软脉煎联合辛伐他汀、阿司匹林对肾精亏虚型颈动脉粥样硬化患者baPWV、ABI的影响
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摘要
目的:观察软脉煎联合辛伐他汀和阿司匹林对肾精亏虚型颈动脉粥样硬化患者肱踝脉搏波传导速度(pulse wave velocity,ba PWV)及踝臂指数(ankle-braehial index,ABI)的影响,探讨中药软脉煎对动脉血管弹性和僵硬度的作用。方法:将98例肾精亏虚型颈动脉粥样硬化患者随机分为对照组和治疗组各49例。对照组予辛伐他汀和阿司匹林治疗,治疗组在对照组用药的基础上加用中药软脉煎治疗,两组疗程均为6个月。治疗前、治疗3个月、6个月后分别比较两组患者的肾精亏虚程度积分,监测两组患者治疗前后ba PVW、ABI变化情况。结果:组内比较,治疗3个月、6个月后,治疗组肾精亏虚程度积分较治疗前降低(P <0. 01),对照组肾精亏虚程度积分较治疗前升高(P <0. 05);组间比较,治疗3个月、6个月后,治疗组肾精亏虚程度积分较对照组低(P <0. 05)。治疗组治疗后ba PWV与治疗前比较,差异无统计学意义(P <0. 05),对照组治疗后ba PWV较治疗前升高(P <0. 01),两组间ba PWV差值比较,治疗组较对照组更大(P <0. 01)。两组治疗后ABI与本组治疗前比较,差异均无统计学意义(P> 0. 05);两组间ABI的差值(治疗前-治疗后)比较,差异无统计学意义(P> 0. 05)。结论:软脉煎联合辛伐他汀和阿司匹林治疗可以延缓ba PWV的上升,通过改善动脉弹性和僵硬度来延缓动脉硬化发展。
Objective: To observe the influence of Decoction for Softening Meridians in combination with simvastatin and Bayaspirin Tablets on brachial-ankle pulse wave conduction velocity and ankle-brachial indexes,and investigate the effect of Chinese herbal compound Decoction for Softening Meridians on arterial elasticity and stiffness. Methods: Ninety-eight cases of carotid atherosclerosis with deficiency of kidney essence were randomly divided into the control group and the treatment group,with 49 cases in each group. The ones in the control group were treated with simvastatin and Bayaspirin Tablets,while the ones in the treatment group were treated with Decoction for Softening Meridians on the basis of the control group. The course of treatment lasted for 6 months. Before the treatment,3 months and 6 months after the treatment,the scores of kidney essence deficiency were recorded,and the brachial-ankle pulse wave velocity( ba PWV) and ankle-brachial indexes( ABI) were monitored before and after the treatment. Ankle brachial indexes were used to analyze the effect of Decoction for Softening Meridians. Results: There was no significant difference in ba PWV in the treatment group between and after the treatment. Ba PWV in the control group was higher than that before the treatment( P < 0. 01). The difference of ba PWV in the treatment group before and after the treatment was more significant than that of the control group( P < 0. 01). Conclusion: Decoction for Softening Meridians in combination with simvastatin and Bayaspirin Tablets can delay the rise of ba PWV and delay the development of arteriosclerosis by improving arterial elasticity and stiffness.
Objective: To observe the influence of Decoction for Softening Meridians in combination with simvastatin and Bayaspirin Tablets on brachial-ankle pulse wave conduction velocity and ankle-brachial indexes,and investigate the effect of Chinese herbal compound Decoction for Softening Meridians on arterial elasticity and stiffness. Methods: Ninety-eight cases of carotid atherosclerosis with deficiency of kidney essence were randomly divided into the control group and the treatment group,with 49 cases in each group. The ones in the control group were treated with simvastatin and Bayaspirin Tablets,while the ones in the treatment group were treated with Decoction for Softening Meridians on the basis of the control group. The course of treatment lasted for 6 months. Before the treatment,3 months and 6 months after the treatment,the scores of kidney essence deficiency were recorded,and the brachial-ankle pulse wave velocity( ba PWV) and ankle-brachial indexes( ABI) were monitored before and after the treatment. Ankle brachial indexes were used to analyze the effect of Decoction for Softening Meridians. Results: There was no significant difference in ba PWV in the treatment group between and after the treatment. Ba PWV in the control group was higher than that before the treatment( P < 0. 01). The difference of ba PWV in the treatment group before and after the treatment was more significant than that of the control group( P < 0. 01). Conclusion: Decoction for Softening Meridians in combination with simvastatin and Bayaspirin Tablets can delay the rise of ba PWV and delay the development of arteriosclerosis by improving arterial elasticity and stiffness.
引文
[1]王文,朱鼎良,孙宁玲,等.重视高血压患者抗血小板治疗,预防缺血性心脑血管疾病[J].中华高血压杂志,2013,21(9):701-704.
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[14]朱彦琪,储光,吴莹,等.脉搏波传导速度的基础与临床[J].国际心血管病杂志,2015,42(6):376-378.
