素食与高血压中医证候特征的临床流行病学调查

发布时间：2018-09-03 20:08

【摘要】：第一部分素食与高血压:循证与中医药研究思路循证医学研究表明,素食可降低血压。中医学认为,嗜食膏粱厚味易生痰浊,痰浊可导致眩晕。本文基于素食探讨了中医药防治高血压研究的思路,首先运用临床流行病学的方法,明确素食与高血压的中医证候学特征,拟定中医素食疗法开展临床研究;其次依据素食降压的营养学基础,探讨中医素食疗法防治高血压的作用机制,为中医药防治高血压提供新思路。第二部分素食与高血压中医证候特征的临床流行病学调查目的调查高血压患者中医证候类型和饮食情况,分析素食与高血压中医证候之间的相关性,为素食与高血压中医药研究提供循证医学证据。方法应用临床流行病学调查方法,进行队列研究设计,根据《中国居民膳食指南2007》中蔬菜水果与鱼禽肉类的比例划分素食组(蔬菜水果占饮食结构80%以上者,即暴露组)和非素食组(蔬菜水果占饮食结构80%及以下者,即非暴露组)。制作《素食与高血压患者临床流行病学调查表》,应用Epidata软件建立素食与高血压患者临床流行病学调查数据库。选择山东中医药大学附属医院2015年7月1日至2015年12月31日收治的高血压住院患者356例,通过中医电子病历系统、HIS系统及问卷调查方式收集患者的一般资料、高血压分级及相关检查等,应用食物频率法调查患者饮食情况,依据患者临床症状和体征并参照《中药新药临床研究指导原则》判定高血压中医证候类型。将数据录入数据库,统计高血压中医证型分布情况和饮食分布情况,并采用多因素logistic回归分析数据得到素食与高血压中医证型的关系。结果1.高血压中医证型分布情况痰湿壅盛型142例(39.89%),肝火亢盛型101例(28.37%),阴阳两虚型80例(22.47%),阴虚阳亢型33例(9.27%)。2.饮食分布情况素食组187例,其中低暴露组120例,高暴露组67例,非素食组169例。3.素食饮食与高血压中医证型相关性食盐量(OR=2.353)、年龄(OR=0.949)和暴露强度(OR=13.259)是痰湿壅盛型的相关因素;暴露强度(OR=0.237)是肝火亢盛型的相关因素;暴露强度(OR=0.591)是阴虚阳亢型的相关因素;年龄(OR=1.064)是阴阳两虚型的相关因素。结论1.高血压中医证候以痰湿壅盛型最多,其次为肝火亢盛型、阴阳两虚型、阴虚阳亢型。2.饮食结构中非素食饮食最多,其次为低暴露素食饮食。3.食盐量、素食比例、年龄与高血压痰湿壅盛型有相关性,并且适当降低食盐量、增加素食比例能降低痰湿壅盛型发生风险;素食比例与高血压肝火亢盛型和阴虚阳亢型有相关性,年龄与阴阳两虚型有相关性。
[Abstract]:Part I vegetarianism and hypertension: evidence-based and traditional Chinese medicine research shows that vegetarianism can lower blood pressure. Chinese medicine believes that the thick taste of preference paste sorghum easily sputum turbid, phlegm can lead to vertigo. Based on vegetarianism, this paper discusses the ideas of traditional Chinese medicine (TCM) in the prevention and treatment of hypertension. Firstly, by using the method of clinical epidemiology, the characteristics of TCM syndromes of vegetarianism and hypertension are clarified, and the clinical study of traditional Chinese medicine vegetarian therapy is developed. Secondly, based on the nutritional basis of vegetarian hypertension, the mechanism of traditional Chinese medicine vegetarian therapy to prevent and treat hypertension is discussed, which provides a new way for traditional Chinese medicine to prevent and treat hypertension. Part two: clinical Epidemiological investigation on the characteristics of vegetarianism and hypertensive TCM Syndromes objective to investigate the types of TCM syndromes and diet of hypertensive patients, and to analyze the correlation between vegetarianism and hypertensive TCM syndromes. To provide evidence-based medical evidence for the study of vegetarian and hypertension Chinese medicine. Methods A cohort study was conducted with the method of clinical epidemiological investigation. According to the proportion of vegetables and fruits to fish, poultry and meat in the Chinese Dietary guidelines 2007, the vegetarians were divided into vegetarianism groups (the proportion of vegetables and fruits accounted for more than 80% of the diet structure). Exposure group and non-vegetarianism group (vegetables and fruits accounted for 80% of diet structure, that is, non-exposed group). The Clinical Epidemiology questionnaire for Vegetarian and Hypertension patients was made and the database of clinical epidemiology investigation of vegetarianism and hypertension was established by using Epidata software. From July 1, 2015 to December 31, 2015, 356 patients with hypertension were selected from the affiliated Hospital of Shandong University of traditional Chinese Medicine. The general data of the patients were collected by means of his system and questionnaire survey. According to the clinical symptoms and signs of the patients and referring to the guiding principles of clinical research of traditional Chinese medicine, the types of TCM syndromes of hypertension were determined by the method of food frequency. The data were inputted into the database, and the distribution of TCM syndromes and diet of hypertension were analyzed. The relationship between vegetarianism and TCM syndromes of hypertension was obtained by using the data of multivariate logistic regression analysis. Result 1. The distribution of TCM syndromes in hypertension was 142 cases (39.89%) of phlegm dampness, 101 cases (28.37%) of hyperactivity of liver fire, 80 cases (22.47%) of deficiency of both yin and yang, 33 cases (9.27%) of hyperactivity of yin and yang. The distribution of diet was 187 cases in vegetarian group, 120 cases in low exposure group, 67 cases in high exposure group, and 169 cases in non vegetarian group. The relative salt content (OR=2.353), age (OR=0.949) and exposure intensity (OR=13.259) of vegetarian diet and TCM syndrome type of hypertension were related factors of phlegm and dampness accumulation, exposure intensity (OR=0.237) was the related factor of liver-fire hyperactivity, exposure intensity (OR=0.591) was the related factor of Yin deficiency and Yang hyperactivity. Age (OR=1.064) is the related factor of deficiency of both yin and yang. Conclusion 1. The TCM syndromes of hypertension are phlegm dampness accumulation type, followed by liver fire hyperactivity type, yin and yang deficiency type, yin deficiency and yang hyperactivity type. 2. Diet structure non-vegetarian diet is the most, followed by low exposure vegetarian diet. 3. Salt content, vegetarian ratio, age and hypertension phlegm dampness accumulation type, and appropriate reduction of salt content, increase vegetarian proportion can reduce the risk of phlegm dampness accumulation type; The proportion of vegetarian diet was correlated with hyperactivity of liver fire and hyperactivity of yin deficiency and yang hyperactivity, and age was associated with deficiency of both yin and yang.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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