基于蒙定水教授“金水相生”法治疗老年高血压病的临床观察及作用机理探讨

发布时间：2018-06-11 18:17

本文选题：高血压 + 金水相生　；参考：《广州中医药大学》2016年博士论文

【摘要】：目的：笔者跟师蒙定水教授,第五批全国名老中医药专家学术经验继承指导教师,继承其治疗高血压病由补肾着手、以及运用六味地黄丸加减治疗高血压的经验基础上,以中医“金水相生”法为指导,通过肺肾同补,以补肺而达到补肾的目的,临床拟加味补肾化痰活血方治疗老年高血压,收效颇多,因此,拟通过临床观察,评价以“金水相生”法指导治疗高血压病的有效性,从而验证老中医的临床经验及发扬老中医的学术专长,这是临床观察的目的之一。1,25二羟基维生素D3(1,25(OH)2D3)与高血压病有一定的关联性,与动脉硬化的发生有密切的联系,动脉粥样硬化的发生,使得老年高血压患者更容易出现靶器官损害,从而心血管事件增加。1,25(OH)2D3缺乏,这也是老年人骨质疏松容易并发骨折的基础,而中医学则认为骨质疏松与肾主藏精,主骨生髓的生理作用有关,肾精充足,肾强则骨强,1,25(OH)2D3可通过促进小肠钙磷吸收,促进钙盐沉积这些机制,另外还可通过刺激成骨细胞分泌胶原蛋白,从而促进骨有机基质的成熟,有利于成骨,这与肾藏精,主骨生髓之作用不谋而合。同时,维生素D其主要来源,来自于机体皮肤,通过紫外线照射皮肤组织,合成维生素D3,再通过肾脏经1α-羟化酶催化合成活性代谢产物1,25(OH)2D3,而老年人群则可因日照不足,皮肤合成维生素D的能力也随之下降,这二点,与中医肺主皮毛切合,研究也表明,哮喘、慢性阻塞性肺疾病等一些呼吸系统的疾病,也与维生素D的缺乏相关,与1,25(OH)2D3水平下降相关,从1,25(OH)2D3这一生理学作用来看,与我们中医学的“金水相生”所涉及的肺、肾生理功能相对应,因此,选择将1,25(OH)2D3作为切入点,探讨“金水相生”法在高血压治疗中的作用机制,这也是我们临床观察的目的。方法：通过临床观察,观察60例老年高血压患者,随机数字表法随机分组,将60例观察对象分为治疗组及对照组。对照组30例,予以西医降压药物常规治疗；治疗组30例,在对照组西药治疗的基础上加用加味补肾化痰活血方治疗；治疗疗程4周。观察两组治疗对于老年高血压患者降压疗效、中医证候积分、颈动脉内中膜厚度、血压变异系数、尿微量白蛋白、β2微球蛋白、基质金属蛋白酶9(MMP-9)、血清1,25二羟基维生素D3(1,25-(OH)2D3)等指标的影响。结果：通过临床试验我们观察到,治疗组与西医对照组治疗后SBP和DBP水平比较,差异无统计学意义(P0.05)。提示两组患者降压临床疗效无差别;两组中医证候疗效比较,治疗组总有效率达90%,而对照组总有效率为66.7%,两组总有效率比较,差异有统计学意义(P0.05),治疗组在改善中医证候方面有显著效果。治疗后两组颈动脉内膜-中层厚度均较治疗前下降,差异具有统计学意义(P0.05)。治疗后,治疗组与对照组的颈动脉内膜-中层厚度比较,差异具有统计学意义(P0.05)。提示治疗组可有效减少颈动脉内膜-中层厚度。治疗后两组的SBPV和DBPV均有不同程度的下降,差异具有统计学意义(P0.05)。治疗后,治疗组的SBPV和DBPV明显低于对照组,差异具有统计学意义(P0.05)。提示治疗组可有效降低患者血压同时,能减少患者的血压变异。治疗后两组尿mALb、尿β2-MG水平均较治疗前减少：治疗后,治疗组的尿mALb、尿β2-MG水平低于对照组,差异具有统计学意义(P0.05)。提示治疗组可减少老年高血压患者尿mALb、尿β2-MG。治疗后治疗组与对照组血清1,25-(0H)2D3水平均较治疗前增加；治疗后,治疗组的血清1,25-(0H)2D3水平高于对照组,差异具有统计学意义(P0.05)。提示治疗组可有效提高老年高血压患者血清1,25-(0H)2D3水平。治疗后两组血清MMP-9水平均较治疗前下降；治疗后,治疗组的血清MMP-9水平明显低于对照组,差异具有统计学意义(P0.05)。提示治疗组可有效降低老年高血压患者MMP-9水平。结论：老年高血压患者,联合加味补肾化痰活血方治疗,虽然在降压效果上与单纯西医治疗差别不大,但联合中药治疗,能有效的改善患者临床症候,减少高血压患者尿微量白蛋白、β2微球蛋白渗出,减轻颈动脉内中膜厚度,有效改善动脉粥样硬化,减少血压变异,其作用机制,可能与提高血清1,25(OH)2D3的水平、以及降低MMP-9的活性相关。“金水相生”法治疗高血压,可有效提升1,25(OH)2D3水平,1,25(OH)2D3是否可作为评价“金水相生”这一经典中医治法的切入点,从而发挥到治疗其他疾病领域,需要更多的以及更深层次的研究。
[Abstract]:Objective: the author followed the Professor Meng Ding Shui and the fifth batch of academic experience of the experts of Chinese traditional Chinese medicine to inherit the instructors, inherit the experience of treating hypertension by kidney tonifying, and the experience of treating hypertension with the addition of six flavored Rehmannia pills in addition and subtraction of hypertension. Objective, the clinical application of reinforcing kidney and eliminating phlegm and activating blood circulation in the treatment of senile hypertension is quite effective. Therefore, the clinical observation is made to evaluate the effectiveness of "golden water phase" to guide the treatment of hypertension, thus to verify the clinical experience of the old Chinese medicine and to develop the academic expertise of the old Chinese medicine, which is one of the purpose of clinical observation.1,25 two hydroxy dimension. D3 (1,25 (OH) 2D3) is associated with hypertension and has a close relationship with the occurrence of arteriosclerosis. The occurrence of atherosclerosis makes the elderly hypertensive patients more prone to target organ damage, and the cardiovascular events increase.1,25 (OH) 2D3 deficiency, which is also the basis of osteoporotic fractures in the elderly. In medicine, it is believed that osteoporosis is related to the physiological function of the main bone of the kidney, the physiological function of the main bone marrow, the kidney essence and the strong bone. 1,25 (OH) 2D3 can promote calcium and phosphorus absorption and promote the deposition of these mechanisms. In addition, it can stimulate the secretion of collagen by stimulating the osteoblasts, thus promoting the maturation of the organic matrix of the bone, which is beneficial to the bone formation, which is beneficial to the kidney. In addition, the main source of vitamin D is from the body skin, the skin tissue, the skin tissue, the vitamin D3, and the synthesis of the active metabolite 1,25 (OH) 2D3 through the kidney through 1 alpha hydroxylase, and the aging population can be caused by the lack of sunshine and the ability to synthesize vitamin D in the skin. Down, these two points, in conjunction with the lung main fur of Chinese medicine, the study also shows that some respiratory diseases such as asthma and chronic obstructive pulmonary disease are related to the deficiency of vitamin D, related to the decline of 1,25 (OH) 2D3 level, and from the lifetime of 1,25 (OH) 2D3, the lung and kidney physiological work involved in the "golden water phase" of our Chinese Medicine As a result, 1,25 (OH) 2D3 is selected as the entry