目的:研究阴虚型高血压(YDSH)患者的血压节律(BPR),建立预测YDSH的随机森林模型。
方法:我们的研究符合制定循证中医临床实践指南的技术流程和规范(T/CACM1032-2017)。我们招募了234名患者,这些患者在招募前被诊断为原发性高血压,但没有服用抗高血压药物。所有参与者均分为阴虚组(YX,n=74)和非阴虚组(NYX,n=160)。参与者由三位经验丰富的首席中医(TCM)医师根据四项检查进行专业分组(即,检查,倾听和嗅觉,询问和触诊)。我们收集了24h动态血压监测(ABPM)和YDSH量表的数据。我们将一天的24小时分为12个两小时的时间段[Chen-Shi(7:00-9:00),Si-Shi(9:00-11:00),Wu-Shi(11:00-13:00),Wei-Shi(13:00-15:00),Shen-Shi(15:00-17:00),You-Shi(17:00-19:00),徐石(19:00-21:00),Hai-Shi(21:00-23:00),Zi-Shi(23:00-1:00),Chou-Shi(1:00-3:00),Yin-Shi(3:00-5:00),毛石(5:00-7:00)]根据“午夜-中午退潮”的理论。我们使用随机森林建立了YDSH的诊断模型,以是否阴虚证为结局。
结果:与NYX组相比,YX组的女性参与者年龄较大,下腰围,体重指数(BMI),舒张压(DBP),吸烟、饮酒率(均P<0.05)。YX组的YDSH评分[28.5(21.0-36.0)]明显高于NYX组[13.0(8.0-22.0)](P<0.001),YX组的典型症状包括胸部发怒,手掌和鞋底,头晕,干眼,像弦一样的细脉冲,疼痛和无力的腰和膝盖,心悸,脸颊发红,耳鸣(均P<0.05)。YX组非北斗型高血压的比例高于NYX组(56.9%vs44.4%,P=0.004)。与NYX组相比,24hDBP标准偏差(SD),夜间DBPSD,Si-ShiDBP,Si-Shi平均动脉压(MAP),Hi-Shi收缩压(SBP),Hi-ShiDBP,Hi-ShiMAP,Zi-ShiSBP,Zi-ShiDBP,紫石地图,周石SBPSD,周石DBPSD,YX组Chou-ShiSBP变异系数(CV)较低(均P<0.05).二元Logistic回归分析显示,YDSH的诊断与年龄呈正相关,心率,YDSH评分,和四个中医症状,包括胸部发火,手掌和鞋底,像弦一样的细脉冲,疼痛和无力的腰和膝盖,面颊发红(均P<0.05),但与吸烟呈负相关(P﹤0.05)。此外,YDSH的诊断与白天SBPSD呈正相关,夜间SBPSD,夜间SBPCV,和Hi-ShiSBPCV,但与24hSBPCV呈负相关,白天DBPSD,夜间DBPSD,Hi-ShiDBP(均P<0.05)。Hi-ShiSBPCV在调整年龄变量后与YDSH诊断呈独立正相关,性别,高血压的病程,BMI,腰围,SBP,DBP,心率,吸烟和饮酒(P=0.029)。建立了基于随机森林的YDSH诊断模型并进行了验证。计算结果表明,特异性和敏感性为77.3%,77.8%和76.9%,分别。
结论:YDSH患者的BPR明显减弱,包括较低的24小时DBPSD和夜间DBPSD,Hi-ShiSBPCV与YDSH的诊断独立相关。基于随机森林的YDSH诊断模型预测精度较好,这对于临床医生区分YDSH和非阴虚患者更有效的中医治疗高血压具有重要价值。
OBJECTIVE: To investigate blood pressure rhythm (BPR) in Yin deficiency syndrome of hypertension (YDSH) patients and develop a random forest model for predicting YDSH.
