摘要
目的:(1)探讨原发性高血压肾损害与不同中医证型的关系。(2)探讨原发性高血压肾损害患者尿微量白蛋白及肾动脉阻力指数(RI)与臂踝脉搏波传导速度(baPWV)、踝肱指数(ABI)的关系。方法:本实验共收集山东中医药大学第二附属医院2010年10月—2011年2月住院病人44例进行研究,其中男28例,女16例,平均年龄55.07岁;均符合高血压肾损害诊断标准。设计原发性高血压肾损害患者登记表,运用四诊的方法收集每个患者的病史资料、客观指标数据准确填入登记表,并参照《中药新药临床研究指导原则》及相关古代文献分别进行辩证,得出辩证证型。分析高血压肾损害患者尿微量白蛋白、RI与中医证型及PWV、ABI关系。所得结果均采用SPSS17.0统计软件包进行数据处理;计量资料结果采用±SD表示,正态分布资料采用t检验,非正态分布资料采用秩和检验,计数资料采用卡方检验;变量间的相关程度,用相关性分析。结果:44例高血压肾损害患者均进入结果分析。肝火亢盛证26例,痰湿壅盛证18例。尿微量白蛋白与中医证型的关系:肝火亢盛组与痰湿壅盛组相比无显著性差异。肾动脉阻力指数与中医证型的关系:肝火亢盛组与痰湿壅盛组相比无显著性差异。肝火亢盛组尿微量白蛋白与PWV呈正相关(P<0.05);痰湿壅盛组尿微量白蛋白与PWV呈正相关(P<0.01)。PWV与中医证型的关系:肝火亢盛组与痰湿壅盛组相比无显著性差异。结论:1.不同中医证型的原发性高血压肾损害患者的尿微量白蛋白、肾动脉阻力指数不同,反映了原发性高血压肾损害的程度与中医证型相关。2.不同中医证型的原发性高血压肾损害患者的PWV、ABI不同,但原发性高血压肾损害的动脉损伤程度与中医证型不相关。
Objective:(1)Explore the relationship between essential hypertensive renal damage and the different Traditional Chinese Medicine(TCM)syndrome type (2)Explore the relationship between microalbuminuria、renal artery resistance index (RI) in patients with essential hypertensive renal impairment and and brachial-ankle pulse wave velocity (baPWV), ankle brachial index(ABI)。Methods:Collect the second of Shandong Medical University Hospital in October 2010 -2011 44 cases in February to study patients, including 28 males and 16 females, mean age 55.07 years; meet diagnostic criteria for hypertensive renal damage . Renal damage in patients with essential hypertension Design registration form, using four diagnostic methods to collect information on each patient's medical history, objective and accurate indicator data fill in the registration form, and with reference to "guidelines for new drug clinical research of Chinese medicine" and related ancient documents separately dialectic dialectical syndrome obtained. Analyze the relationship between microalbuminuria, RI and TCM syndrome and PWV, ABI . The results are used SPSS17.0 statistical package for data processing;±SD using results of the measurement data, said normal data using t test, non-normal data using rank-sum test, chi-square test with count data; understand the variables extent of close contact with the correlation analysis. Results:44 cases of hypertensive patients with renal impairment are the result analysis. Liver dampness Kang Sheng Group in 26 cases, 18 cases of tan shi yong sheng Group. the relationship between TCM and Microalbuminuri:Liver dampness Kang Sheng Group and tan shi yong sheng Group had no significant difference. the relationship between TCM and Renal arterial resistance index: Liver dampness Kang Sheng Group and tan shi yong sheng group have no significant difference.In Liver dampness Kang Sheng Group microalbuminuria is positively correlated with PWV (P<0.05); In tan shi yong sheng Group microalbuminuria is positively correlated with PWV (P<0.01). the relationship between TCM and PWV: Liver dampness Kang Sheng group and tan shi yong sheng Group was not significant. Conclusion:1. Primary renal hypertension of different syndromes of microalbuminuria, renal artery resistance index values of different, reflecting a relationship between the degree of primary hypertension renal damage and TCM syndrome type. 2. Primary renal hypertension of different syndromes of PWV, ABI values different, but not reflecting a relationship between hypertensive renal impairment artery damage degree and TCM syndrome type。
引文
[1]王海燕.肾脏病学[M].北京:人民卫生出版社,1998.
[2]郑筱萸.中药新药临床研究知道原则(试行)[S].北京:中国医药科技出版社,2002.
[3]程文江,覃志成,郭峰,等.原发性高血压病602例中医证候流行病学研究[J].浙江中西医结合杂志, 2003, 13 (4) : 261 .
[4]唐蜀华.高血压病[J].江苏中医药, 2004, 25 (10) : 11 - 12 .
