The Relationship Between Immune Mechanism,Cytokines And Blood Pressure,Syndrome Type Or Body Constitution Of TCM In Patients With Primary Hypotension

Objectives: 1.To determine the levels of serum Ig G,Ig A,Ig M,Ig E,TNF-α,IL-6,complement 3(C3),complement 4(C4),ET and NO in patients with suspected hypotension,and to explore the predictive value of different indicators for the occurrence of primary hypotension(PH)in these patients under the background of combination of Chinese and Western medicine;2.To explore the relationships between immune inflammation reaction and primary hypotension;3.To study the distribution profile of syndrome types of TCM in patients with PH;4.To study the distribution features of body constitution in patients with PH;5.To explore the differences of immune and cytokine indicators among different syndrome types of TCM in patients with PH;6.To explore the difference of immune and cytokine indicators among different body constitutions in patients with PH.Methods:Total of 280 patients with suspected hypotension were included,and various immune and cytokine indicators of serum were measured.All subjects were divided into 108 patients of the PH group and 172 patients of the normotensive group by ambulatory blood pressure monitoring,and the differences in general data and various immune and cytokine indicators between the two groups were compared.The ROC curves were used to explore the predictive value of different indicators for the occurrence of PH;All patients of PH were divided into subgroups according to the profiles of syndrome types of TCM and body constitutions,and the differences in immunity and various cytokines indicators were compared among the subgroups.Results:(1)There was a significant difference in gender between the PH group and the normal BP group(81.5% vs 69.2%,P<0.05);TNF-α(7.79±2.32 vs7.06±2.25),IL-6(3.76±1.44 vs 3.28±1.64)and C3(0.93±0.16 vs 0.99±0.16)had statistically significant differences(all P<0.05);(2)In the comparison of the syndrome types between the PH group and the normal BP group,there were significant difference between the two groups(all P<0.01)in the deficiency of both Qi and Yin(77.8% vs 52.9%)and the deficiency of both Qi and Yang(18.5% vs43.6%);(3)In the comparison of body constitution between two groups,yin deficiency(76.9% vs 50.6%),sputum Wetness(12.0% vs.40.7%)and deficiency of Qi(6.5% vs.0.6%)were significantly different between the two groups(All P<0.01);(4)The most common types of TCM syndromes of patients was deficiency of both qi and yin(84cases),but not qi and yang deficiency(20 cases)or yin and yang deficiency(4 cases);(5)In the PH group,the traditional Chinese medicine physique type was mainly yin-deficiency constitution,which constitutes were Yin deficiency(83 cases)>Phlegm dampness(13 cases)>Qideficiency(7 cases)>Yang deficiency(4cases)> Dampness and heat(1 case)>Qistagnation(0 case).(6)The predictive values of TNF-α,IL-6 and C3 were relatively low but significantly for PH(all P<0.05)and the cut-off values were 5.92pg/mL,3.08pg/mL,0.92g/L respectively;(7)The predictive value of C3 in patients with non-Qi and Yin deficiency and non-Yin deficiency were significant(P<0.05)and the cut-off value was 1.03g/L,the sensitivity was 53.1%,the specificity was 79.2% in group of non-Qi and Yin respectively but1.03g/L,51.8%,80.0% in group of non-Yin deficiency respectively deficiency,the C3 cut-off value was 1.03g/L,the sensitivity was 53.1%,and the specificity was79.2%;In the patients of the non-Yin deficiency group,the C3 cut-off value was1.03g/L,and the sensitivity was 51.8%.The specificity was 80.0%.Conclusions:(1)The majority of patients suffering from PH are women,and the indicators of TNF-α and IL-6 are increased mainly,the C3 decreased mainly in PH Group.The indicators of Ig M,Ig E,and NO in PH Group were all greater than the normal range of the indicators.(2)The patients with PH accounted for a larger proportion of deficiency of both Qi and Yin while the proportion of both Qi and Yang was less.(3)The patients with PH accounted for a larger proportion of Yin-deficiency while the proportion of Phlegm-dampness in the group was less.(4)The TCM syndromes of PH are mostly with deficiency of both qi and yin.(5)The body constitution of PH in traditional Chinese medicine is mainly yin deficiency and phlegm-dampness.(6)It is an indicator of highest sensitivity in predicting the occurrence of PH by TNF-α and the disease is more likely to be diagnosed when TNF-α>5.92pg/ml in patients with suspected hypotension;The patients with suspected hypotension are more likely to be diagnosed to PH when IL-6>3.08pg/ml;The patients with suspected hypotension are more likely to be diagnosed to PH when C3<0.92g/L.(7)The patients with non-qi and yin deficiency or non-yin deficiency are more likely to be diagnosed to PH when C3<1.03g/L.