本文選題：高血壓 + 金水相生　； 參考：《廣州中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：目的：筆者跟師蒙定水教授,第五批全國名老中醫(yī)藥專家學(xué)術(shù)經(jīng)驗(yàn)繼承指導(dǎo)教師,繼承其治療高血壓病由補(bǔ)腎著手、以及運(yùn)用六味地黃丸加減治療高血壓的經(jīng)驗(yàn)基礎(chǔ)上,以中醫(yī)“金水相生”法為指導(dǎo),通過肺腎同補(bǔ),以補(bǔ)肺而達(dá)到補(bǔ)腎的目的,臨床擬加味補(bǔ)腎化痰活血方治療老年高血壓,收效頗多,因此,擬通過臨床觀察,評價以“金水相生”法指導(dǎo)治療高血壓病的有效性,從而驗(yàn)證老中醫(yī)的臨床經(jīng)驗(yàn)及發(fā)揚(yáng)老中醫(yī)的學(xué)術(shù)專長,這是臨床觀察的目的之一。1,25二羥基維生素D3(1,25(OH)2D3)與高血壓病有一定的關(guān)聯(lián)性,與動脈硬化的發(fā)生有密切的聯(lián)系,動脈粥樣硬化的發(fā)生,使得老年高血壓患者更容易出現(xiàn)靶器官損害,從而心血管事件增加。1,25(OH)2D3缺乏,這也是老年人骨質(zhì)疏松容易并發(fā)骨折的基礎(chǔ),而中醫(yī)學(xué)則認(rèn)為骨質(zhì)疏松與腎主藏精,主骨生髓的生理作用有關(guān),腎精充足,腎強(qiáng)則骨強(qiáng),1,25(OH)2D3可通過促進(jìn)小腸鈣磷吸收,促進(jìn)鈣鹽沉積這些機(jī)制,另外還可通過刺激成骨細(xì)胞分泌膠原蛋白,從而促進(jìn)骨有機(jī)基質(zhì)的成熟,有利于成骨,這與腎藏精,主骨生髓之作用不謀而合。同時,維生素D其主要來源,來自于機(jī)體皮膚,通過紫外線照射皮膚組織,合成維生素D3,再通過腎臟經(jīng)1α-羥化酶催化合成活性代謝產(chǎn)物1,25(OH)2D3,而老年人群則可因日照不足,皮膚合成維生素D的能力也隨之下降,這二點(diǎn),與中醫(yī)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統(tǒng)的疾病,也與維生素D的缺乏相關(guān),與1,25(OH)2D3水平下降相關(guān),從1,25(OH)2D3這一生理學(xué)作用來看,與我們中醫(yī)學(xué)的“金水相生”所涉及的肺、腎生理功能相對應(yīng),因此,選擇將1,25(OH)2D3作為切入點(diǎn),探討“金水相生”法在高血壓治療中的作用機(jī)制,這也是我們臨床觀察的目的。方法：通過臨床觀察,觀察60例老年高血壓患者,隨機(jī)數(shù)字表法隨機(jī)分組,將60例觀察對象分為治療組及對照組。對照組30例,予以西醫(yī)降壓藥物常規(guī)治療；治療組30例,在對照組西藥治療的基礎(chǔ)上加用加味補(bǔ)腎化痰活血方治療；治療療程4周。觀察兩組治療對于老年高血壓患者降壓療效、中醫(yī)證候積分、頸動脈內(nèi)中膜厚度、血壓變異系數(shù)、尿微量白蛋白、β2微球蛋白、基質(zhì)金屬蛋白酶9(MMP-9)、血清1,25二羥基維生素D3(1,25-(OH)2D3)等指標(biāo)的影響。結(jié)果：通過臨床試驗(yàn)我們觀察到,治療組與西醫(yī)對照組治療后SBP和DBP水平比較,差異無統(tǒng)計學(xué)意義(P0.05)。提示兩組患者降壓臨床療效無差別;兩組中醫(yī)證候療效比較,治療組總有效率達(dá)90%,而對照組總有效率為66.7%,兩組總有效率比較,差異有統(tǒng)計學(xué)意義(P0.05),治療組在改善中醫(yī)證候方面有顯著效果。治療后兩組頸動脈內(nèi)膜-中層厚度均較治療前下降,差異具有統(tǒng)計學(xué)意義(P0.05)。治療后,治療組與對照組的頸動脈內(nèi)膜-中層厚度比較,差異具有統(tǒng)計學(xué)意義(P0.05)。提示治療組可有效減少頸動脈內(nèi)膜-中層厚度。治療后兩組的SBPV和DBPV均有不同程度的下降,差異具有統(tǒng)計學(xué)意義(P0.05)。治療后,治療組的SBPV和DBPV明顯低于對照組,差異具有統(tǒng)計學(xué)意義(P0.05)。提示治療組可有效降低患者血壓同時,能減少患者的血壓變異。治療后兩組尿mALb、尿β2-MG水平均較治療前減少：治療后,治療組的尿mALb、尿β2-MG水平低于對照組,差異具有統(tǒng)計學(xué)意義(P0.05)。提示治療組可減少老年高血壓患者尿mALb、尿β2-MG。治療后治療組與對照組血清1,25-(0H)2D3水平均較治療前增加；治療后,治療組的血清1,25-(0H)2D3水平高于對照組,差異具有統(tǒng)計學(xué)意義(P0.05)。提示治療組可有效提高老年高血壓患者血清1,25-(0H)2D3水平。治療后兩組血清MMP-9水平均較治療前下降；治療后,治療組的血清MMP-9水平明顯低于對照組,差異具有統(tǒng)計學(xué)意義(P0.05)。提示治療組可有效降低老年高血壓患者M(jìn)MP-9水平。結(jié)論：老年高血壓患者,聯(lián)合加味補(bǔ)腎化痰活血方治療,雖然在降壓效果上與單純西醫(yī)治療差別不大,但聯(lián)合中藥治療,能有效的改善患者臨床癥候,減少高血壓患者尿微量白蛋白、β2微球蛋白滲出,減輕頸動脈內(nèi)中膜厚度,有效改善動脈粥樣硬化,減少血壓變異,其作用機(jī)制,可能與提高血清1,25(OH)2D3的水平、以及降低MMP-9的活性相關(guān)。“金水相生”法治療高血壓,可有效提升1,25(OH)2D3水平,1,25(OH)2D3是否可作為評價“金水相生”這一經(jīng)典中醫(yī)治法的切入點(diǎn),從而發(fā)揮到治療其他疾病領(lǐng)域,需要更多的以及更深層次的研究。
[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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R249;R259

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本文編號：2006221