METHODS: Our study was consistent with technical processes and specification for developing guidelines of Evidence-based Chinese medicine clinical practice (T/CACM 1032-2017). We enrolled 234 patients who had been diagnosed with primary hypertension without antihypertensive medications prior to the enrollment. All participants were divided into Yin deficiency group (YX, n = 74) and non-Yin deficiency group (NYX, n = 160). Participants were professionally grouped by three experienced chief Traditional Chinese Medicine (TCM) physicians according to four examinations (i.e., inspection, listening and smelling, inquiry and palpation). We collected data on 24 h ambulatory blood pressure monitoring (ABPM) and YDSH rating scale. We divided 24 h of a day into 12 two-hour periods [Chen-Shi (7:00-9:00), Si-Shi (9:00-11:00), Wu-Shi (11:00-13:00), Wei-Shi (13:00-15:00), Shen-Shi (15:00-17:00), You-Shi (17:00-19:00), Xu-Shi (19:00-21:00), Hai-Shi (21:00-23:00), Zi-Shi (23:00-1:00), Chou-Shi (1:00-3:00), Yin-Shi (3:00-5:00), Mao-Shi (5:00-7:00)] according to the theory of \"midnight-midday ebb flow\". We used random forest to build the diagnostic model of YDSH, with whether it was Yin deficiency syndrome as the outcome.
RESULTS: Compared with NYX group, YX group had more female participants with older age, lower waist circumference, body mass index (BMI), diastolic blood pressure (DBP), and smoking and drinking rate (all P < 0.05). The YDSH rating scores of YX group [28.5 (21.0-36.0)] were significantly higher than NYX group [13.0 (8.0-22.0)] (P < 0.001), and the typical symptoms of YX group included vexing heat in the chest, palms and soles, dizziness, dry eyes, string-like and fine pulse, soreness and weakness of lumbus and knees, palpitations, reddened cheeks, and tinnitus (all P < 0.05). The ratio of non-dipper hypertension in YX group was higher than in NYX group (56.9% vs 44.4%, P = 0.004). Compared with NYX group, 24 h DBP standard deviation (SD), nighttime DBP SD, Si-Shi DBP, Si-Shi mean arterial pressure (MAP), Hi-Shi systolic blood pressure (SBP), Hi-Shi DBP, Hi-Shi MAP, Zi-Shi SBP, Zi-Shi DBP, Zi-Shi MAP, Chou-Shi SBP SD, Chou-Shi DBP SD, Chou-Shi SBP coefficient of variation (CV) were lower in YX group (all P < 0.05). Binary Logistic Regression analysis showed that the diagnosis of YDSH was positively correlated with age, heart rate, YDSH rating scores, and four TCM symptoms including vexing heat in the chest, palms and soles, string-like and fine pulse, soreness and weakness of lumbus and knees, and reddened cheeks (all P < 0.05), but was negatively correlated with smoking (P﹥0.05). In addition, the diagnosis of YDSH was positively correlated with daytime SBP SD, nighttime SBP SD, nighttime SBP CV, and Hi-Shi SBP CV, but was negatively correlated with 24 h SBP CV, daytime DBP SD, nighttime DBP SD, and Hi-Shi DBP (all P < 0.05). Hi-Shi SBP CV had independent and positive correlation with the diagnosis of YDSH after adjusting the variables of age, gender, course of hypertension, BMI, waist circumference, SBP, DBP, heart rate, smoking and drinking (P = 0.029). Diagnostic model of YDSH was established and verified based on the random forest. The results showed that the calculation accuracy, specificity and sensitivity were 77.3%, 77.8% and 76.9%, respectively.
CONCLUSIONS: The BPR was significantly attenuated in YDSH patients, including lower 24 h DBP SD and nighttime DBP SD, and Hi-Shi SBP CV is independently correlated with the diagnosis of YDSH. The prediction accuracy of diagnosis model of YDSH based on the random forest was good, which could be valuable for clinicians to differentiate YDSH and non-Yin deficiency patients for more effective hypertensive treatment of TCM.