare the differences between groups and LSD twoby-two comparison for measurement data that conformed to normal distribution with uniform variance,and rank sum test was used for measurement data that did not conform to normal distribution or did not have uniform variance,and Kruskal-Wallis method was used for post hoc multiple comparisons.The chi-square test was used for intergroup comparisons of count data,Fisher’s exact test was used for cell values<5,and LSD test was used for comparisons between two groups.The variables of interest were searched for according to the univariate correlation analysis method,and the relationship between evidence type and multiple factors was explored using binary logistic regression analysis,and variables were screened using the stepwise method with α=0.05.Results:1.Distribution of TCM evidence types:the highest percentage of phlegm and stasis evidence(49.41%),followed by liver-yang hyperactivity evidence(24.90%),liverkidney yin deficiency evidence(20.16%),and the lowest percentage of qi deficiency and blood stasis evidence(5.53%).2.General data distribution:Middle-aged and elderly patients aged 60-69 and 70-79 years accounted for more patients(33.20%,30.04%),while young patients aged 30-39 and 40-49 years were fewer(1.58%,7.51%),with a male to female ratio of about 3:4.The duration of hypertension was evenly distributed,with the highest percentage of patients(22.53%)having a duration of 10 to 20 years,and the subtypes were Systolic and diastolic hypertension were predominant(79.45%),and there were no patients with pure diastolic hypertension.Hypertension classification was predominantly grade 3(65.22%),with the largest proportion of very high-risk individuals(84.58%)in the risk stratification.The presence of carotid thickening accounted for 68.53%of patients,and the site of plaque occurrence was at the bifurcation of the common carotid artery,with soft plaques predominating in nature,followed by mixed plaques,while hard plaques were the least.The largest number of patients had dizziness(89.72%),followed by insomnia(46.64%),and few patients had no obvious symptoms(1.58%).Dark tongue(37.55%),yellowish coating(34.39%)and slippery pulse(29.25%)accounted for the largest number of patients.The percentage of patients with a history of smoking was 22.92%,a history of alcohol consumption was 17.39%,and a family history was 33.60%.The highest number of patients had combined fatty liver(46.25%),followed by hyperlipidemia(43.87%),subclavian artery plaque(37.94%),and limb atherosclerosis(30.83%).3.Univariate analysis:The results of chi-square test showed that the differences in the distribution of age,hypertension subtype,smoking history,alcohol consumption history,combined limb arteriosclerosis,pulmonary diagnostic imaging abnormalities,retinal arteriosclerosis,cervical disc herniation,cardiac insufficiency,anxiety status,and depression status among different evidence types were statistically significant(P<0.05);ANOVA and rank sum of laboratory tests showed that the distribution of T3,T4,FT3,FT4,Mg,hsCRP,CHE,GGT,LAP,TG,APO-A1 were statistically different among evidence types.The results of ANOVA and rank-sum test for laboratory tests showed that the distribution of T3,T4,FT3,FT4,Mg,hsCRP,CHE,GGT,LAP,TG,and APO-A1 were statistically different among the evidence types(P<0.05);the results of ANOVA and rank-sum test for ambulatory blood pressure indexes showed that minSBP,SBP PTD,SBP Leese,mDBP,dmDBP,nmDBP,minDBP,DBP PTD,DBP Leese,minMAP,mMAP,MAP PTD,MAP PTE,MAP Leese,sdPP,and SBPCV were statistically different among different types(P<0.05);the chi-square test for carotid ultrasound showed that carotid thickening and large plaque nature were statistically different among different types(P<0.05).The chi-square test of carotid ultrasound showed that there was a statistical difference in the distribution of aortic valve insufficiency and left ventricular wall hypertrophy among the different types(P<0.05),and the rank sum test of related parameters showed that there was a statistical difference in the septal thickness and left ventricular posterior wall thickness among the different types(P<0.05).4.Multivariate analysis:(1)Logistic regression analysis of evidence type and general data showed that the effects of hypertension subtype,history of alcohol consumption,combined cervical disc protrusion or anxiety state on the evidence of hyperactivity of liver and yang were statistically significant(P<0.05);the effects of history of alcohol consumption and combined cardiac insufficiency on the evidence of phlegm and blood stasis were statistically significant(P<0.05);the effects of history of smoking,combined limb arteriosclerosis or retinal arteriosclerosis There was a statistically significant effect of smoking history and combined limb arteriosclerosis or retinal atherosclerosis on the evidence of Qi deficiency and blood stasis(P<0.05);there was a statistically significant effect of combined depressive state on the evidence of liver and kidney yin deficiency(P<0.05).(2)Logistic regression analysis of evidence type and laboratory tests showed that the effect of HDL-C on the evidence of hyperactivity of liver yang was statistically significant(P<0.05);the effect of Mg and P on the evidence of mutual stagnation of phlegm and blood was statistically significant(P<0.05);the effect of FT3,FT4,AntiTPO and TG on the evidence of qi deficiency and blood stasis was statistically significant(P<0.05);the effects of Anti-Tg,CREA,UA and K on liver-kidney yin deficiency evidence were statistically significant(P<0.05).(3)Logistic regression analysis of the evidence type and ambulatory blood pressure examination showed that the effects of dmDBP,mMAP and MAP PTE on the evidence of hyperactivity of liver and Yang were statistically significant(P<0.05);the effects of minSBP and minMAP on the evidence of Qi deficiency and blood stasis were statistically significant(P<0.05).(4)Logistic regression analysis of evidence type and carotid ultrasonography showed that there was a statistically significant effect of the nature of the larger plaque on the right side on the evidence of qi deficiency and blood stasis(P<0.05),and a statistically significant effect of the nature of the larger plaque on the left side on the evidence of liver and kidney yin deficiency(P<0.05).(5)Logistic regression analysis of the evidence type and cardiac ultrasonography showed that there was a statistically significant effect of the degree of aortic valve insufficiency on the evidence of phlegm-stasis interconnection,the evidence of qi deficiency and blood stasis and the evidence of liver-kidney yin deficiency(P<0.05).Conclusion:1.The distribution of TCM evidence of hypertension combined with carotid atherosclerosis was dominated by the evidence of phlegm and stasis,followed by the evidence of hyperactivity of liver and yang,yin deficiency of liver and kidney and Qi deficiency and blood stasis,respectively.2.Blood lipids,UA,CREA,ambulatory blood pressure indexes such as minSBP and mMAP,ultrasound classification of aortic valve insufficiency and the nature of carotid plaque ultrasonography were correlated with the TCM evidence of hypertension combined with carotid atherosclerosis. |
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