六味地黄丸合丹栀逍遥散加减治疗H型高血压阴虚阳亢证的临床观察

目的:探讨六味地黄丸合丹栀逍遥散加减治疗H型高血压阴虚阳亢证的疗效及对血管内皮功能和炎症因子的影响。方法:将150例患者随机按数字表法分为对照组和观察组各75例。对照组口服马来酸依那普利叶酸片,1片/次,1次/d,血压还不能控制者加服硝苯地平缓释片,20~30 mg/次,2次/d。观察组西医治疗措施同对照组,并内服六味地黄丸合丹栀逍遥散加减,1剂/d。两组疗程均为连续治疗12周。每日偶测血压,比较治疗前后收缩压(SBP),舒张压(DBP)水平和血压达标情况;进行治疗前后动态血压监测,记录24 h收缩压标准差(24 h SSD),24 h舒张压标准差(24 h DSD),24 h平均收缩压(24 h SBP),24 h平均舒张压(24 h DBP);进行治疗前后踝臂指数(ABI)和肱动脉血流介导血管舒张功能(FMD)评价;进行治疗前后阴虚阳亢证评分;检测治疗前后白细胞介素-6(IL-6),IL-10,高敏C反应蛋白(hs CRP)和同型半胱氨酸(Hcy)水平。结果:观察组患者SBP,DBP,24 h SSD,24 h DSD,24 h SBP和24 h DBP水平均较对照组降低(P<0.01);观察组偶测血压达标率为81.19%,高于对照组的66.98%(χ^2=29.81,P<0.01);观察组患者ABI和FMD均高于对照组(P<0.01),阴虚阳亢证评分低于对照组(P<0.01);观察组患者Hcy,瘦素,IL-6,hs-CRP水平均低于对照组(P<0.01),IL-10水平高于对照组(P<0.01)。结论:在降压和补充马来酸依那普利叶酸片治疗的基础上,六味地黄丸合丹栀逍遥散加减治疗H型高血压阴虚阳亢证患者,可更好控制血压和Hcy水平,减轻血压变异性,提高血压达标率,改善临床症状,改善血管内皮功能,并能调节炎症因子。

Clinical Efficacy of Liuwei Dihuangwan Combined with Danzi Xiaoyaosan on H-type Hypertension with Syndrome of Yin Deficiency and Yang Hyperactivity

Objective:To discuss the clinical efficacy of Liuwei Dihuangwan combined with Danzi Xiaoyaosan on H-type hypertension with syndrome of Yin deficiency and Yang hyperactivity and its effect on vascular endothelial function and inflammatory factors.Method:One hundred and fifty patients were randomly divided into control group(75 cases)and observation group(75 cases)by random number table.Patients in control group got enalapril maleate and folic acid tablets,1 tablet/time,1 time/day,and patients with uncontrollable blood pressure were also given nifedipine sustained-release tablets,20-30 mg/time,2 times/days.In addition of the therapy of control group,patients in observation group were also given modified Liuwei Dihuangwan combined with Danzi Xiaoyaosan,1 dose/day.The course of treatment was 12 weeks.Before and after treatment,systolic blood pressure(SBP),diastolic blood pressure(DBP)and up-to-standard blood pressure were detected.And ambulatory blood pressure,standard deviation of 24-hours systolic blood pressure(24 h SSD),standard deviation of 24-hour diastolic blood pressure 24 h DSD),24 h mean systolic blood pressure(24 h SBP),24 h mean diastolic blood pressure(24 h DBP)were recorded.And ankle brachial index(ABI)and brachial artery blood flow mediated diamete(FMD)were discussed,syndrome of Yin deficiency and Yang hyperactivity was scored,and levels of iterleukin-6(IL-6),IL-10,high-sensitivity C-reactive protein(hsCRP)and homocysteine(Hcy)were detected.Result:The levels of SBP,DBP,24 h SSD,24 h DSD,24 h SBP and24 h DBP were all lower than those in control group(P<0.01).The achievement rate of accidental blood pressure in observation group was 81.19%,which was higher than 66.98%in control group(χ^2=29.81,P<0.01).And levels of ABI,FMD and IL-10 were higher than those in control group(P<0.01),while the score of syndrome of Yin Deficiency and Yang Hyperactivity and the levels of Hcy,leptin,IL-6 and hs-CRP were lower than those in control group(P<0.01).Conclusion:In addition to the therapy of antihypertensive and folic acid,Liuwei Dihuangwan combined with Danzi Xiaoyaosan can be given to control the level of blood pressure and Hcy,relieve the variability of blood pressure,alleviate clinical symptoms,raise the rate of achievement rate of blood pressure,improve the function of vascular endothelium,and regulate inflammatory factors.