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Study on blood pressure rhythm in hypertensive patients with yin deficiency syndrome and a random forest model for predicting hypertension with yin deficiency syndrome

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Journal of Traditional Chinese Medicine 2024年第3期44卷 564-571页

作者： ZHOU ying LI Ping LUAN Jianwei SHEN Rui WU yinglan XU Qiwen WANG Xinyue ZHU Yao XU Xiangru LIU Zitian JIANG Yuning ZHONG Yong HE Yun JIANG Weimin Department of Cardiology the Affiliated Hospital of Nanjing University of Chinese MedicineJiangsu Province Hospital of Traditional Chinese Medicine Department of Health Management Centre Jinling HospitalAffiliated Hospital of Medical SchoolNanjing University Emergency Department Longhua HospitalShanghai University of Traditional Chinese Medicine Department of General Internal Medicine the Affiliated Hospital of Nanjing University of Chinese MedicineJiangsu Province Hospital of Traditional Chinese Medicine

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), ZiShi(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). Com

关键词： blood pressure rhythm blood pressure variability hypertension random forest yin deficiency syndrome

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Consensus on diagnostic criteria for yin deficiency syndrome in hypertension:a modified Delphi study

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Journal of Traditional Chinese Medicine 2023年第1期43卷 181-187页

作者： HE Yun HE Jing XU Xiangru LI Haixiao SHI Rongwei LIANG Junya ZHOU ying ZHU Yao CHEN Xiaohu TANG Shuhua XIAO Min ZHAN Libin PEI yinghao JIANG Weimin Department of General Internal Medicine Jiangsu Province Hospital of Chinese Medicine Affiliated to Hospital of Nanjing University of Traditional Chinese MedicineNanjing 210029China Department of Hepatology Jiangsu Province Hospital of Chinese Medicine Affiliated to Hospital of Nanjing University of Traditional Chinese MedicineNanjing 210029China Department of Emergency Longhua Hospital affiliated to Shanghai University of Traditional Chinese MedicineShanghai 200032China Department of Institute of Hypertension Jiangsu Province Hospital of Chinese Medicine Affiliated to Hospital of Nanjing University of Traditional Chinese MedicineNanjing 210029China Department of Cardiology Jiangsu Province Hospital of Chinese Medicine Affiliated to Hospital of Nanjing University of Traditional Chinese MedicineNanjing 210029China Department of Cardiology Dongzhimen Hospital Affiliated to Beijing University of Chinese MedicineBeijing 100700China School of Traditional Chinese Medicine&School of Integrated Chinese and Western Medicine Nanjing University of Chinese MedicineNanjing 210023China Department of Intensive Care Unit Jiangsu Province Hospital of Chinese Medicine Affiliated to Hospital of Nanjing University of Traditional Chinese MedicineNanjing 210029China

OBJECTIVE:To reach consensus on the diagnostic criteria for yin deficiency syndrome in hypertension(YDSH)patients by a modified Delphi method.METHODS:Our study was consistent with T/CACM 1032-2017.The methodology of RAND/UCLA appropriateness was used to develop consensus guidance statements.A nationwide panel of experienced clinical experts from 19 provinces was constructed.These experts were all prominent in Traditional Chinese Medicine(TCM)of cardiovascular diseases.This consensus process consisted of two rounds of questionnaires and a final round of consultation to analyze the weight score of each item.Moreover,the data extraction process is carried out independently by third-party researchers(LIANG Junya,SUN Yang,and DU Xiaona).When there is disagreement in all three rounds,the expert panel group(odd number)are invited to vote,and the one with more votes wins.In the questionnaires,participants were asked to rate the appropriateness of each syndrome item using a nine-point Likert scale.The consensus was defined as a panel median rating 1-3 or 7-9 without disagreement.And then the diagnostic criteria of YDSH were formed according to the weight score in the final round.RESULTS:Twenty-eight experts(84.8%)participated in the first round,and thirty-one(93.9%)finished the second round.After two rounds,the consensus of YDSH was reached on 11 items(25.6%),including symptoms,signs,and pulse condition.Twenty-one experts(63.6%)completed the final round in which they used a grading system for each item.Red tongue with scanty fur had the highest weighting(22.8%),followed by heat in the palms and soles(20.1%).CONCLUSIONS:The consensus-based diagnostic criteria for YDSH,formed by a modified Delphi method,can be widely incorporated in TCM.A further clinical study will be conducted to analyze the diagnosis value and cut-off score of our YDSH criteria.

关键词： yin deficiency syndrome hypertension consensus Delphi technique weight score

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Liver metabolomic characteristics in three different rat models of yin deficiency based on ultra-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry

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Journal of Traditional Chinese Medicine 2023年第2期43卷 274-285页

作者： HU Xingyao LIU Hongning YAN Xiaojun CHEN Zhong FU Liu LIU Ge CHEN Xuan SHANG Guangbin Jiangxi University of Chinese Medicine Research Center for Differention and Development of Traditional Chinese Medicine(TCM)Basic Theory Jiangxi Province Key Laboratory of TCM EtiopathogenisisNanchang 330004China

OBJECTIVE:To investigate the mechanism of yin deficiency syndrome(YDS) by analyzing the liver metabolomic characteristics of three different yin deficiency rat models METHODS:Following the TCM etiology,for clinical features and pathological manifestations of modern medicine,three kinds of animal models of yin deficiency were induced and replicated.Totally 48 Sprague-Dawley(SD) male rats were randomly divided into blank group,irritation induced model group,Fuzi-Ganjiang induced model group,and thyroxine-reserpine induced model group.After successful development of model,the ultraperformance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry was carried out to detect metabolites in each group.The metabolites of rat liver were analyzed for the characteristics of their biomarkers.The pathway enrichment analysis and metabolic network construction were performed through various online databases including Metabolite Biology Role,Human Metabolome Database,MetaboAnalyst,and Kyoto Encyclopedia of Genes and Genomes.RESULTS:The SD rats in the experimental group showed symptoms like less weight gain,reduced diet and water intake,high body temperature,increased liver and kidney indexes,and abnormal liver and kidney tissue morphology.Moreover,the rats showed high increased levels of serum cyclic adenosine monophosphate,estradiol,alanine transaminase,and aspartate aminotransferase and decreased levels of cyclic guanosinc monophosphate and testosterone.We found four key interrelated metabolic pathways in the liver tissue metabolomics,including the biosynthesis of pantothenic acid and coenzyme A,and metabolism of alpha-linolenic acid metabolism,glycerophospholipid metabolism,and sphingolipid.CONCLUSION:The liver and kidney YDS is closely related to the biosynthesis of pantothenic acid and CoA and abnormal metabolism of α-linolenic acid,glycerophospholipid,and sphingolipid in SD rats.

关键词： molecular biology integrative medicine yin deficiency syndrome syndrome complex

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