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[17]王东盛,王成纲,陆英,等.经皮穿刺动脉导管药盒系统药物灌注治疗下肢动脉硬化闭塞症的研究[J].中国医药导报,2011,18(8):104-105.
[18]程瑶.补肾化痰活血法联合阿托伐他汀治疗对颈动脉粥样硬化斑块的影响[J].中国中医药科技,2017,24(4):463-464.
[19]田琳,贾莉,牟秀霞,等.补肾活血方治疗颈动脉粥样硬化斑块临床研究[J].中国中医药信息杂志,2017,24(12):17-20.
[20]金彪.补肾活血解毒方治疗颈动脉粥样硬化症临床观察[J].中医临床研究,2013,5(18):24-25.
[21]杜文婷,刘萍,杜文娇,等.补肾法对比他汀治疗颈动脉粥样硬化疗效与安全性的系统评价[J].中华中医药学刊,2015,33(9):2235-2242.
[22]申定珠,陈川,迟惠英,等.从血管老化角度探讨动脉粥样硬化中医防治策略[J].中国中西医结合杂志,2012,32(2):266-268.
[23]申定珠,陈川,邢三丽,等.基于Ang II、ApoE表达探讨补肾中药复方首参颗粒对颈动脉粥样硬化患者的影响[J].中国医药导报,2017,14(10):96-99,108.
[24]陈明荃,顾耘,徐辉.颈动脉粥样硬化患者中医证候分布探讨[J].中华中医药学刊,2012,30(6):1394-1396.
[25]刘若轩,李常青,邓志军,等.熟地黄对急性血瘀症大鼠血液流变性和凝血功能的改善作用[J].广东药学院学报,2015,31(5):621-624.
[26]李新才,曾碧映,邓凤君,等.黄芪水提取物对载脂蛋白E基因敲除大鼠动脉硬化斑块部位基质金属蛋白酶-9表达及斑块形成的影响[J].中国老年学杂志,2013,33(22):5074-5075.
[27]罗菁.虎杖和山楂提取物用于治疗冠状动脉粥样硬化斑块的临床效果分析[J].中医临床研究,2017,9(5):28-29.
[28]郭慧玲,江蕾,胡志方,等.荷叶水提物的降血脂作用实验探讨[J].江西中医药大学学报,2015,27(2):103-105.
[29]邢雁伟,腾菲,高永红,等.绞股蓝总甙片联合阿托伐他汀钙片治疗对冠心病合并高脂血症患者血脂以及炎症指标的影响[J].中西医结合心脑血管病杂志,2013,11(6):655-657.
[30]杜文婷,王臻楠,顾耘.中药复方软脉煎抗动脉粥样硬化的研究概况[J].中西医结合心脑血管病杂志,2016,14(21):2502-2504.
[31]NENBYAC,ZALTSMANAB.Fibrous cap formation ordestructionthe critical importance of vascular smoothmuscle cell proliferation,migration and matrix formation[J].Cardiovase Res,1999,41(2):345-360.
[32]AIMESRT,QUIGLEY JP.Matrixmetalloproteinase-2 is an interstitial collagenase inhibitor free enzyme catalyzes the cleavage of collagen fibrils and soluble native type I collagen generating the specific 3/4-and-1/4-length fragments[J].J BiolChem,1995,270(11):5872-5876.
[33]GROTEK,FLACH I,LUCHTEFELDM,et al.Mechanial stretch enhancesmRNA expression and proenzyme release ofmatrixmetalloproteinase2(MMP2)via NAD(P)Hoxidasederived reactive oxygen species[J].CircRes,2003,92(11):80-86.
[34]顾耘.软脉煎治疗颈动脉粥样硬化的临床研究[J].辽宁中医杂志,2004,31(8):634-637.
[2]YAMASHINA A,TOMIYAMA H.Arteriosclerosis and pulse wave elocity[J].Nihon Rinsho,2004,62(1):80-86.
[3]王宏宇,张维忠,龚兰生,等.高血压病大动脉扩张性与左室肥厚关系探讨[J].中华心血管病杂志,2000,28(3):177-180.
[4]王宏宇,张维忠,龚兰生,等.高血压合并动脉粥样硬化与大动脉缓冲功能关系的研究[J].中华心血管病杂志,2001,29(4):206-209.
[5]王俊.辛伐他汀对高血压合并颈动脉硬化患者肱踝脉搏波传导速度及颈动脉内膜中层厚度的影响[J].实用临床医药杂志,2012,16(21):28-30.
[6]顾耘,潘露茜,陈家和,等.软脉煎治疗动脉粥样硬化的临床和实验研究述评[J].上海中医药杂志,2010,44(3):12-14.
[7]中国医师协会超声医师分会.血管和浅表器官超声检查指南[M].北京:人民军医出版社,2011:29.
[8]郭万学.超声医学[M].6版.北京:人民军医出版社,2013:62.
[9]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:44.
[10]邓铁涛.中医诊断学[M].上海:上海科学技术出版社,2013:92.
