贯煎方治疗阴虚阳亢型难治性高血压临床疗效观察  

Clinical observation on the clinical curative of Guanjian Decoction on refractory hypertension with syndrome of Yin deficiency and Yang hyperactivity

作　　者：刘安平[1,2] 刘吉善[1] 黄斌[1] 范海斌[1] 徐鹏[1] 张春霞[2] 刘祥树[3] 王熙 陈刚 LIU Anping;LIU Jishan;Huang Bin;FAN Haibin;XU Peng;ZHANG Chunxia;LIU Xiangshu;WANG Xi;CHEN Gang(Shiyan Hospital of Traditional Chinese Medicine, Shiyan 442012, Hubei, China;Hubei University of Traditional Chinese Medicine, Wuhan 430065, Hubei, China;Dongfeng General Hospital, Shiyan 442000, Hubei, China;Taihe Hospital, Shiyan 442000, Hubei, China;Hubei College of Traditional Chinese Medicine, Jingzhou 434020, Hubei, China)

机构地区：[1]湖北省十堰市中医医院,湖北十堰442012 [2]湖北中医药大学,湖北武汉430065 [3]东风公司总医院,湖北十堰442000 [4]湖北省十堰市太和医院(湖北医药学院附属医院),湖北十堰442000 [5]湖北中医药高等专科学校,湖北荆州434020

出　　处：《现代中西医结合杂志》2020年第32期3541-3545,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：国家自然科学基金资助项目(81373704);湖北省卫生计生委中医药中西医结合科研项目(LY2017-19);全国名老中医药专家传承工作室建设项目(国中医药人教函〔2012〕149号);十堰市科学技术研究与开发项目(16Y79)。

摘　　要：目的探讨贯煎方配合西药常规疗法治疗阴虚阳亢型难治性高血压的临床疗效及可能作用机制。方法选择2015年12月—2018年6月在湖北省十堰市中医医院刘吉善专家门诊就诊的阴虚阳亢型难治性高血压患者160例,采用前瞻性、自身对照研究方法进行观察,研究过程中原用西药降压药不变。安慰剂对照阶段:以1∶1比例将患者随机分为贯煎方组和安慰剂组,观察2组治疗1周的血压变化。自身对照阶段:安慰剂组患者治疗1周后改服贯煎方中药汤剂,与原贯煎方组一样均服用4周,观察中药治疗前后血压、症状、血浆内皮素-1(ET-1)和降钙素基因相关肽(CGRP)水平及其比值、血清胱抑素C(Cys C)和β2-微球蛋白(β2-MG)变化。结果治疗1周后,安慰剂组收缩压和舒张压均无明显变化(P均>0.05),而贯煎方组收缩压和舒张压均明显下降(P均<0.05)。自身对照阶段:中药治疗后收缩压和舒张压均显著下降(P均<0.05),收缩压平均降幅为41.3 mmHg(1 mmHg=0.133 kPa),舒张压平均降幅为18.78 mmHg;症状积分显著降低(P<0.05),症状显效率为75.6%(121/160);ET-1、Cys C、β2-MG水平及ET-1/CGRP均较治疗前显著下降(P均<0.05),CGRP较治疗前显著升高(P<0.05)。结论在西药常规治疗基础上,采用贯煎方内服治疗阴虚阳亢型难治性高血压能进一步降低患者血压,改善临床症状,并对肾脏功能具有一定的保护作用,机制可能与中药复方调节ET-1与CGRP水平,平衡二者对血管的舒缩作用有关。Objective It is to explore the clinical curative effect and possible mechanism of Gguanjian Decoction combined with normal therapy of western medicine in the treatment of refractory hypertension with syndrome Yin deficiency and yang hyperactivity.Methods 160 cases patients with refractory hypertension with syndrome Yin deficiency and yang hyperactivity who were treated at the outpatient clinic of professor LIU Jishan,Shiyan Hospital of Traditional Chinese Medicine from December 2015 to June 2018 were collected,they were observed by a adopt prospective,self-controlled research method,and their original western medicine antihypertensive drugs remain unchanged during the research process.Placebo-controlled stage:the patients were randomly divided into Guanjian decoction group and placebo group at a ratio of 1:1,and the blood pressure changes of the two groups were observed after treatment for 1 week.Self-control stage:the patients in the placebo group were switched to the traditional Chinese medicine Guanjian Decoction after 1 week of treatment,and they were treated for 4 weeks as the same as the original Guanjian Decoction group.The changes of blood pressure,symptoms,the levels of plasma endothelin-1(ET-1)and calcitonin gene-related peptide(CGRP)and their ratio,serum cystatin(Cys C)andβ2-microglobulin(β2-MG)before and after treatment with traditional Chinese medicine were observed.Results After 1 week of treatment,there was no significant change in systolic and diastolic blood pressure in the placebo group(both P>0.05),while the systolic and diastolic blood pressure in the Guanjian decoction group decreased significantly(both P<0.05).Self-control stage:after treatment with traditional Chinese medicine,both systolic and diastolic blood pressure decreased significantly(both P<0.05),the average decrease in systolic blood pressure was 41.3 mmHg,and the average decrease in diastolic blood pressure was 18.78 mmHg;the symptom score was significantly reduced(P<0.05),and the remarkable effective rate of symptoms was 75.6%

关 键 词：难治性高血压 贯煎方 内皮素-1 降钙素基因相关肽 胱抑素C Β2-微球蛋白 

分 类 号：R544.1[医药卫生—心血管疾病]