原发性低血压病及中医分型与血浆内皮素、一氧化氮等因子关系的临床研究
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摘要
背景：血液中一些化学物质对心肌和血管平滑肌的活动发
生影响，从而对血压起调节作用，可能参与原发性低血压的发
病。
目的：研究内皮素、一氧化氮、儿茶酚胺、空腹血糖、血
清胰岛素及电解质水平的改变在原发性低血压发病中所起作
用，为原发性低血压病及中医分型提供现代实验室参考依据。
资料与方法：按WHO诊断标准及中医辨证标准，选择原发
性低血压患者50例（其中男18例，女32例），平均年龄36.07
±7.52岁（26-45岁）。中医辨证气虚16例，血虚10例，肝郁
12例，阴虚12例，偶测血压平均值88.5±6.5/56.4±6.7mmHg。
正常对照组30例（其中男11例，女19例）平均年龄34.12±
8.46岁（24-44岁）。采用放免法检测血浆内皮素（ET）；采用
铬还原比色法测定一氧化氮（NO）；采用改良荧光法测定血浆去
甲肾上腺素（NE）及肾上腺素（E）；采用自动生化分析仪测定
空腹血糖（FPG），血Na~+、K~+、Ca~(2+)；采用放射免疫法测定胰岛
素（FIN）；采用以空腹血糖与血清胰岛素乘积的倒数作为胰岛
素敏感性指数。
结果：1．原发性低血压组NO水平高于正常对照组，差异非
常显著u＜0．01人ET水平显著高于对照组u．05人NO与
‘ET比值较对照组有显著差异u＜0．05）；2．原发性低血压组血
中儿茶酚胺浓度与对照组比较未见差异；3．原发性低血压组
Na丫K”显著高于对照组，具统计学意义吓 t 0．01人 4．原发性
低血压组空腹血糖、血清胰岛素较对照组升高，具统计学意义
。O＜0．05）；5．四组 NO水平均显著高于对照组，气虚组与肝郁
组尤为显著仔＜0．of人 且气虚组 NO水平显著高于阴虚组和血
虚组O＜0．05，P＜0．of人 气虚组叮水平显著高于对照组u
＜0．05人 组间比较未见显著差异；6．肝郁组儿茶酚胺较对照组
明显增高，组间比较未见明显差异；7，气虚组、血虚组、阴
虚组血K“浓度低于对照组；其中气虚组和阴虚组Na丫K”高于对
＿＿照组，均具统计学显著意义吓＜0．of，Pwto．05人 但组间比较
‘差异不明显；8．气虚组、血虚组和阴虚组空腹血糖及血清胰岛
素均显著低于对照组但组间比较差异不明显。9．经直线相关分
析得出，原发性低血压患者的收缩压和舒张压均与NO． ET。
NO砸T、血K”显著相关u＜0．01入 10．经逐步回归分析后得出
与收缩压关系最密切的是NO、FPG、NE，与舒张压关系最密切
的是NO、K”、FPG、Na”。
·结论：血浆一氧化氮、内皮素水平的改变可能参与原发性
低血压的发病，同时也为原发性低血压中医分型提供物质基础
和现代实验室诊断参考指标。
w
ABSTRACT
Background: Some chemicals in blood can modulate blood
pressure by exerting an effect on cardiac myocyte and vascular
smooth muscle, which may be involved in the pathogenesis
mechanism of essential hypotension.
Objectives: To provide modem laboratory reference for essential
hypotension and its TCM types by researching the change of plasma
endothelin(ET), nitric oxide(NO), adrenaline(E) and
norepinephrine(NE), fasting plasma glucose(FPG), fasting
insulin(FIN) and insulin sensitive index(ISI) level.
Materials and Methods: According to WHO diagnosis criteria and
TCM differentiation criteria. We selected 50 cases (18 male, 32
female) the average age is 36.07?7.52, among them 12 cases in
liver-Qi stagnation group, 16 cases in Qi deficiency group, 10 cases
in blood deficiency group and 12 cases in essence deficiency group.