[11]韦秀英,郑杨杨,周玉.2型糖尿病患者颈动脉内中膜厚度与臂踝脉搏波传导速度的关系[J].中国老年学杂志,2011,10(19):3677-3678.
[12]吴晓春,季乃军,吴少琴,等.瑞舒伐他汀对血脂正常的无动脉硬化原发性高血压患者颈动脉内膜中层厚度及肱踝脉搏波传导速度的影响[J].实用医学杂志,2014,30(5):818-820.
[13]TANAKA H,MUNAKATA M,KAWANO Y,et a1.Comparison between carotid femoral and brachial uankle pulse wave velocity as measures of arterial stiffness[J].J Hypertens,2009,27(10):2022-2027.
[14]朱彦琪,储光,吴莹,等.脉搏波传导速度的基础与临床[J].国际心血管病杂志,2015,42(6):376-378.
[15]何晓玲,赵霞,薛红霞,等.老年高血压脉搏波传导速度与颈动脉硬化的关系[J].河北医药,2013,35(8):1212-1213.
[16]卢玉润,李英,洪大情,等.臂踝脉搏波速度和踝臂指数在高血压人群中评估动脉硬化和动脉粥样硬化的价值[J].中国慢性病预防与控制,2014,22(6):722-724.
[17]王东盛,王成纲,陆英,等.经皮穿刺动脉导管药盒系统药物灌注治疗下肢动脉硬化闭塞症的研究[J].中国医药导报,2011,18(8):104-105.
[18]程瑶.补肾化痰活血法联合阿托伐他汀治疗对颈动脉粥样硬化斑块的影响[J].中国中医药科技,2017,24(4):463-464.
[19]田琳,贾莉,牟秀霞,等.补肾活血方治疗颈动脉粥样硬化斑块临床研究[J].中国中医药信息杂志,2017,24(12):17-20.
[20]金彪.补肾活血解毒方治疗颈动脉粥样硬化症临床观察[J].中医临床研究,2013,5(18):24-25.
[21]杜文婷,刘萍,杜文娇,等.补肾法对比他汀治疗颈动脉粥样硬化疗效与安全性的系统评价[J].中华中医药学刊,2015,33(9):2235-2242.
[22]申定珠,陈川,迟惠英,等.从血管老化角度探讨动脉粥样硬化中医防治策略[J].中国中西医结合杂志,2012,32(2):266-268.
[23]申定珠,陈川,邢三丽,等.基于Ang II、ApoE表达探讨补肾中药复方首参颗粒对颈动脉粥样硬化患者的影响[J].中国医药导报,2017,14(10):96-99,108.
[24]陈明荃,顾耘,徐辉.颈动脉粥样硬化患者中医证候分布探讨[J].中华中医药学刊,2012,30(6):1394-1396.
[25]刘若轩,李常青,邓志军,等.熟地黄对急性血瘀症大鼠血液流变性和凝血功能的改善作用[J].广东药学院学报,2015,31(5):621-624.
[26]李新才,曾碧映,邓凤君,等.黄芪水提取物对载脂蛋白E基因敲除大鼠动脉硬化斑块部位基质金属蛋白酶-9表达及斑块形成的影响[J].中国老年学杂志,2013,33(22):5074-5075.
[27]罗菁.虎杖和山楂提取物用于治疗冠状动脉粥样硬化斑块的临床效果分析[J].中医临床研究,2017,9(5):28-29.
[28]郭慧玲,江蕾,胡志方,等.荷叶水提物的降血脂作用实验探讨[J].江西中医药大学学报,2015,27(2):103-105.
[29]邢雁伟,腾菲,高永红,等.绞股蓝总甙片联合阿托伐他汀钙片治疗对冠心病合并高脂血症患者血脂以及炎症指标的影响[J].中西医结合心脑血管病杂志,2013,11(6):655-657.
[30]杜文婷,王臻楠,顾耘.中药复方软脉煎抗动脉粥样硬化的研究概况[J].中西医结合心脑血管病杂志,2016,14(21):2502-2504.
[31]NENBYAC,ZALTSMANAB.Fibrous cap formation ordestructionthe critical importance of vascular smoothmuscle cell proliferation,migration and matrix formation[J].Cardiovase Res,1999,41(2):345-360.
[32]AIMESRT,QUIGLEY JP.Matrixmetalloproteinase-2 is an interstitial collagenase inhibitor free enzyme catalyzes the cleavage of collagen fibrils and soluble native type I collagen generating the specific 3/4-and-1/4-length fragments[J].J BiolChem,1995,270(11):5872-5876.
[33]GROTEK,FLACH I,LUCHTEFELDM,et al.Mechanial stretch enhancesmRNA expression and proenzyme release ofmatrixmetalloproteinase2(MMP2)via NAD(P)Hoxidasederived reactive oxygen species[J].CircRes,2003,92(11):80-86.
[34]顾耘.软脉煎治疗颈动脉粥样硬化的临床研究[J].辽宁中医杂志,2004,31(8):634-637.