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华中科技大学 同济医学院 附属武汉市中心医院,武汉 430014
陈厚斌,主治医生,从事肾内科及中西医结合临床工作,E-mail:1418452286@qq.com
郑宇明,副主任医师,从事肾内科临床工作,E-mail::2811590703@qq.com
收稿日期:2019-03-20,
网络出版日期:2019-05-09,
纸质出版日期:2019-10-05
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陈厚斌, 郑宇明, 喻佛定. 防己黄芪汤加味治疗高血压早期肾损害气虚湿阻证的临床疗效[J]. 中国实验方剂学杂志, 2019,25(19):68-73.
Hou-bin CHEN, Yu-ming ZHEN, Fo-ding YU. Clinical Efficacy of Modified Fangji Huangqitang on Early Renal Damage with Qi Deficiency and Dampness Obstruction Syndrome in Hypertension[J]. Chinese journal of experimental traditional medical formulae, 2019, 25(19): 68-73.
陈厚斌, 郑宇明, 喻佛定. 防己黄芪汤加味治疗高血压早期肾损害气虚湿阻证的临床疗效[J]. 中国实验方剂学杂志, 2019,25(19):68-73. DOI: 10.13422/j.cnki.syfjx.20191631.
Hou-bin CHEN, Yu-ming ZHEN, Fo-ding YU. Clinical Efficacy of Modified Fangji Huangqitang on Early Renal Damage with Qi Deficiency and Dampness Obstruction Syndrome in Hypertension[J]. Chinese journal of experimental traditional medical formulae, 2019, 25(19): 68-73. DOI: 10.13422/j.cnki.syfjx.20191631.
目的:
2
观察防己黄芪汤加味治疗高血压早期肾损害(气虚湿阻证)的疗效及抗炎和血管内皮保护功能。
方法:
2
将144例患者随机按数字表法分为观察组和对照组。对照组口服氯沙坦钾片,50 mg/次,1次/d;和硝苯地平控释片,30 mg/次,1次/d;并调整生活方式。观察组在对照组治疗的基础上,内服防己黄芪汤加味,1剂/d。每周测量血压,记录血压达标情况,进行治疗前后动态血压检测,记录24 h收缩压标准差(24 hSSD),24 h舒张压标准差(24 hDSD),24 h平均收缩压(24 hSBP),24 h平均舒张压(24 hDBP),计算动态脉压指数(PPI)和动态动脉硬化指数(AASI),检测治疗前后尿
β
2
微球蛋白(
β
2
-MG),尿
N
-乙酰-
β
-氨基葡萄糖苷酶(NAG),血胱抑素C(CysC),尿微量白蛋白(UmALB),计算UmALB与肌酐(Cr)比值(UACR);进行治疗前后症状、体征评分;检测治疗前后白细胞介素-6(IL-6),IL-1
β
,肿瘤坏死因子-
α
(TNF-
α
),一氧化氮(NO)和内皮素-1(ET-1)水平。
结果:
2
在12周的观察期间,观察组偶测血压达标率为89.09%,高于对照组的81.52%(
χ
2
=18.776,
P
<
0.01);治疗后观察组24 hSBP,24 hDBP,24 hSSD,24 hDSD水平均低于对照组(
P
<
0.01);观察组PPI和AASI均低于对照组(
P
<
0.05);观察组
β
2
-MG,CysC,NAG,UmALB和UACR水平均低于对照组(
P
<
0.01);观察组血清IL-6,IL-1
β
和TNF-
α
水平均低于对照组(
P
<
0.01);观察组血清NO水平高于对照组,ET-1水平低于对照组(
P
<
0.01);经秩和检验,观察组中医证候疗效优于对照组(
Z
=2.146,
P
<
0.05)。
结论:
2
在西医治疗的基础上,采用防己黄芪汤加味内服治疗高血压早期肾损害(气虚湿阻证)患者,可起到控制血压水平,提高血压达标率,降低血压变异性,保护肾功能、减轻临床症状,提高临床疗效的效果,还具有抑制炎症反应和改善血管内皮功能的作用。
Objective:
2
To observe the efficacy of modified Fangji Huangqitang on early renal damage in hypertension (Qi deficiency and dampness obstruction syndrome) and its effect in resisting inflammation and protecting vascular endothelium.
Method:
2
One hundred and forty-four patients were randomly divided into control group and observation group by random number table. Patients in control group got losartan potassium tablets
50 mg/time
1 time/day
and nifedipine controlled-release tablets
30 mg/time
1 time/day. In addition to the therapy of control group
patients in observation group were alsog given modified Fangji Huangqitang
1 dose/day. The qualification rate of blood pressure was recorded for every week
and ambulatory blood pressure was detected before and after treatment. Standard deviation of systolic blood pressure for 24 h (24 hSSD)
standard deviation of diastolic pressure for 24 h (24 hDSD)
mean systolic blood pressure for 24 h (24 hSBP)
average diastolic pressure for 24 h (24 hDBP) were recorded
and dynamic pulse pressure index (PPI)
dynamic arteriosclerosis index (AASI)
and ratio of UmALB and creatinine (CR) were calculated
levels of beta 2 microglobulin (
β
2
-MG)
urinary
N
-acetyl-beta-glucosaminidase (NAG)
serum cystatin C (CysC)
urinary microalbumin (UmALB)
interleukin-6 (IL-6)
interleukin-1
β
(IL-1
β
)
tumor necrosis factor-
α
(TNF-
α
)
nitric oxide (NO)
endothelin-1 (ET-1) were detected
and symptoms and signs were scored.
Result:
2
During the 12-week observation period
the qualification rate of blood pressure in observation group was 89.09%
which was higher than 81.52%in control group (
χ
2
=18.776
P
<
0.01). Levels of 24 hSBP
24 hDBP
24 hSSD
24 h DSD
PPI
AASI
β
2
-MG
CysC
NAG
UmALB
UACR
IL-6
IL-1
β
TNF-
α
and ET-1 were lower than those in control group (
P
<
0.01)
while level of NO was higher than that in control group (
P
<
0.01). And by rank sum test
the clinical efficacy in observation group was better than that in control group (
Z
=2.146
P
<
0.05).
Conclusion:
2
In addition of the western medicine therapy
modified Fangji Huangqitang can be added to control blood pressure level
improve blood pressure compliance rate
reduce blood pressure variability
protect renal function
prevent and relieve clinical symptoms
improve the clinical efficacy
inhibit inflammatory reaction and improve endothelial function.
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