摘要
目的观察平肝熄风汤治疗肝肾阴虚型妊娠期高血压(HDP)的临床疗效。方法选取2021年1月至2023年12月收治的136例肝肾阴虚型HDP患者为研究对象,按照随机数字表法分为对照组和治疗组,每组68例。2组均予常规基础治疗,对照组予拉贝洛尔治疗,治疗组在对照组基础上予平肝熄风汤治疗。2组均治疗7 d后统计疗效,比较2组治疗前后中医证候评分(包括手足心热、口干便结、视物模糊、舌红苔少、脉弦细数)、24 h动态血压(包括24 h平均收缩压和24 h平均舒张压)、血流动力学指标[包括阻力指数(RI)、搏动指数(PI)、收缩期和舒张末期最大血流速度的比值(S/D)]、血液指标[包括胰岛素样生长因子1(IGF-1)、可溶性凝集素样氧化型低密度脂蛋白受体-1(sLOX-1)、热休克蛋白70(HSP70)、可溶性晚期糖基化终末产物受体(sRAGE)及血液黏度]水平变化情况,比较2组治疗期间不良反应发生情况,比较2组最终妊娠结局情况。结果与本组治疗前比较,2组治疗后中医证候手足心热、视物模糊、口干便结、脉弦细数、舌红苔少评分均降低(P<0.05),且治疗组治疗后中医证候各项评分均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后24 h平均收缩压、24 h平均舒张压水平均降低(P<0.05),且治疗组治疗后24 h平均收缩压、24 h平均舒张压水平均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后血流动力学指标RI、PI、S/D水平均降低(P<0.05),且治疗组治疗后RI、PI、S/D水平均/低于对照组(P<0.05)。与本组治疗前比较,2组治疗后血液指标IGF-1、sRAGE水平均升高(P<0.05),HSP70、sLOX-1及血液黏度水平均降低,且治疗组治疗后IGF-1、sRAGE水平均高于对照组(P<0.05),HSP70、sLOX-1及血液黏度水平均低于对照组(P<0.05)。治疗组不良反应总发生率27.94%(19/68),对照组不良反应总发生率14.71(10/68),2组不良反应总发生率比较差异无统计学意义(P>0.05)。治疗组早产、剖宫产及宫内窘迫的发生率分别为5.88%(4/68)、27.94%(19/68)、5.88%(4/68),对照组早产、剖宫产及宫内窘迫的发生率分别为22.06%(15/68)、45.59%(31/68)、17.65%(12/68),治疗组早产率、剖宫产率、宫内窘迫率均低于对照组(P<0.05)。结论平肝熄风汤可有效缓解肝肾阴虚型HDP患者临床症状,调节患者血清IGF-1、HSP70、sLOX-1、sRAGE水平,降低患者血压及血液黏度,进一步改善患者子宫动脉血流动力学,进而改善妊娠结局,且安全性良好。
Objective To evaluate the clinical efficacy of Pinggan Xifeng Decoction in patients with hypertensive disorders of pregnancy(HDP)exhibiting a liver and kidney yin deficiency pattern.Methods A total of 136 patients with liver and kidney yin deficiency type HDP treated between January 2021 and December 2023 were randomized by random number table into a control group and a treatment group,with 68 patients in each group.Both groups received routine baseline therapy.The control group was treated with labetalol.The treatment group received Pinggan Xifeng Decoction in addition to the control regimen.After seven days of therapy,outcomes were assessed.Measured outcomes included traditional Chinese medicine(TCM)syndrome scores for heat in the palms and soles,dry mouth with constipation,blurred vision,red tongue with scant coating,and a wiry,thin and rapid pulse;24 hour ambulatory blood pressure including mean systolic and mean diastolic pressure;uterine artery hemodynamic indices including resistive index(RI),pulsatility index(PI)and the systolic to end diastolic velocity ratio(S/D);serum biomarkers including insulin like growth factor 1(IGF-1),soluble lectin like oxidized low density lipoprotein receptor 1(sLOX-1),heat shock protein 70(HSP70),soluble receptor for advanced glycation end products(sRAGE)and whole blood viscosity(WBV);adverse reactions during treatment;and final pregnancy outcomes.Results Both groups experienced significant improvement from baseline in TCM symptom scores after treatment(P<0.05).Post treatment syndrome scores were lower in the treatment group than in the control group(P<0.05).Twenty 24 hour mean systolic and mean diastolic pressures decreased significantly in both groups after treatment(P<0.05),with greater reductions in the treatment group compared with the control group(P<0.05).Uterine artery hemodynamic indices RI,PI and S/D declined in both groups after treatment(P<0.05),and the treatment group showed larger decreases than the control group(P<0.05).Serum IGF-1 and sRAGE increased in both groups after treatment(P<0.05),while HSP70,sLOX-1 and blood viscosity decreased(P<0.05).Improvements in IGF-1 and sRAGE were greater in the treatment group,and reductions in HSP70,sLOX-1 and WBV were greater in the treatment group compared with the control group(P<0.05).The overall incidence of adverse reactions in the treatment group was comparable to the control group(27.94%[19/68]vs 14.71%[10/68],P>0.05).The treatment group had significantly lower rates of preterm birth,cesarean section and fetal distress than the control group(5.88%[4/68]vs 22.06%[15/68],27.94%[19/68]vs 45.59%[31/68],5.88%[4/68]vs 17.65%[12/68],respectively,P<0.05).Conclusion Pinggan Xifeng Decoction added to conventional therapy effectively alleviates symptoms in patients with HDP of liver and kidney yin deficiency type,favorably modulates serum IGF-1,HSP70,sLOX-1 and sRAGE,lowers blood pressure and blood viscosity,improves uterine artery hemodynamics and pregnancy outcomes,and demonstrates good safety.
作者
郑稳
薛晓丹
万瑞
苏晓晓
ZHENG Wen;XUE Xiaodan;WAN Rui;SU Xiaoxiao(Department of Obstetrics and Gynecology,Yellow River Sanmenxia Hospital,Sanmenxia,Henan 472000)
出处
《河北中医》
2026年第4期555-559,共5页
Hebei Journal of Traditional Chinese Medicine
关键词
妊娠期高血压
肝肾阴虚型
中药疗法
平肝熄风汤
Hypertensive disorders of pregnancy
Liver and kidney yin deficiency type
Chinese medicine therapy
Pinggan Xifeng Decoction
