| Purpose:Observe the possible correlation between Traditional Chinese Medicine (TCM) syndrome types and syndrome elements of essential hypertension (EH) with EH risk stratification、cardiovascular risk factors、target organ damage、complications and renin, angiotensinogen gene polymorphism. Explore TCM objective, standardized theoretical and clinical basis, attempt to provide laboratory indicators、genetics and molecular biology basis for EH TCM, so that TCM medicine can play a greater potentiality and superiority in the treatment of EH.Methods:Select150EH patients who meet the inclusion criteria. According to the "Chinese medicine clinical research guidelines,2002Revision" standard, patients are divided into4syndrome types:Liver-fire syndrome, Hyperactivity of yang due to deficiency of yin syndrome, Deficiency of both yin and yang syndrome, Profuse expectoration and retention of dampness syndrome. And determine the common EH syndrome elements of this group of patients, include: wind and fire、wind phlegm、 phlegm and humid、hot and phlegm、hot and humid、wet、blood stasis、Qi stagnation、Liver-fire、Qi-weak、Yin-weak、Yang-weak etc. According to the "Chinese Hypertension Prevention Guide2010", analyze and assess the risk stratification and the prognostic factors of the enrolled patients. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) is used to detect renin (REN) gene G10631A, angiotensinogen (AGT) gene C521T polymorphism of the patients. Statistical analyze the correlation between EH syndromes, syndrome factors with the risk stratification、prognostic factors and REN G10631A、AGT C521T gene polymorphism.Results:1. The proportion of EH syndromes occur in the patients:Profuse expectoration and retention of dampness syndrome (51.33%)>Hyperactivity of yang due to deficiency of yin syndrome (20.67%)>Deficiency of both yin and yang syndrome (17.33%)>Liver-fire syndrome (10.67%). Men and women comparing the groups, men with Profuse expectoration and retention of dampness syndrome, Deficiency of both yin and yang syndrome is more, women with Profuse expectoration and retention of dampness syndrome, Hyperactivity of yang due to deficiency of yin syndrome as much; Hyperactivity of yang due to deficiency of yin syndrome in the proportion of women (24.4%), male (15.6%), but the difference is not statistically significant (P>0.05)2. The relationship between EH syndrome types and risk stratification:in the very high-risk group, the proportional of Profuse expectoration and retention of dampness syndrome (51.8%)> Hyperactivity of yang due to deficiency of yin syndrome (20.6%)>Deficiency of both yin and yang syndrome (17.0%)> Liver-fire syndrome (10.6%); the patients of Profuse expectoration and retention of dampness syndrome in the very high-risk group (51.8%), high-risk group (40.0%), but the difference was not statistically significant (P>0.05)3. The proportion of Liver-fire syndrome EH patients who have a family history (18.2%) is significantly higher than those patients without a family history of EH (6.3%), the difference is statistically significant (P<0.05)4. The relationship between EH syndrome types and cardiovascular risk factors:the age of the patients, Deficiency of both yin and yang syndrome group is significantly greater than other syndromes, Liver-fire syndrome group is significantly less than other syndromes, difference is statistically significant (P<0.01); diastolic blood pressure levels of the patients, Liver-fire syndrome group is significantly higher than Deficiency of both yin and yang syndrome group; difference is statistically significant (P<0.01); triglyceride levels, Liver-fire syndrome group is significantly higher than Deficiency of both yin and yang syndrome group, difference is statistically significant (P<0.05); the patients with a history of smoking, Liver-fire syndrome group is significantly higher than the patients without a history of smoking, difference is statistically significant (P<0.05)5. The relationship between EH syndrome types and target organ damage:BUN levels of the patients of Deficiency of both yin and yang syndrome is significantly higher than other syndromes, difference is statistically significant (P<0.05); left ventricular end-diastolic diameter of Liver-fire syndrome group is significantly larger than Hyperactivity of yang due to deficiency of yin syndrome group, difference is statistically significant (P<0.05)6. The relationship between EH syndrome types and the patients with clinical disease:EH Profuse expectoration and retention of dampness syndrome type patients, associated with cerebrovascular disease accounted for (63.9%) is significantly higher than those without cerebrovascular disease (39.7%), difference is statistically significant (P<0.01); in the patients of EH associated with cerebrovascular disease, the proportion of TCM:Profuse expectoration and retention of dampness syndrome (63.9%)>Deficiency of