益气活血法对老年高血压颈动脉粥样硬化病变干预的临床观察
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摘要
目的:通过观察以益气活血为主要治法对老年高血压颈动脉粥样硬化病变患者血脂、血管活性物质、颈总动脉内膜中膜(IMT)、颈总动脉血流量以及临床症状的干预,论证益气活血法是治疗老年高血压颈动脉粥样硬化病变的基本治疗方法。方法:采用分层随机分组法将患者分为益气活血研究组28例和对照组24例,2周为一疗程,共进行3个疗程。结果:统计学资料显示,研究组在调节血脂、调节血管活性物质、降低颈总动脉IMT、增加颈总动脉血流量、改善临床症状以及防治辛伐他汀肝损害等方面均明显优于对照组,并有统计学意义。结论:通过多环节、多机制、多靶点综合作用,研究组有效的延缓了老年高血压颈动脉粥样硬化病变的进程,改善了临床症状,而且有效地防治了辛伐他汀肝功能损害。提示益气活血法是治疗老年高血压颈动脉粥样硬化病变的有效的基本治疗方法。
Objective: To observe the clinic effect of the integration of traditional and western medicine in curing Senile Hypertensive Disease complicated with Carotid Atherosclerosis by using the Chinese traditional medicine combination of supplementing qi and activating blood, to discuss the effecting mechanism and the effecting target. And to reasoning the basic disease mechanism of senile hypertensive disease coincidenced with carotid atherosclerosis is qi deficiency and blood stasis. Method: All suffers were grouped by statistic through delaminating and disparted into two troops. One is used the Chinese traditional medicine combination of supplementing qi and activate blood and simvastatin, another simvastatin only. Resolute: There are outstanding evident differences between the two troops. The investigating troop is better in many aspects, such as adjusting the blood fat, the vasoactive substances, depressing carotid intima-media thickness, subsidising the carotid atheromatous plaque and improving the clinic symptom, and all has statistics meaning. Conclusion: The Chinese traditional medicine combination of supplementing qi and activate blood of Huang Qi Injection Xiang Dan Injection this research choosed operated through many taches, many mechanisms and many targets, which efficiently stayed the course of senile hypertensive disease complicated with carotid atherosclerosis. So, we can say that this combination is a better combination in the therapy of senile hypertensive disease complicated with carotid atherosclerosis
引文
[1] 中国高血压防治指南修订委员会.《中国高血压防治指南》,2005;3~39.
    [2] 蔡海江.动脉粥样硬化基础与临床EM].江苏:江苏科学技术出版社,1996,87.
    [3] Salonen J T, Salonen R,Ultrasound B-mode in observational studies of atherosclerotic progress [J] .Circulation,1993; 88: 20~28.
    [4] Russell Ross,PH D. Atherosclerosis-an inflammatory disease [J] .N Engl JIV.Ed,1999; 340: 115~26.
    [5] 郑筱萸.中药新药临床研究指导原则EM].北京:中国中医药科技出版社,2002,73~76.
    [6] 韩启德.生命科学与医学中的复杂性[R].北京:中科院基础局,2005.
    [7] 李建生.老年医学概论[M].北京:人民卫生出版社,2003,296~297.
    [8] Ki Scrstis P.Roberts L.It's not just the genes[J].Science,2002;296(5568):685.
    [9] 李梢,王永炎.医学研究中系统论与还原论的关联关系[J].北京中医药大学学报,2005:28(5):1~5.
    [10] 印会河.中医基础理论[M].上海:上海科学技术出版社.1994,5~7.
    [11] 王永炎.中医研究的三个重要趋势[J].天津中医药,2005;22(2):89~91.
    [12] 郭伟星,刘伟明,林惠娟,等.益肾降压流浸膏治疗老年高血压病的临床研究[J].中国中医药科技,2000;7(3):137.
    [13] 方力行,张本坤,钱爱珠,等.高肇基辨治高血压病学术思想及电脑系统医理设计[J].上海中医药杂志,1992;(3):6~8.
    [14] 张银娣,王幼林,沈建平,等.黄芪皂甙甲的抗炎和降压作用[J].药学学报,1984;19(5):333~661.
    [15] 王宝琴,苏健,鲁静.黄芪甲甙的检测在中药质控中的应用[J].中国中药杂志,1996;21(3):161~164.