30 healthy people (11 male, 19 female), were taken as the control
group. Their average age is 34.12?8.46.We detected plasma ET by
RIA method, NO by colorimeteric method, plasma E, NE by
fluorimetric method, FPG, electrolytes by the glucose oxidase
method, and take the reverse of the product of FPG and FIN as ISI.
Results: 1 .Compared with the control group, the level of NO was
very significantly higher than that in treatment group (PKO.Ol); the
level of ET and the ratio of NO/ET increased significantly, too.
2.There were no obvious difference between the treatment group
and the control group in the level of E and NE. 3.The ratio of
Na~/K~ in treatment group was obviously higher than that in control
group, which had statistic meaning. 4. The level of FPG, FIN
increased significantly, which had statistical meaning.5. The level of
NO in the four group were significantly higher than that in the
control group and there were obviously difference among Qi
deficiency group, essence deficiency group and blood deficiency
group. 6.There were no significant difference among the four groups
in the levels of E, NE, FPG, FIN, ISI and among the four groups and
the control group.7. The level of K~ in the Qi deficiency group,
essence deficiency group and blood deficiency group is lower than
that in the control group, but there was no clinical meaning. 8.There
was a close negative correlation between the blood pressure and NO,
NO[ET, K~. 9.The main factors which affect diastolic blood pressure
(DBP) is NO, FPG, Nat. The main factors which affect systolic
blood pressure are NO, FPG, NE.
Conclusion: The change of ET and NO level may play an important
role in the pathogenesis of essential hypotension and may provide
material basis for essential hypotension TCM pattern types and
reference index of modem laboratory.
生影响，从而对血压起调节作用，可能参与原发性低血压的发
病。
目的：研究内皮素、一氧化氮、儿茶酚胺、空腹血糖、血
清胰岛素及电解质水平的改变在原发性低血压发病中所起作
用，为原发性低血压病及中医分型提供现代实验室参考依据。
资料与方法：按WHO诊断标准及中医辨证标准，选择原发
性低血压患者50例（其中男18例，女32例），平均年龄36.07
±7.52岁（26-45岁）。中医辨证气虚16例，血虚10例，肝郁
12例，阴虚12例，偶测血压平均值88.5±6.5/56.4±6.7mmHg。
正常对照组30例（其中男11例，女19例）平均年龄34.12±
8.46岁（24-44岁）。采用放免法检测血浆内皮素（ET）；采用
铬还原比色法测定一氧化氮（NO）；采用改良荧光法测定血浆去
甲肾上腺素（NE）及肾上腺素（E）；采用自动生化分析仪测定
空腹血糖（FPG），血Na~+、K~+、Ca~(2+)；采用放射免疫法测定胰岛
素（FIN）；采用以空腹血糖与血清胰岛素乘积的倒数作为胰岛
素敏感性指数。
结果：1．原发性低血压组NO水平高于正常对照组，差异非
常显著u＜0．01人ET水平显著高于对照组u．05人NO与
‘ET比值较对照组有显著差异u＜0．05）；2．原发性低血压组血
中儿茶酚胺浓度与对照组比较未见差异；3．原发性低血压组
Na丫K”显著高于对照组，具统计学意义吓 t 0．01人 4．原发性
低血压组空腹血糖、血清胰岛素较对照组升高，具统计学意义
。O＜0．05）；5．四组 NO水平均显著高于对照组，气虚组与肝郁
组尤为显著仔＜0．of人 且气虚组 NO水平显著高于阴虚组和血
虚组O＜0．05，P＜0．of人 气虚组叮水平显著高于对照组u
＜0．05人 组间比较未见显著差异；6．肝郁组儿茶酚胺较对照组
明显增高，组间比较未见明显差异；7，气虚组、血虚组、阴
虚组血K“浓度低于对照组；其中气虚组和阴虚组Na丫K”高于对
＿＿照组，均具统计学显著意义吓＜0．of，Pwto．05人 但组间比较
‘差异不明显；8．气虚组、血虚组和阴虚组空腹血糖及血清胰岛
素均显著低于对照组但组间比较差异不明显。9．经直线相关分
析得出，原发性低血压患者的收缩压和舒张压均与NO． ET。
NO砸T、血K”显著相关u＜0．01入 10．经逐步回归分析后得出
与收缩压关系最密切的是NO、FPG、NE，与舒张压关系最密切
的是NO、K”、FPG、Na”。
·结论：血浆一氧化氮、内皮素水平的改变可能参与原发性
低血压的发病，同时也为原发性低血压中医分型提供物质基础
和现代实验室诊断参考指标。
w
ABSTRACT
Background: Some chemicals in blood can modulate blood
pressure by exerting an effect on cardiac myocyte and vascular
smooth muscle, which may be involved in the pathogenesis
mechanism of essential hypotension.
