参泽双降汤对糖尿病合并高血压患者肾素—血管紧张素—醛固酮系统（RAAS）的影响

发布时间：2018-09-11 12:16

【摘要】：目的:通过运用参泽双降汤干预糖尿病合并高血压病患者,观察相关检验指标以及中医临床症候的变化,评价糖尿病合并高血压患者使用参泽双降汤治疗后的临床疗效,并探讨本方作用机制。方法:随机选取60例符合糖尿病合并高血压诊断标准以及中医证型属于气阴两虚夹痰瘀的患者分为治疗组、对照组,并随机选取30例符合原发性高血压诊断标准以及中医证型属于气阴两虚夹痰瘀的患者组成高血压组。(1)将三组患者的治疗前卧位和立位肾素(PRA)、血管紧张素II(Ang II)及醛固酮(ALD)水平、血脂水平进行比较;(2)观察糖尿病合并高血压的这两组患者治疗前后血浆卧位和立位PRA、卧立位Ang II及ALD水平,血糖(FPG、2h PG)、血压、胰岛素抵抗指数(HOMA-IR)以及中医症候积分的变化;(3)对糖尿病合并高血压患者血浆卧位和立位AngⅡ与FBG、2h PG进行相关性分析。治疗组是在常规的治疗基础上加用参泽双降汤,每天一剂,早晚两次饭后分次服用,疗程为2周;对照组仅使用常规的治疗方法。结果:(1)糖尿病合并高血压治疗组卧立位PRA、Ang II及ALD水平和治疗前比较有所降低,本治疗组治疗前后数据用统计学方法比较,其差异有意义(P0.01),对照组治疗前后RAAS无明显差异(P0.05),两组治疗后比较,治疗组卧立位PRA、Ang II及ALD水平降低较对照组明显(P0.05或P0.01),说明参泽双降汤治疗组在改善RAAS方面优于单纯西药对照组。(2)糖尿病合并高血压两组患者治疗后空腹血糖和餐后血糖均较治疗前下降,与治疗前比较差异在统计学方法上有意义(P0.01),治疗后的两组水平比较,治疗组的血糖值下降比对照组明显(P0.05)。(3)糖尿病合并高血压两组患者治疗后血压分别与治疗前均有下降,其差异有统计学意义(P0.01),两组治疗后比较,中药治疗组血压下降较对照组更明显(P0.05或P0.01),说明参泽双降汤治疗组在降压方面优于单纯使用西药组。(4)治疗组治疗后HOMA-IR较治疗前下降(P0.01),对照组治疗前后无统计学差异(P0.05)。(5)对三组患者治疗前卧立位PRA、Ang II及ALD水平、血脂进行比较,发现治疗前糖尿病合并高血压组卧立位Ang II水平高于高血压组,二者有统计学差异(P0.05或P0.01);三组血脂治疗前无统计学差异(P0.05)。(6)将Ang II与血糖进行相关分析,发现卧立位Ang II与FBG与2h PG呈线性正相关,控制年龄、血压、血脂因素后进行偏相关分析,发现Ang II与2h PG呈显著正相关。(7)糖尿病合并高血压组治疗后两组中医证候临床疗效比较,参泽双降汤治疗组的总有效率是93.33%,参泽双降糖对照组的总有效率是70.00%,其差异在统计学方法上有意义(P0.05)。(8)不良反应:本方治疗组患者出现临床不良反应的概率要低于对照组。结论:糖尿病合并高血压患者在常规降压降糖治疗基础上加用参泽双降汤治疗后,显示出良好的临床效果,能够改善患者RAAS系统激素水平,降低血糖、血压,胰岛素抵抗以及缓解临床症状,参泽双降汤治疗组各项指标均优于对照组,本方不良反应比较少,受试者的依从性好。
[Abstract]:Objective: To evaluate the clinical effect of Shenze Shuangjiang Decoction on diabetes mellitus complicated with hypertension and explore its mechanism by observing the changes of relevant test indexes and clinical symptoms of traditional Chinese medicine. Patients with Qi and Yin deficiency and phlegm and blood stasis were divided into treatment group and control group, and 30 patients with essential hypertension were randomly selected as hypertension group. (2) To observe the changes of plasma PRA, Ang II and ALD, blood glucose (FPG, 2H PG), blood pressure, insulin resistance index (HOMA-IR) and TCM syndrome score in patients with diabetes mellitus and hypertension before and after treatment; (3) To observe the changes of plasma PRA, Ang II and ALD levels in prone and orthostatic positions, blood glucose (FPG, 2H PG), blood pressure, insulin resistance index (HOMA-IR) and TCM syndrome score in patients with diabetes mellitus and hypertension. Results: (1) The levels of PRA, Ang II and ALD in patients with diabetes mellitus and hypertension in the prone position and in the orthostatic position were compared. Compared with the control group, the PRA, Ang II and ALD levels in the treatment group were significantly lower than those in the control group (P 0.05 or P 0.01), indicating that the Shenze Shuangjiang Decoction treatment group is improving the RAAS prescription. (2) After treatment, fasting blood glucose and postprandial blood glucose in diabetes mellitus patients with hypertension were lower than those before treatment, and the difference was statistically significant (P 0.01). After treatment, the level of blood glucose in the treatment group was significantly lower than that in the control group (P 0.05). The blood pressure of the two groups decreased after treatment, and the difference was statistically significant (P 0.01). Compared with the control group, the blood pressure of the treatment group decreased more significantly (P 0.05 or P 0.01), indicating that the Shenze Shuangjiangtang treatment group was superior to the western medicine group in reducing blood pressure. (4) The HOMA-IR of the treatment group was better than that of the control group after treatment. The levels of PRA, Ang II and ALD, and blood lipids in the three groups were compared before and after treatment. It was found that Ang II in the diabetes and hypertension group was higher than that in the hypertension group before treatment, and there was no significant difference between the three groups before and after treatment (P 0.05 or P 0.01). (6) Ang II was positively correlated with FBG and 2H PG in supine position, and was positively correlated with FBG and 2H PG in supine position. The total effective rate was 93.33%. The total effective rate of Shenze Shuangjiangtang control group was 70.00%. The difference was statistically significant (P 0.05). (8) Adverse reactions: The incidence of clinical adverse reactions in the treatment group was lower than that in the control group. After treatment, Shenze Shuangjiang Decoction showed a good clinical effect, can improve the RAAS system hormone levels, reduce blood sugar, blood pressure, insulin resistance and alleviate clinical symptoms, Shenze Shuangjiang Decoction treatment group than the control group, the side effects of this prescription is less, the subject's compliance is good.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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