高血壓頸動脈粥樣硬化火熱證清火養(yǎng)陰散結(jié)法干預(yù)研究
發(fā)布時間：2018-11-15 17:30
【摘要】：目的:進(jìn)一步完善“人迎脈積”“火熱致中”理論,觀察在該理論指導(dǎo)下的清火舒脈方治療高血壓CAS火熱證的臨床療效,為干預(yù)CAS,預(yù)防中風(fēng)提供借鑒。方法:試驗(yàn)組和對照組常規(guī)服用規(guī)定劑量的降壓藥(以苯磺酸氨氯地平和(或)氯沙坦鉀為主)、阿司匹林腸溶片及辛伐他汀;試驗(yàn)組在對照組基礎(chǔ)上加服清火舒脈方免煎顆粒;兩組均以6周為1療程,連續(xù)治療3個療程;每6周隨訪一次,記錄臨床癥狀、舌脈、血壓;兩組分別在治療前后進(jìn)行常規(guī)安全指標(biāo)(血常規(guī)、尿常規(guī)、大便常規(guī)、心電圖)、血生化、頸動脈彩超檢查;觀察治療前后兩組患者中醫(yī)癥候療效、頸動脈內(nèi)中膜厚度、頸總動脈內(nèi)徑、頸動脈狹窄度、斑塊面積、血壓、血脂、血糖、尿酸、同型半胱氨酸的變化。結(jié)果:兩組中醫(yī)癥候(火熱、陰虛、痰、瘀血)均有改善,對照組痰、瘀血、陰虛改善無統(tǒng)計(jì)學(xué)意義(P0.05),火熱證積分療效評價,試驗(yàn)組顯著優(yōu)于對照組(F0.01);兩組血壓均明顯改善(P0.01),試驗(yàn)組較對照組收縮壓水平降低顯著(P0.05),舒張壓水平無統(tǒng)計(jì)學(xué)意義(P0.05),降壓療效比較無顯著意義(P0.05);兩組LDL-C均顯著改善(P0.01),試驗(yàn)組TC亦有顯著改善(P0.01),TG、Lp(a)治療效果不佳(P0.05)。對照組TC改善一般(P0.05),TG、Lp(a)治療效果亦不佳(P0.05);兩組GLU、Hcy、UA水平均有改善,試驗(yàn)組GLU、Hcy改善有統(tǒng)計(jì)學(xué)意義(P0.05),對照組GLU、Hcy無統(tǒng)計(jì)學(xué)意義(P0.05),組間比較無統(tǒng)計(jì)學(xué)意義(P0.05);兩組雙側(cè)IMT及平均IMT均略下降,但均無統(tǒng)計(jì)學(xué)意義(P0.05),組間比較無統(tǒng)計(jì)學(xué)意義(P0.05);兩組斑塊數(shù)目均有下降,試驗(yàn)組有統(tǒng)計(jì)學(xué)意義(P0.05),組間比較無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組Crouse積分治療前后組內(nèi)、組間比較,均無統(tǒng)計(jì)學(xué)意義(P0.05);兩組斑塊面積均有改善,試驗(yàn)組右側(cè)改善有統(tǒng)計(jì)學(xué)意義(P0.05),左側(cè)改善無統(tǒng)計(jì)學(xué)意義(P0.05)。對照組雙側(cè)斑塊面積改善均無統(tǒng)計(jì)學(xué)意義(P0.05)。試驗(yàn)組右側(cè)斑塊面積較對照組有意義(P0.05)。結(jié)論:清火養(yǎng)陰散結(jié)法指導(dǎo)下的清火舒脈方聯(lián)合基礎(chǔ)西藥治療高血壓CAS火熱證,能有效改善臨床癥狀,降低血壓的同時改善血脂、血糖、尿酸、同型半胱氨酸縮水平,減斑塊面積,延緩甚至逆轉(zhuǎn)CAS進(jìn)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.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259
本文編號：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.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259
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