point to explore the mechanism of "golden water phase" in the treatment of hypertension. It is also the purpose of our clinical observation. Methods: through clinical observation, 60 elderly patients with hypertension were observed, and the random digital table method was divided into groups, and 60 cases were divided into treatment group and control group. In the control group, 30 cases were treated with western medicine, and 30 cases in the treatment group were treated with supplemented kidney and phlegm and Huoxue Decoction on the basis of the control group. The treatment course was 4 weeks. The curative effect of two groups of treatment for elderly hypertensive patients was observed, the TCM syndrome score, the thickness of the middle membrane in the carotid artery, the blood pressure variation coefficient, and the urine trace white were observed. The effect of protein, beta 2 microglobulin, matrix metalloproteinase 9 (MMP-9), serum 1,25 two hydroxyvitamin D3 (1,25- (OH) 2D3). Results: through clinical trials, we observed that there was no statistically significant difference between the treatment group and the western medicine control group after the treatment of SBP and DBP (P0.05). The results showed that the clinical efficacy of two groups of patients had no difference; two The total effective rate of the group of TCM syndrome was 90%, the total effective rate of the control group was 66.7%, the total effective rate of the control group was 66.7%, the difference between the two groups was statistically significant (P0.05). The treatment group had significant effect on the improvement of TCM syndrome. The thickness of the carotid intima middle layer in the two groups after treatment decreased compared with that before the treatment (P0.05). After treatment, the difference of carotid intima medium thickness between the treatment group and the control group was statistically significant (P0.05). It suggested that the treatment group could effectively reduce the thickness of the carotid artery intima medium layer. After treatment, the SBPV and DBPV of the two groups were decreased in varying degrees, and the difference was statistically significant (P0.05). After treatment, the SBPV and DBPV were significantly lower in the treatment group. In the control group, the difference was statistically significant (P0.05). It suggested that the treatment group could effectively reduce the blood pressure and reduce the variation of blood pressure in the patients. After treatment, the urine mALb and urinary beta 2-MG were lower than before the treatment. After treatment, the urine mALb and urinary beta 2-MG were lower than those in the control group (P0.05). The difference was statistically significant (P0.05). The group can reduce the urine mALb in the elderly patients with hypertension. The serum 1,25- (0H) 2D3 level of the treatment group and the control group increased after the treatment of urine beta 2-MG.. After treatment, the serum 1,25- (0H) 2D3 level of the treatment group was higher than that of the control group, the difference was statistically significant (P0.05). It suggested that the treatment group could effectively improve the 1,25- (0H) 2D3 water in the serum of the elderly patients with hypertension. After treatment, the level of serum MMP-9 in the two groups was lower than that before the treatment. After treatment, the level of serum MMP-9 in the treatment group was significantly lower than that in the control group. The difference was statistically significant (P0.05). The results suggested that the treatment group could effectively reduce the level of MMP-9 in the elderly hypertensive patients. The effect of hypotension is not very different from that of simple western medicine, but the combination of traditional Chinese medicine can effectively improve the clinical symptoms of the patients, reduce the urine microalbumin, the exudation of beta 2 microglobulin, reduce the thickness of the middle membrane of the carotid artery, improve the atherosclerosis and reduce the variation of blood pressure. The mechanism of its action may be to improve the serum 1,25 (OH) 2D3 The "golden water phase" method can effectively improve the level of 1,25 (OH) 2D3, and whether 1,25 (OH) 2D3 can be used as a breakthrough point to evaluate the classic traditional Chinese medicine treatment of "golden water phase", so that the "golden water phase" method can be used as a breakthrough point for the treatment of other diseases and need more and deeper research.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R259

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