高血压颈动脉粥样硬化火热证清火养阴散结法干预研究
发布时间：2018-11-15 17:30
【摘要】：目的:进一步完善“人迎脉积”“火热致中”理论,观察在该理论指导下的清火舒脉方治疗高血压CAS火热证的临床疗效,为干预CAS,预防中风提供借鉴。方法:试验组和对照组常规服用规定剂量的降压药(以苯磺酸氨氯地平和(或)氯沙坦钾为主)、阿司匹林肠溶片及辛伐他汀;试验组在对照组基础上加服清火舒脉方免煎颗粒;两组均以6周为1疗程,连续治疗3个疗程;每6周随访一次,记录临床症状、舌脉、血压;两组分别在治疗前后进行常规安全指标(血常规、尿常规、大便常规、心电图)、血生化、颈动脉彩超检查;观察治疗前后两组患者中医症候疗效、颈动脉内中膜厚度、颈总动脉内径、颈动脉狭窄度、斑块面积、血压、血脂、血糖、尿酸、同型半胱氨酸的变化。结果:两组中医症候(火热、阴虚、痰、瘀血)均有改善,对照组痰、瘀血、阴虚改善无统计学意义(P0.05),火热证积分疗效评价,试验组显著优于对照组(F0.01);两组血压均明显改善(P0.01),试验组较对照组收缩压水平降低显著(P0.05),舒张压水平无统计学意义(P0.05),降压疗效比较无显著意义(P0.05);两组LDL-C均显著改善(P0.01),试验组TC亦有显著改善(P0.01),TG、Lp(a)治疗效果不佳(P0.05)。对照组TC改善一般(P0.05),TG、Lp(a)治疗效果亦不佳(P0.05);两组GLU、Hcy、UA水平均有改善,试验组GLU、Hcy改善有统计学意义(P0.05),对照组GLU、Hcy无统计学意义(P0.05),组间比较无统计学意义(P0.05);两组双侧IMT及平均IMT均略下降,但均无统计学意义(P0.05),组间比较无统计学意义(P0.05);两组斑块数目均有下降,试验组有统计学意义(P0.05),组间比较无统计学意义(P0.05)。两组Crouse积分治疗前后组内、组间比较,均无统计学意义(P0.05);两组斑块面积均有改善,试验组右侧改善有统计学意义(P0.05),左侧改善无统计学意义(P0.05)。对照组双侧斑块面积改善均无统计学意义(P0.05)。试验组右侧斑块面积较对照组有意义(P0.05)。结论:清火养阴散结法指导下的清火舒脉方联合基础西药治疗高血压CAS火热证,能有效改善临床症状,降低血压的同时改善血脂、血糖、尿酸、同型半胱氨酸缩水平,减斑块面积,延缓甚至逆转CAS进程。
[Abstract]:Objective: to improve the theory of "Renying meridian" and "heat causing middle", observe the clinical effect of Qinghuoxuangchai prescription in treating hypertension CAS fire heat syndrome, and provide reference for intervention of CAS, to prevent apoplexy. Methods: the experimental group and the control group were given regular dose of antihypertensive drugs (mainly amlodipine benzenesulfonate and / or losartan potassium), aspirin enteric-coated tablets and simvastatin. The experimental group was treated with Qinghuoshuchai decoction without decoction on the basis of the control group, the two groups were treated with 6 weeks as a course of treatment for 3 consecutive courses, followed up once every 6 weeks to record the clinical symptoms, tongue vein, blood pressure; Before and after treatment, routine safety indexes (blood routine, urine routine, stool routine, ECG), blood biochemistry, carotid artery color Doppler examination were performed in the two groups. The changes of TCM syndromes, carotid intima-media thickness, common carotid artery diameter, carotid stenosis, plaque area, blood pressure, blood lipid, blood glucose, uric acid and homocysteine were observed before and after treatment. Results: the symptoms of traditional Chinese medicine (fire heat, yin deficiency, phlegm, blood stasis) were improved in both groups. There was no statistical significance in the improvement of phlegm, blood stasis and yin deficiency in the control group (P0.05). The evaluation of the curative effect of fire heat syndrome integral was significantly better in the experimental group than in the control group (F0.01). The blood pressure of the two groups were significantly improved (P0.01). The systolic blood pressure level in the experimental group was significantly lower than that in the control group (P0.05), the diastolic blood pressure level had no statistical significance (P0.05), and the effect of lowering blood pressure was not significant (P0.05). LDL-C was significantly improved in both groups (P0.01), TC was also significantly improved in the experimental group (P0.01), and the effect of TG,Lp (a) was not good (P0.05). In the control group, TC was improved generally (P0.05), and the effect of TG,Lp (a) was not good (P0.05). The level of GLU,Hcy,UA was improved in both groups. The improvement of GLU,Hcy in the test group was statistically significant (P0.05), the GLU,Hcy in the control group was not statistically significant (P0.05), and there was no statistical significance between the two groups (P0.05). The bilateral IMT and average IMT decreased slightly in both groups, but there was no significant difference between the two groups (P0.05), but there was no significant difference between the two groups (P0.05). The number of plaque decreased in both groups, the experimental group had statistical significance (P0.05), and there was no significant difference between the two groups (P0.05). There was no significant difference in Crouse score between the two groups before and after treatment (P0.05); the plaque area of the two groups were improved, the right side of the trial group improved statistically (P0.05), the left side of the improvement was not statistically significant (P0.05). In the control group, there was no significant improvement in plaque area (P0.05). The plaque area on the right side in the trial group was significantly higher than that in the control group (P0.05). Conclusion: under the guidance of the method of clearing fire and nourishing yin and dispersing knot, the combination of Qinghuo Shuqi recipe and basic western medicine can effectively improve the clinical symptoms of hypertension CAS, reduce blood pressure and improve the levels of blood lipid, blood glucose, uric acid and homocysteine constriction at the same time. Reduce plaque area, delay or even reverse the progress of CAS.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259