    [16] 吴其夏,余应年,卢建主编.新编病理生理学[M].北京:人民卫生出版社,1999,191~200.
    [17] 何熹延,何吟绵,方蕴春.黄芪治疗心脑血管病的现代研究[M].南京:南京大学出版社,1998,50~55.
    [18] 周宏灏,邬文健,郭兆贵.黄芪对麻醉犬不同区域血管的作用[J].湖南医学院学报,1981:6(4):277~279.
    [19] 俞淦琪.补阳还五汤的临床应用和体会[J].浙江中医杂志,1980;15(1):35.
    [20] 何熹延,何吟绵.冠心病心绞痛中医治疗法则及其疗效原理研究进展[J].中医药信息.1997;(3):8~10.
    [21] 唐其柱,李庚山,黄从新,等.当归对冠心病患者血浆内皮素含量的影响[J].中国中西医结合杂志,1995;15(9):539~540.
    [22] 邓常清,葛金文,王群,等.比较黄芪和活血方对家兔脑再灌注损伤血栓素A2及前列环素和环核苷酸的影响[J].中国中西医结合杂志,1995;15(3):165~167.
    [23] 赵国民.补阳还五汤加减治疗老年眩晕证40例观察[J].黑龙江中医药,1991;(1):20~21.
    [24] 张权斌.大剂量黄芪治疗高血压病15例[J].实用中西医结合杂志,1991;4(10):629~630.
    [25] 张德超.眩晕从瘀论治[J].中医杂志,1992;33(9):15~16.
    [26] 刘叔林.从风病医血探讨气血病变的本质[J].山东中医杂志,1993;12(3):9~10.
    [27] 胡丽霞,倪幼方,吴福娣,等.黄芪对冠心病心绞痛的疗效观察[J].上海医药,1995,(11):7~8.
    [28] 郭兆贵,许树梧,贾宏银,等.黄芪的外周血管作用及与A_2氨酪酸的比较[J].中医杂志,1980,(5):73.
    [29] 施海明,李勇,奚悦文,等.应用活动平板运动试验、24小时动态心电图评价黄芪注射液对冠心病心肌缺血的治疗作用[J].上海医药,1995;(11):19~21.
    [30] 徐标,刘俊,李远东,等.黄芪注射液治疗冠心病的临床疗效观察[J].上海医药,1997;(5):12~13.
    [31] 曹志军,杨汉光.大剂量黄芪注射液治疗冠心病的临床疗效观察[J].北京中医,1997:(3):27~29.
    [32] 孙琳.黄芪注射液治疗46例冠心病伴高粘滞血症疗效分析[J].上海医药,1997;(8):18~19.
    [33] 薛全福,戴顺龄,吴云清,等.川芎、黄芪对金葡地鼠颊囊微循环的作用[J].中华 医学杂志,1986;66(7):409~412.
    [34] 江纪武.植物药有效成分手册EM].北京:人民卫生出版社,1986,35~37.
    [35] 柯铭清.中草药有效成分理化和药理特性[M].长沙:湖南科学技术出版社,1980,48.
    [36] 颜德馨.活血化瘀法临床实践[M].云南:云南卫生出版社,1980,30.
    [37] 中尾万三.关于中药丹参的成分[J].药学杂志,1934,54(9):844.
    [38] 陈可冀.活血化瘀药化学药理与l临床[M].山东:山东科学技术出版社,1995,17~46.
    [39] 杨保津.丹参的活性成分[J].中成药研究,1986;(3):36.
    [40] 中国中西医结合学会活血化瘀研究学会.血瘀证与活血化瘀研究[M].北京:学苑出版社,1990,198~201.
    [41] 孙锡铭.丹参素的新药理作用[J].中草药,1991;22(1):20~23.
    [42] 晏勇.丹参对脑梗塞患者血清HDL-C的影响[J].重庆医科大学学报,1989;14(2):112~115.
    [43] 徐理纳.22种活血化瘀药对狗外周血流量的作用[J].新医药学杂志,1984;5(3):5~14.
    [44] 李承珠.丹参抗凝血作用的研究[J].中西医结合杂志,1983;(5):297.
    [45] 曹培桢,冯瑞华,冯召开.腹蛇抗栓酶加复方丹参注射液治疗脑梗塞疗效观察[J].广西中医药杂志,1994;(4):3.
    [46] 上海第一医学院中山医院.注射大剂量复方丹参对狗左冠状动脉回旋支流量、股动脉流量及左心室内压力的影响[J].医药工业,1976;(4)16~20.