Objectives: To provide modem laboratory reference for essential
hypotension and its TCM types by researching the change of plasma
endothelin(ET), nitric oxide(NO), adrenaline(E) and
norepinephrine(NE), fasting plasma glucose(FPG), fasting
insulin(FIN) and insulin sensitive index(ISI) level.
Materials and Methods: According to WHO diagnosis criteria and
TCM differentiation criteria. We selected 50 cases (18 male, 32
female) the average age is 36.07?7.52, among them 12 cases in
liver-Qi stagnation group, 16 cases in Qi deficiency group, 10 cases
in blood deficiency group and 12 cases in essence deficiency group.
30 healthy people (11 male, 19 female), were taken as the control
group. Their average age is 34.12?8.46.We detected plasma ET by
RIA method, NO by colorimeteric method, plasma E, NE by
fluorimetric method, FPG, electrolytes by the glucose oxidase
method, and take the reverse of the product of FPG and FIN as ISI.
Results: 1 .Compared with the control group, the level of NO was
very significantly higher than that in treatment group (PKO.Ol); the
level of ET and the ratio of NO/ET increased significantly, too.
2.There were no obvious difference between the treatment group
and the control group in the level of E and NE. 3.The ratio of
Na~/K~ in treatment group was obviously higher than that in control
group, which had statistic meaning. 4. The level of FPG, FIN
increased significantly, which had statistical meaning.5. The level of
NO in the four group were significantly higher than that in the
control group and there were obviously difference among Qi
deficiency group, essence deficiency group and blood deficiency
group. 6.There were no significant difference among the four groups
in the levels of E, NE, FPG, FIN, ISI and among the four groups and
the control group.7. The level of K~ in the Qi deficiency group,
essence deficiency group and blood deficiency group is lower than
that in the control group, but there was no clinical meaning. 8.There
was a close negative correlation between the blood pressure and NO,
NO[ET, K~. 9.The main factors which affect diastolic blood pressure
(DBP) is NO, FPG, Nat. The main factors which affect systolic
blood pressure are NO, FPG, NE.
Conclusion: The change of ET and NO level may play an important
role in the pathogenesis of essential hypotension and may provide
material basis for essential hypotension TCM pattern types and
reference index of modem laboratory.
引文
1. Lu scher, Huang SK, Yang JY, et al. Endothelium—derived relaxing and contracting factors. Kidney Int, 1991;39:575
2. Furchgott RF, Zawadsk JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle of acethylcholine.Nature, 1980;288:373
3. Nagosho H, Vehara Y,Kanai F, et al. Prostaglandin D2 inhibits inducible nitric oxide synthase expression in rat vascular smooth muscle cells. Circ Res, 1998,82(2):204
4．王逸民．一氧化氮的生物医学．临床检验杂志，1998；16(1)：61-62
5. Natanson C, Freeman BD, Zeni F, et al. Response of the septic vasculature to prolonged vasopressor therapy with N (omega) - monomethy 1-L-arginine and epinephrine in canines. Ann Intern Med, 1994;120:771
6. Lowenstein CJ, Tseng EE, Brock MV, et al. Neuonal nitric oxide synathase inhibitor reduces neuronal apoptosis after hypothermic ciculatory arrest. Ann Intern Med, 1994;120:227
7. Harrison DG. Release of nitrogen oxides from cultured bovine aortic endothelial cells is not impaired by calcium channel antagonists. Cardiol Clin, 1996; 14(1): 1-15
8. RajagopalanS, et al. J Clin Invest, 1996,97(9):1916—1923
9．汤健．心血管活性物质与心血管疾病．北京医科大学·中国协和医科大学联合出版社；1997．12
10. Paulus WJ, Vantrimpont PJ, Shah AM. Acute effect of nitric oxide on left vontricular relaxarion and diastolic distensnibility in humans, Assessment by bicornory Sodium nitroprusside infusion.
