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1.湖南中医药大学,长沙 410208
2.湖南中医药大学 第一附属医院,长沙 410007
李兰心,在读硕士,从事心血管疾病的临床与科研工作,E-mail:522537172@qq.com
陈新宇,博士,主任医师,从事心血管疾病的临床与科研工作,E-mail:cxysmyx@163.com
收稿日期:2020-10-09,
网络出版日期:2020-12-08,
纸质出版日期:2021-05-05
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李兰心,陈新宇,蔡虎志.温胆汤合血压平方加减治疗中青年高血压痰湿壅盛证的临床观察[J].中国实验方剂学杂志,2021,27(09):106-111.
LI Lan-xin,CHEN Xin-yu,CAI Hu-zhi.Clinical Efficacy of Midified Wendantang and Xueyaping Recipe in Middle Aged and Young People with Hypertension and Phlegm Dampness Retention[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(09):106-111.
李兰心,陈新宇,蔡虎志.温胆汤合血压平方加减治疗中青年高血压痰湿壅盛证的临床观察[J].中国实验方剂学杂志,2021,27(09):106-111. DOI: 10.13422/j.cnki.syfjx.20210233.
LI Lan-xin,CHEN Xin-yu,CAI Hu-zhi.Clinical Efficacy of Midified Wendantang and Xueyaping Recipe in Middle Aged and Young People with Hypertension and Phlegm Dampness Retention[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(09):106-111. DOI: 10.13422/j.cnki.syfjx.20210233.
目的
2
探讨温胆汤合血压平方加减治疗中青年高血压痰湿壅盛证的临床疗效及对代谢情况的影响。
方法
2
随机将120例患者按数字表法分为对照组和观察组。两组均口服富马酸比索洛尔片,5~10 mg/次,1次/d。对照组口服半夏天麻丸,6 g/次,2次/d;观察组给予温胆汤合血压平方加减内服,1剂/d。两组疗程均12周。进行家庭血压监测,记录治疗后血压达标情况;进行治疗前后动态血压监测,记录24 h平均舒张压(24 h DBP),24 h平均收缩压(24 h SBP),24 h 平均脉压(24 h PP)和血压变异性(BPV)指标[24 h收缩压标准差(24 h SSD),24 h舒张压标准差(24 h DSD),收缩压变异系数(nSCV),舒张压变异系数(nDCV),比较夜间系数];进行治疗前后痰湿壅盛证评分、体质量指数(BMI)和腰臀比(WHR)评价;检测治疗前后高密度脂蛋白胆固醇(HDL-C),尿酸(UA),总胆固醇(TC),空腹血糖(FBG),低密度脂蛋白胆固醇(LDL-C),甘油三酯(TG)和空腹胰岛素(FINS),并计算胰岛素抵抗指数(HOMA-IR);检测治疗前后同型半胱氨酸(Hcy),胱抑素C(CysC),血管紧张素Ⅱ(AngⅡ)和核转录因子-
κ
B(NF-
κ
B)水平。
结果
2
观察组血压达标率为94.74%(54/57),高于对照组的达标率为80.70%(46/57)(
χ
2
=5.211,
P
<
0.05);观察组24 h SBP,24 h DBP,24 h PP,24 h SSD,24 h DSD,nSCV,nDCV均低于对照组(
P
<
0.01);观察组痰湿壅盛证积分低于对照组(
P
<
0.01);观察组UA,TC,TG,LDL-C和HOMA-IR均低于对照组(
P
<
0.05),HDL-C高于对照组(
P
<
0.05);观察组Hcy,CysC,AngⅡ和NF-
κ
B水平均低于对照组(
P
<
0.01)。
结论
2
在西药干预的基础上,内服温胆汤合血压平方加减治疗中青年高血压痰湿壅盛证患者可进一步控制血压水平,提高了血压的达标率,稳定了血压,并减轻痰湿壅盛证症状,改善代谢情况和BPV,抑制炎症因子,从而降低了ASCVD的危险因素。
Objective
2
To discuss the clinical efficacy of modified Wendantang combined with Xueyaping recipe in the middle aged and young people with hypertension and syndrome of phlegm dampness accumulation, and investigate its effect on metabolism.
Method
2
One hundred and twenty patients were divided into control group and observation group averagely. Patients in both groups got lifestyle intervention and bisoprolol maleate tablets, 5-10 mg/time, 1 time/day. Patients in observation group additionally took modified Wendantang combined with Xueyaping recipe, 1 dose/day. Patients in control group addiiotnally got placebo granules Banxia Tianma Wan, 6 g/time, 2 times/day. The treatment was continued for 12 weeks in both groups. Blood pressure was measured at home to measure the compliance rate of blood pressure during the treatment and after the treatment. Before and after treatment, 24 h mean systolic blood pressure (24 h SBP), 24 h mean pulse pressure (24 h PP), 24 h mean diastolic blood pressure (24 h DBP), blood pressure variability (BPV) [24 h systolic blood pressure standard deviation (24 h SSD), 24 h diastolic blood pressure standard deviation (24 h DSD), systolic blood pressure variation coefficient (nSCV), and diastolic blood pressure variation coefficient (nDCV) were recorded,compare night coefficients]. Scores of syndrome of phlegm dampness accumulation, body mass index (BMI) and waist hip ratio (WHR) were evaluated. Levels of uric acid (UA), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterin (HDL-C), low-density lipoprotein cholesterin (LDL-C), fasting blood glucose (FBG) and fasting insulin (FINS), insulin resistance index (HOMA-IR), homocysteine (Hcy), Cystatin C (CysC), angiotensin Ⅱ (Ang Ⅱ) and nuclear factor kappa B (NF-
κ
B) were measured. In addition, the safety was evaluated.
Result
2
Compliance rate of blood pressure in observation group was 94.74%(54/57), higher than 80.70% (46/57) in control group (
χ
2
=5.211,
P
<
0.05). Levels of 4 h SBP, 24 h DBP, 24 h PP, 24 h SSD, 24 h DSD, nSCV, nDCV, Hcy, CysC, AngⅡ, and NF-
κ
B in observation group were all lower than those detected from control group (
P
<
0.01). Score of syndrome of phlegm dampness accumulation was lower than that in control group (
P
<
0.01). Levels of UA, TC, TG, LDL-C and HOMA-IR were lower than those in control group (
P
<
0.05), while level of HDL-C was higher than that detected from control group (
P
<
0.05).
Conclusion
2
Based on lifestyle and western medicine intervention, Wendantang combined with Xueyaping recipe can further control the blood pressure level, reduce the symptoms of phlegm dampness retention syndrome, improve blood pressure variability, improve the compliance rate of blood pressure, improve the metabolism of patients and reduce the risk factors of ASCVD in middle aged and young people with hypertension.
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