    [47] 上海第一医学院生理教研组.丹参制剂静脉滴注治疗冠心病的疗效和原理初步探讨[J].中华内科杂志,1977;2(1):203~206.
    [48] 宋怀方.复方丹参治疗23例糖尿病肾病的临床观察[J].南京中医学院学报,1994;10(2):14.
    [49] 杨卫东.丹参的氧自由基清除作用[J].中国药理通报,1990;6(2):118.
    [50] 张世华.用激光多普勒效应测定丹参液对肠系膜微循环的影响[J].中西医结合杂志,1984:4(9):546.
    [51] 朱洪生.丹参对心脏缺血停跳时心肌保护效能的研究[J].上海第二医学院学报, 1984;4(3):177.
    [52] 张昕新.丹参注射液对四氯化碳中毒小鼠、大鼠肝脏血流量及肝损伤作用[J].中国药理学通报,1986;2(6):10.
    [53] 刘斌.复方丹参对肝硬化大鼠肝脏缺血再灌注损伤的影响[J].徐州医学院学报,1996;16(3):265.
    [54] 何秀英.黄芪注射液与丹参注射液合用治疗脑梗塞30例临床观察[J].上海医药,1996;(9):9.
    [55] 安平.黄芪与丹参注射液联合治疗充血性心力衰竭临床疗效观察[J].全国中医、中西医结合心脑血管病学术研讨会论文专辑.中国中西医结果学会,1997:117~118.
    [56] 周丽,黄立武.复方丹参注射液单用和伍用黄芪注射液治疗心绞痛疗效观察[J].实用中西医结合杂志,1997,10(11):1083~1084.
    [57] 胡晓春,刘开富,田兆敏,等.复方丹参注射液合黄芪注射液治疗老年高血压心肌缺血60例[J].新中医,2003,35(9):52~53.
    [58] ClavelIAL,MattinglyMT, Stevens7'L,et al.Angiotensin converting enzyme inhibition modulates endogenous endothelin in chronic canine thoracic 69 inferior vena caval constriction[J].JClinInvest, 1996; 97(5): 1286~1292.
    [59] Schulz R,Triggle CR.Role of NO in vascularsmooth muscle and cardiac muscle function[J].Trends Pharmacol Sci, 1994; 15(7):255~259.
    [60] IchikiT, UsuiM, KatoM, et al.Downregulation of angiotensinli type 1 receptor gene transcription by nitric oxide[J].Hypertension, 1998; 31:342~348.
    [61] Luschcr, T.F.etal.Endothelium-dcrivcd relaxing and comtractring Factor [J] .Kidney Int,1991 ; 39:575~590.
    [62] Martin Ti,Lan Ls,Roger DN,etal.Prostanoids in platelet vasoular Interactions [J] .Am Jcardiac,1983; 52(2):22~27.
    [63] 郑磊明,宋春表,季寇芳,等.脑血管病心肌梗塞病人血浆中血栓素B:和6-酮前列环素F1含量测定的临床分析[J].临床荟萃,1994;(907):769.
    [64] 朱伟,许文荣,焦志军,等.血浆PTF、TXB2和6-keto-PGF_(1α)检测在老年脑梗塞、高血压患者中的临床意义[J].临床检验杂志,1998;16(4):223.
    [65] 赵传河、梁君超、史发明,等,糖尿病患者与正常人TXB_2和PGF_(1α)对照研究[J].中国民政医学杂志,1995:7(6):331~332.
    [66] Steinberg D, et al. Lipoprotein and atherosclerosis-current concepts [J]. JAMA, 1990; 264: 3047.
    [67] Van Tol A. Reverse cholesterol transport [J]. In: Cholesterol transport systems and their relation to atherosclerosis, eds Steinmetz A, et al: Berlin, Springer Vedag, 1989: 85~89.
    [68] Berg K. A new system in man-the Lp system [J]. Acta Pathol Microbiol Stand, 1963: 59: 369.
    [69] SasakiR, Yamano S, Yamamoto, et al. Vascul remodeling of the carotid artery in patients wit untreated essential hypertension in creases with age [J]. Hypertens Res, 2002: 25: 373~379.
    [70] Zizek B, Poredos P. Dependence of morphological Changes of the carotid arteries on essential hypertension and accompanying risk factors lint Angiol [J]. Acta Pathol Microbiol Stand, 2002: 21: 70~77.