Cirulation, 1994;89:2070
11． Yanagisawa M, Kurihara H, Kimura S, et al. A novel potent vascontrictor peptide produced by vscular endothelin cell. Nature, 1983;332:411
12． Shiba R, Jackman HI, Morris PW, et al. Inactivation of endothelin I by deamidase (lysosmal protective protein). J Biol Chem, 1992;267:2872
13． Lemischka IR, Pelosi AJ, Dunniu MS, et al. Clonal, in vivio behaivor of the totipotent hematopotietic stem cell. Semin Immnmol, 1991;3:349
14． Wu-weng JR, Chiou Wj, Huang ZJ, et al. Endotjelin receptors in human smooth muscle cells:antagonist potency differs on agonistevoked responses, Am J Physiol, 1994; 267(5ptl):c1185
15． Oriji GK, Keiser HR. Protein kinase C mediates angiotension II-induced contractions and the release of Endothelin and prostacyclin in rat aortic rings. Prostaglandins Leukotrienes Essential Fatty Acids. 1997,57:135
16． Aramori L, Nakanish S. Couping of two Endothlin receptor subtypes to differing signal transduction in transferred Chinese hamster ovary cells. J Biol Chem, 1992,267:12468
17． Homma S, Maclean MR, Mcculloch KM, et al. Endothelin ETA and ETB-receptor mediated vasonpontriction in rat pulmonary arteries and arteries. J Cardiovasc Pharmacol,1994;23:838
18． 张海涛．内皮素的临床研究进展．心血管病学进展，1999；20 (3) ：131-133
19． Shutov-AA. Role of cerebral mechanisms in the development of arterial hypotension Zh-Nevropatel. Psikhiatr, 1983,83(10) : 1509
20. Man Shikov. Functional state of the cortical and medullary layers of the adrenals in primary hypotension. Cadiogiia,1976,16(11):78
21. Ziehler M. The sympathetic nervous system defect in promary othostatic hypotension. New Eng J Med, 1997,(2110):293-296
22. Kaloeva-ZD. Indicators of the lkallikrein- kinin system in children with primary arterial hypotnsion. Pediatria, 1989.10(4):43
23. Leont'eva-IV. Charactitreristics of the cardio-vasclar system in children with primary arterial hypotension. Pediatriia, 1991;6(3):23
24．郑济国．诺迪康治疗低血压48例疗效观察．中原医刊，1997；24(10)：46
25．周建飞，屈晓霞．低血压病的诊断及治疗探讨(附130例病例报告)．铁道医学，1996；24(5)；312
26．俞玲，潘稜，胡锡衷，等．福建省某农村农民原发性低血压调查．中国慢性病预防与控制，1994；2(6)；257--258
27．白新盛，林建富，洪国盛，等．原发性低血压445例调查分析．福建医药杂志，1987；9(3)：40-41
28．李维绥，高锦团，黄翠芬，等．大学生低血压发生率调查．福建医学院学报，1988；22(2)；163—165
29．张栓，穆晓红．低血压的中医药治疗和实验研究近况．中医药信息，1995；10(1)；1-5
2. Furchgott RF, Zawadsk JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle of acethylcholine.Nature, 1980;288:373
3. Nagosho H, Vehara Y,Kanai F, et al. Prostaglandin D2 inhibits inducible nitric oxide synthase expression in rat vascular smooth muscle cells. Circ Res, 1998,82(2):204
4．王逸民．一氧化氮的生物医学．临床检验杂志，1998；16(1)：61-62
5. Natanson C, Freeman BD, Zeni F, et al. Response of the septic vasculature to prolonged vasopressor therapy with N (omega) - monomethy 1-L-arginine and epinephrine in canines. Ann Intern Med, 1994;120:771
6. Lowenstein CJ, Tseng EE, Brock MV, et al. Neuonal nitric oxide synathase inhibitor reduces neuronal apoptosis after hypothermic ciculatory arrest. Ann Intern Med, 1994;120:227
7. Harrison DG. Release of nitrogen oxides from cultured bovine aortic endothelial cells is not impaired by calcium channel antagonists. Cardiol Clin, 1996; 14(1): 1-15
8. RajagopalanS, et al. J Clin Invest, 1996,97(9):1916—1923
9．汤健．心血管活性物质与心血管疾病．北京医科大学·中国协和医科大学联合出版社；1997．12
10. Paulus WJ, Vantrimpont PJ, Shah AM. Acute effect of nitric oxide on left vontricular relaxarion and diastolic distensnibility in humans, Assessment by bicornory Sodium nitroprusside infusion.
