益气活血方联合依那普利对老年原发性高血压血管内皮功能的影响  

Effect of Yiqi Huoxue Recipe Combined with Enalapril on Vascular Endothelial Function in Elderly Patients with Essential Hypertension

作　　者：杨晓萍 张冯佐[1] 黄燕莉 盖云[1] 张翼 何立群[3] YANG Xiaoping;ZHANG Fengzuo;HUANG Yanli;GAI Yun;ZHANG Yi;HE Liqun(Department of Traditional Medicine,Seventh People′s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China;Department of Traditional Chinese Medicine,Tongren Hospital,Shanghai 200050,China;Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China)

机构地区：[1]上海中医药大学附属第七人民医院传统医学科,上海200137 [2]上海市同仁医院中医科,上海200050 [3]上海中医药大学附属曙光医院,上海200021

出　　处：《世界中医药》2023年第6期828-833,共6页World Chinese Medicine

基　　金：国家自然科学基金项目(81373615);海上名医传承模式研究及名方的临床应用项目(2020LP016);浦东新区卫生系统重点专科建设项目(PWZzK2017-01)。

摘　　要：目的:观察益气活血方联合依那普利对老年原发性高血压患者血管内皮功能的影响。方法:选取2017年10月至2020年12月上海市第七人民医院收治的老年Ⅰ级原发性高血压患者120例作为研究对象,按照随机数字表法随机分为中药组、中西医结合组和西药组,每组40例。所有患者均给予饮食、运动和基础治疗(降压、降脂及抗血小板),中药组口服益气活血方,西药组口服依那普利,中西医结合组采用联合治疗,疗程12周,观察3组患者内皮素-1(ET-1)、血管紧张素(Ang)Ⅱ,白细胞介素-6(IL-6)、C反应蛋白(CRP),组织纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制剂及血流介导血管舒张功能(FMD)水平。结果:中西医结合组、中药组和西药组的血压疗效分别是95%、92.5%、90%,组间比较差异无统计学意义(P>0.05)。3组的中医证候有效率分别是87.5%、75%和62.5%,中西医结合组优于西药组(Z=6.667,P=0.010)。治疗后,中西医结合组下调ET-1、IL-6、CRP和PAI-1水平与改善FMD优于中药组(P<0.05);下调AngⅡ及CRP水平,优于西药组(P<0.05)。结论:益气活血方联合依那普利,能显著改善老年高血压患者的血管内皮功能,其作用机制可能与下调ET-1、AngⅡ、IL-6、CRP及PAI-1,升高t-PA、FMD有关,值得在老年高血压患者中推广运用。Objective:To observe the effect of Yiqi Huoxue Recipe(YQHX)combined with enalapril on vascular endothelial function in elderly patients with essential hypertension.Methods:A total of 120 elderly patients with gradeⅠessential hypertension who were admitted to Shanghai Seventh People′s Hospital from October 2017 to December 2020 were selected and randomly assigned into a Chinese medicine group(YQHX),an integrated Chinese and western group(YQHX+enalapril),and a western medicine group(enalapril)(n=40)according to the random number table method.All the patients received diet,exercise,and basic therapy(blood pressure-lowering,lipid-lowering,and antiplatelet therapy).Each course of the treatment was 12 weeks.The levels of endothelin-1(ET-1),angiotensinⅡ(AngⅡ),interleukin-6(IL-6),C-reactive protein(CRP),tissue-type plasminogen activator(t-PA),plasminogen activator inhibitor-1(PAI-1),and flow-mediated dilation(FMD)were compared among the three groups.Results:The therapeutic effects on blood pressure of the integrated Chinese and western medicine group,the Chinese medicine group,and the western medicine group were 95%,92.5%,and 90%,respectively,which showed no statistical significance between each other(P>0.05).The effective rates for TCM syndromes in the three groups were 87.5%,75%,and 62.5%,respectively,and the integrated group outperformed the western medicine group(Z=6.667,P=0.010).The integrated group outperformed the Chinese medicine group in the down-regulation of ET-1,IL-6,CRP,and PAI-1 and the improvement of FMD(P<0.05),and it was superior to the western medicine group in the down-regulation of AngⅡand CRP(P<0.05).Conclusion:YQHX combined with enalapril can improve the vascular endothelial function in elderly hypertensive patients by down-regulating the expression of ET-1,AngⅡ,IL-6,CRP,and PAI-1,up-regulating the expression of t-PA,and increasing FMD.Therefore,this therapy is worth popularizing in elderly hypertensive patients.

关 键 词：益气活血方 依那普利 原发性高血压 阴阳两虚证 血管内皮功能 血流介导血管舒张功能 血管内皮素-1 白细胞介素-6 

分 类 号：R259[医药卫生—中西医结合]