both yin and yang syndrome (22.2%)>Hyperactivity of yang due to deficiency of yin syndrome (11.1%)>Liver-fire syndrome (2.8%). In the patients of Liver-fire syndrome, the proportion of patients without cardiac disease (16.7%) is significantly higher than the patients with cardiac disease (6.0%), difference is statistically significant(P<0.05). The distribution ratios of EH syndromes between EH with diabetes and EH without diabetes do not have a statistically significant difference (P>0.05).7. The distribution of AGT C521T polymorphism of the three genotypes TT, CT、CC and allele T、C in EH different syndromes do not have a statistically significant difference(P>0.05). The proportion of REN G10631A genotype AA+GA and GG in Hyperactivity of yang due to deficiency of yin syndrome(41.9%,58.1%), Deficiency of both yin and yang syndrome(19.2%,80.8%), two syndromes between the two groups(x2=3.374, P=0.066), its distribution ratios tend to have statistically significant. The proportion of REN G10631A allele A、G frequency in Hyperactivity of yang due to deficiency of yin syndrome(24.2%,75.8%), Deficiency of both yin and yang syndrome (9.6%、90.4), difference between them is statistically significant(P<0.05).8. The proportion of AGT C521T genotype TT+CT and CC in phlegm and humid (17.1%、82.9%), Qi-weak (32.3%、67.7%), the difference between the two groups is statistically significant (P<0.05); the proportion of TT+CT and CC in wind phlegm (14.3%、85.7%), Qi-weak (32.3%、67.7%), the difference between the two groups is statistically significant (P <0.05). The proportion of REN G10631A genotype AA+GA and GG in two different syndrome elements:wet (52.9%、47.1%) and Qi-weak (27.4%、72.6%); wet (52.9%、47.1%) and Yang-weak (17.9%、82.1%); Yang-weak (17.9%、82.1%) and blood stasis (43.6%、56.4%); the differences of syndrome elements between two groups are statistically significant (P<0.05).9. The proportion of AGT C521T polymorphism CT genotype patients without a EH family history (20.0%) is significantly higher than the patients with a family history (7.3%), while the proportion of CC genotype patients with a family history (92.7%) is significantly higher than those without a Family history (77.9%), the difference is statistically significant (P<0.05). The distribution ratio of REN G10631A polymorphism between patients with a EH family history and without a family history do not have a statistically significant difference (P>0.05)10. The proportion of AGT C521T、REN G10631A polymorphism between the EH patients with disease (including cerebrovascular disease、heart disease、diabetes) and without concomitant diseases do not have a statistically significant difference (P>0.05)11. The distribution of AGT C52T、REN G10631A gene polymorphism in the syndrome types associated with cerebrovascular disease is no significant difference (P>0.05). The distribution of syndrome elements:the proportion of TT+CT and CC in the wind phlegm (12.2%、87.8%), Qi-weak (34.4%、65.6%), the difference between the two groups is statistically significant (P<0.05). The proportion of AA+GA and GG in phlegm and humid (28.3%、71.7%), blood stasis (53.3%、46.7%), the difference between the two groups is statistically significant (P<0.05)12. The distribution of AGT C521T、REN G10631A gene polymorphism in the syndrome types associated with heart disease is no significant difference (P>0.05). The distribution of syndrome elements:the proportion of TT+CT and CC in hot and phlegm (0.0%、100.0%), Qi-weak (32.6%、67.4%), the difference between the two groups is statistically significant (P <0.05). The proportion of AA+GA and GG in wet (57.1%、42.9%), Yang-weak (12.5%、87.5%), the difference between the two groups is statistically significant (P<0.05)Conclusion:1. TCM syndrome types of EH and EH prognostic factors in this group of patients, such as age、smoking history、triglycerides、blood urea nitrogen、left ventricular end-diastolic diameter and so have some relevance.2. AGT C521T polymorphism and EH family histories have some relevance in this group of patients, but REN G10631A polymorphism has nothing to do with a family history of EH.3. AGT C521T polymorphism and EH TCM syndrome types is no significant correlation in this group of patients. REN AA+GA and GG genotypes tend to have some relevance with Hyperactivity of yang due to deficiency of yin syndrome and Deficiency of both yin and yang syndrome. REN gene A、G allele frequency has some relevance with Hyperactivity of yang due to deficiency of yin syndrome and Deficiency of both yin and yang syndrome.4. AGT C521T、REN G10631A gene polymorphism have some relevance with TCM syndrome elements of EH.Thus, EH prognostic factors、AGT C521、REN G10631Apolymorphism can be used as an objective indicators of EH TCM syndrome types and syndrome elements, and also have a certain reference value of TCM diagnosis and treatment of EH. |
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