本文编号：2333968
[Abstract]:Objective: to improve the theory of "Renying meridian" and "heat causing middle", observe the clinical effect of Qinghuoxuangchai prescription in treating hypertension CAS fire heat syndrome, and provide reference for intervention of CAS, to prevent apoplexy. Methods: the experimental group and the control group were given regular dose of antihypertensive drugs (mainly amlodipine benzenesulfonate and / or losartan potassium), aspirin enteric-coated tablets and simvastatin. The experimental group was treated with Qinghuoshuchai decoction without decoction on the basis of the control group, the two groups were treated with 6 weeks as a course of treatment for 3 consecutive courses, followed up once every 6 weeks to record the clinical symptoms, tongue vein, blood pressure; Before and after treatment, routine safety indexes (blood routine, urine routine, stool routine, ECG), blood biochemistry, carotid artery color Doppler examination were performed in the two groups. The changes of TCM syndromes, carotid intima-media thickness, common carotid artery diameter, carotid stenosis, plaque area, blood pressure, blood lipid, blood glucose, uric acid and homocysteine were observed before and after treatment. Results: the symptoms of traditional Chinese medicine (fire heat, yin deficiency, phlegm, blood stasis) were improved in both groups. There was no statistical significance in the improvement of phlegm, blood stasis and yin deficiency in the control group (P0.05). The evaluation of the curative effect of fire heat syndrome integral was significantly better in the experimental group than in the control group (F0.01). The blood pressure of the two groups were significantly improved (P0.01). The systolic blood pressure level in the experimental group was significantly lower than that in the control group (P0.05), the diastolic blood pressure level had no statistical significance (P0.05), and the effect of lowering blood pressure was not significant (P0.05). LDL-C was significantly improved in both groups (P0.01), TC was also significantly improved in the experimental group (P0.01), and the effect of TG,Lp (a) was not good (P0.05). In the control group, TC was improved generally (P0.05), and the effect of TG,Lp (a) was not good (P0.05). The level of GLU,Hcy,UA was improved in both groups. The improvement of GLU,Hcy in the test group was statistically significant (P0.05), the GLU,Hcy in the control group was not statistically significant (P0.05), and there was no statistical significance between the two groups (P0.05). The bilateral IMT and average IMT decreased slightly in both groups, but there was no significant difference between the two groups (P0.05), but there was no significant difference between the two groups (P0.05). The number of plaque decreased in both groups, the experimental group had statistical significance (P0.05), and there was no significant difference between the two groups (P0.05). There was no significant difference in Crouse score between the two groups before and after treatment (P0.05); the plaque area of the two groups were improved, the right side of the trial group improved statistically (P0.05), the left side of the improvement was not statistically significant (P0.05). In the control group, there was no significant improvement in plaque area (P0.05). The plaque area on the right side in the trial group was significantly higher than that in the control group (P0.05). Conclusion: under the guidance of the method of clearing fire and nourishing yin and dispersing knot, the combination of Qinghuo Shuqi recipe and basic western medicine can effectively improve the clinical symptoms of hypertension CAS, reduce blood pressure and improve the levels of blood lipid, blood glucose, uric acid and homocysteine constriction at the same time. Reduce plaque area, delay or even reverse the progress of CAS.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259
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