摘要
目的 观察清眩降压汤对原发性高血压（PH）患者临床疗效及肾素-血管紧张素-醛固酮系统（RAAS）的影响.方法 采用前瞻性研究方法,选择2016月4月至2017年3月武汉市第三医院光谷院区收治的确诊为PHⅠ-Ⅱ级的178例患者,按服药方法不同将患者分为对照组和观察组,每组89例.对照组口服苯磺酸氨氯地平5 mg、每日1次;观察组在对照组基础上加用清眩降压汤（天麻20 g、钩藤20 g、川芎15 g、丹参10 g、葛根20 g、麦冬20 g、枸杞子25 g、菊花10 g、伏神15 g、茯苓10 g、甘草5 g）,每日1剂（400 mL）,早晚饭后分服;两组均连续服用4周.观察两组动态血压变化情况和血浆肾素、醛固酮（ALD）、血管紧张素Ⅱ（AngⅡ）水平,通过测定肝、肾功能的变化评估用药安全性.结果 两组治疗后白天收缩压（D-SBP）和舒张压（D-DBP）、夜间SBP（N-SBP）和DBP（N-DBP）、24 h平均SBP（24 h-SBP）和平均DBP（24 h-DBP）均较治疗前降低,且观察组治疗后D-DBP、N-SBP、24 h-DBP均明显低于对照组〔D-DBP（mmHg,1 mmHg=0.133 kPa）：78.24±5.35比81.56±6.23,N-SBP（mmHg）：117.35±5.42比122.63±7.23,24 h-DBP（mmHg）：74.15±5.26比80.51±6.52,均P〈0.05〕;两组治疗后肾素、ALD、AngⅡ水平也均较治疗前降低,且以观察组治疗后的降低程度较对照组更显著〔肾素（ng/L）：5.46±0.41比7.82±0.36,ALD（ng/L）：128.48±31.42比168.48±28.32,AngⅡ（ng/L）：52.35±14.27比75.38±15.65,均P〈0.05〕;两组治疗前后丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、尿素（Urea）和肌酐（Cr）水平均无明显变化,说明药物安全性好.结论 清眩降压汤能安全有效地降低PH患者血压水平,其作用机制可能与影响RAAS有关.
Objective To observe the clinical therapeutic effect of Qingxuan Jiangya decoction on patients with primary hypertension （PH） and its influence on their rennin-angiotensin-aldosterone system （RAAS）. Methods A prospective study was conducted, including 178 patients with definite diagnosis of PH （Ⅰ-Ⅱ grade） who came from Guanggu district to the third Hospital of Wuhan City from April 2016 to March 2017, and they were divided into a control group and an observation group according to the method of taking medicine, each group 89 cases. The control group received 5 mg amlodipine besylate, orally once a day; the observation group on the basis of treatment in the control group, the Qingxuan Jiangya decoction （gastrodia rhizome 20 g, uncaria 20 g, ligusticum rhizome 15 g, salviae miltiorrhizae 10 g, puerarin 20 g, radix ophiopogonis 20 g, fructus lycii 25 g, chrysanthemum 10 g, root poria 15 g, poria cocos 10 g, radix glycyrrhizae 5 g） was added, a dose （400 mL） divided into two parts, one part taken twice daily, in the morning and in the evening after meals; the two groups took the treatment continuously for 4 weeks. The blood pressure dynamic changes and plasma levels of renin, angiotensin Ⅱ （Ang Ⅱ）, aldosterone （ALD） and clinical efficacy were observed, and the safety of the drugs was evaluated by measuring the changes of liver and kidney functions. Results After treatment in the two groups, the daytime systolic pressure （D-SBP） and diastolic pressure （D-DBP） and nighttime SBP （N-SBP） and DBP （N-DBP）, the mean of 24 hours-SBP and 24 hours-DBP were all lower than those before treatment, and the D-DBP, N-SBP and 24 hours-DBP of the observation group were significantly lower than those of control group [D-DBP （mmHg, 1 mmHg = 0.133 kPa）： 78.24±5.35 vs. 81.56±6.23, N-SBP （mmHg）：117.35±5.42 vs. 122.63±7.23, 24 hours-DBP （mmHg）： 74.15±5.26 vs. 80.51±6.52, all P 〈 0.05]; after treatment, the levels of renin, Ang Ⅱ and ALD in two groups were also declined, and the degrees of decrease in the observation group were more significant than those in the control group [renin （ng/L）： 5.46±0.41 vs. 7.82±0.36, ALD （ng/L）：128.48±31.42 vs. 168.48±28.32, Ang Ⅱ （ng/L）： 52.35±14.27 vs. 75.38±15.65, all P〈 0.05]; there were no significant changes in the levels of alanine aminotransferase （ALT）, aspartate transaminase （AST）, urea and creatinine （Cr） before and after treatment in the two groups, showing that the treatment was safe. Conclusion Qingxuan Jiangya decoction can effectively and safely reduce the blood pressure in PH patients, and its mechanism is possibly related to its influence on RAAS.
作者
徐莉
王唯
李希辉
孙建斌
Xu Li Wang Wei Li Xihui Sun Jianbin(Department of Laboratory, Guanggu District, the Third Hospital of Wuhan City, 430000 Wuhan, Hubei, China Department of Nuclear Medicine, Hubei Provincial Tumor Hospital, Wuhan 430000, Hubei, China Department of Laboratory, the Third Hospital of Wuhan City, Wuhan 430000, Hubei, China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2017年第5期532-535,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