Cirulation, 1994;89:2070
11． Yanagisawa M, Kurihara H, Kimura S, et al. A novel potent vascontrictor peptide produced by vscular endothelin cell. Nature, 1983;332:411
12． Shiba R, Jackman HI, Morris PW, et al. Inactivation of endothelin I by deamidase (lysosmal protective protein). J Biol Chem, 1992;267:2872
13． Lemischka IR, Pelosi AJ, Dunniu MS, et al. Clonal, in vivio behaivor of the totipotent hematopotietic stem cell. Semin Immnmol, 1991;3:349
14． Wu-weng JR, Chiou Wj, Huang ZJ, et al. Endotjelin receptors in human smooth muscle cells:antagonist potency differs on agonistevoked responses, Am J Physiol, 1994; 267(5ptl):c1185
15． Oriji GK, Keiser HR. Protein kinase C mediates angiotension II-induced contractions and the release of Endothelin and prostacyclin in rat aortic rings. Prostaglandins Leukotrienes Essential Fatty Acids. 1997,57:135
16． Aramori L, Nakanish S. Couping of two Endothlin receptor subtypes to differing signal transduction in transferred Chinese hamster ovary cells. J Biol Chem, 1992,267:12468
17． Homma S, Maclean MR, Mcculloch KM, et al. Endothelin ETA and ETB-receptor mediated vasonpontriction in rat pulmonary arteries and arteries. J Cardiovasc Pharmacol,1994;23:838
18． 张海涛．内皮素的临床研究进展．心血管病学进展，1999；20 (3) ：131-133
19． Shutov-AA. Role of cerebral mechanisms in the development of arterial hypotension Zh-Nevropatel. Psikhiatr, 1983,83(10) : 1509
20. Man Shikov. Functional state of the cortical and medullary layers of the adrenals in primary hypotension. Cadiogiia,1976,16(11):78
21. Ziehler M. The sympathetic nervous system defect in promary othostatic hypotension. New Eng J Med, 1997,(2110):293-296
22. Kaloeva-ZD. Indicators of the lkallikrein- kinin system in children with primary arterial hypotnsion. Pediatria, 1989.10(4):43
23. Leont'eva-IV. Charactitreristics of the cardio-vasclar system in children with primary arterial hypotension. Pediatriia, 1991;6(3):23
24．郑济国．诺迪康治疗低血压48例疗效观察．中原医刊，1997；24(10)：46
25．周建飞，屈晓霞．低血压病的诊断及治疗探讨(附130例病例报告)．铁道医学，1996；24(5)；312
26．俞玲，潘稜，胡锡衷，等．福建省某农村农民原发性低血压调查．中国慢性病预防与控制，1994；2(6)；257--258
27．白新盛，林建富，洪国盛，等．原发性低血压445例调查分析．福建医药杂志，1987；9(3)：40-41
28．李维绥，高锦团，黄翠芬，等．大学生低血压发生率调查．福建医学院学报，1988；22(2)；163—165
29．张栓，穆晓红．低血压的中医药治疗和实验研究近况．中医药信息，1995；10(1)；1-5