    [71] 王拥军.应加强颈动脉粥样硬化的基础和临床研究[J].中华神经科杂志.2001:34:257~258.
    [72] Hodis HN, Mack WJ, Labree Let al. The yole of carotid arterial intima-media thickness in predicting clinical coronary events [J]. Ann Intern Med, 1998; 128: 262~265.
    [73] 袁洪,杨侃.老年高血压[M].北京:人民卫生出版社,2002,85~88.
    [74] The ALLHAT officers and coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial(ALLHAT). JAMA, 2002, 288(23): 2981~2997.
    [75] Sever PS, Dahlof B, Poulter NR, et al for the ASCOT investigators. The prevention of coronary events and stroke with atorvastain in hypertensive subjects with average or below average cholesterol levels. The Anglo-Scandinavian Cardiac Outcomes Trial: Lipid Lowering Arm(ASCOT: LLA). Lancet, 2003, 361: 1149~1158.
    [1] 中国高血压防治指南修订委员会.《中国高血压防治指南》,2005;3~39.
    [2] 袁洪,杨侃.老年高血压[M].北京:人民卫生出版社,2002,85~88.
    [3] 赵瑞红.中医辨证治疗老年高血压病[J].新中医,2005,37(11):83~84.
    [4] 屈松柏,李家庚.实用中医心血管病学[M].北京:北京科学技术文献出版社,1993.347—354.
    [5] 陈可冀.岳美中老中医治疗老年病经验[M].北京.中医古籍出版社,1978,13.
    [6] 赵立诚,邓中炎.邓铁涛治疗高血压病经验辑要[J]。新医学,1983,14(3):117~118.
    [7] 陈茂仁.益肾降压汤治疗老年高血压66例[J].天津中医,1992,(5):21.
    [8] 孙柏杨,黄丽娟,曹若楠.醒脑清眩片治疗中老年高血压病的临床及实验研究[J].中医杂志,1995,36(1):28~29.
    [9] 段学忠.益气化瘀汤治疗老年高血压病30例[J].新中医,1991,23(3):27~29
    [10] 孙锡印,杨雯琳.延寿降压汤改善老年高血压病脂质代谢的研究[J]。湖南中医药导报,1997,3(5):10~12.
    [11] 李运伦,姚晓渝.补肾方对老年高血压患者的影响[J].中国医药学报,1999,14(5):346~348.
    [12] The ALLHAT officers and coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial(ALLHAT) [J]. JAMA, 2002, 288(23): 2981~2997.
    [13] Sever PS, Dahlof B, Poulter NR, et al for the ASCOT investigators. The prevention of coronary events and stroke with atorvastain in hypertensive subjects with average or below average cholesterol levels. The Anglo-Scandinavian Cardiac Outcomes Trial: Lipid Lowering Arm(ASCOT: LLA) [J]. Lancet, 2003, 361: 1149~1158.
    [14] 王国民,程方洲,唐国华.伲福达与银杏叶联用治疗老年高血压病34例临床分析[J].福建中医药,2005,5:26.
    [15] 马红兵,宋翼,王静.中西医结合治疗老年单纯收缩期高血压病55例[J].时珍国医国药,2005,16(10):1047.
    [16] 张俊莲.中西医结合治疗老年高血压病36例[J].中西医结合心脑血管病杂志,2003,1(8):486~487.
    [17] 戴英,巫容.中西医结合治疗老年高血压40例临床观察[J].现代中西医结合杂志,2002,11(4):315~316.
    [18] 肖君芳,蔡建中.中西医结合治疗对老年性2级高血压患者生活质量影响调查研究[J].福建中医药,2002,(33)1:10~11.
    [19] Hayaishi-Okano R, Yamasaki Y, Katakami N, et al. Elevated C-reactive protein associates with early-stage carotid atherosclerosis in yong subjects with ldiabetes[J]. Diabetes Care, 2002, 25: 1432~1438.
    [20] Sasaki R, Yamano S, Yamamoto T, et al. Vascular remodeling of the carotid artery in patients with un-treated essential hypertension in creases with age [J]. Hypertens Res, 2002, 25: 373~379.
    [21] 孙余华,裴卫东,惠汝太.炎症与动脉粥样硬化基础和临床研究新进展[J].中国循环杂志,2003,18(3):232~235.

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