[5]张荣珍.高血压病靶器官损害的中医药治疗思路[J].陕西中医学院学报, 2003, 26 (专辑) : 69—71.
[6]陈刚,郭茂川,张六通,等.肾虚、血瘀、痰浊阻络为衰老的基本病机[J].中国中医基础医学杂志, 2001, 7 (7) : 8- 9 .
[7]蔡光先,等.高血压病常见证候流行病学观察[J].中医杂志,1999, 40 (8) :492 - 493.
[8] Word Health Organization. International Society of Hypertension guidelines for the management of hypertension Guidelines Subcommittee [J] .Hypertension, 1999,17(8): 152 -183.
[9] Meaume S,Rudnichi A,Lynch A,et al.Aortic pulse wave velocity as a marker of cardiovascular disease in subjects over 70 years old[J]. Hypertension,2001,19(7):871-877.
[10] Wang Hi,Zhang W,Gong LS,et a1.Study of relationship between arteriosclerosis and large arterial buffering function in patients with essential hypertension[J]. Chin Cardiol,2001,29(6):206-209.
[11] Nichols 0’Rourke MF.McDonald’S Blood Flow in Arteries. Theoretical, Ex- perimental and Clinical Principles[M].Oxford:Oxford University Press,2005.
[12] Tomiyama H,Koji Y,Yambe M,et al.Brachial—ankle pulse wave velocity is a simple and independent predictor of prognosis in patients with acute coronary syndrome[J].Circ ,2005,69(7):815—822.
[13] Mancia G,De Backer G,Domimczak A,et a1.2007 Guidelines for themanagement of arterial hypertension:The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension(ESH) and of the European Society of Cardiology(ESC)[J].Eur Heart ,2007,28(12): 1462-1 536.
[14]王领军,胡大一,李田昌,等.踝臂指数评价缺血性卒中下肢外周动脉病多中心临床研究[J].中国医药导刊,2005,7(1):27-29.
[15]李保应,高海青,李小利,等.脉搏波速度和踝臂指数与心血管危险因素的关系[J].山东大学学报(医学版),2007,45(7):669-672.
[1]欧敏,周宜轩诊治原发性高血压早期肾损害经验[J].中医药临床杂志,2005,17(1):78.
[2]孟伟,滋阴降火通络汤治疗高血压病早期肾损害的临床研究[J].山东中医药大学学报,2003,27(5):364.
[3]程广书.高血压肾损害的中医药治疗思路[J].河南中医,2001,2l (1):3l.
[4]严冬,蒋为民,唐蜀华。降压益肾颗粒治疗高血压病早期肾损害35例疗效观察[J].中医药研究,1999,15(1);6-7.
[5]饶向荣,吴瑞英.94例肾实质性高血压的辨证研究[J].江西中医药,1997,16(4):18.
[6]叶景华.治疗肾性高血压经验[J].湖南中医杂志,1997,13(4):21-22
[7]冯国标.中西医结合治疗肾性高血压96例观察[J].实用中医药杂志,2001,17
[8]顾左宁,陈宁勇.于肝降压号为主辨治肾性高血压78例[J].南京中医药大学学报,1997,16(4):241-242
[9]刘宏伟.临床解惑[J].中医杂志,1998,17(4):374-373.
[10]王国印,原发性高血压早期肾损害中医证型与血、尿β2–MG及尿ALB、IgG的关系[J].安徽中医学院学报,2004,23(1):10-12.
[11]丁碧云、邵正斌、郑林等,原发性高血压早期肾损害与中医证型的相关性研究[J].安徽中医学院学报,2006,25(4):6-9.
[12]汪绍兴,华杰,中西医结合治疗高血压病肾损害[J].湖北中医杂志,2002,24(12):19
[13]魏国健,钟培金,丘伟中,中西医结合治疗高血压病早期肾损害临床观察[J].现代医院,2006,6(3):67-69
[14]唐树德,刘国明.首乌治疗早期肾脏损害血瘀型高血压患者28例[J].中国中西医结合杂志,1994,14(5):302—303
[15]张英.不同疗法对二肾一夹型高血压大鼠血管紧张素、心钠素含量影响的比较[J].中国针灸,1996,(5):35—37
[16]魏国健,钟培金,丘伟中.中西医结合治疗高血压病早期肾损害临床观察[J].现代医院,2006,6(3):67—69.
[17]赵林双,廖玉华,王敏,等.抗β1和M受体自身抗体和神经内分泌激素与高血压合并肾损害的关系[J].第二军医大学学报,2006,27(10):1150.
[18] PATRICIAFP,ESTEBAND.JOSEBO,eta1.Angiotensin convertin genzyme gene I/D polymorphismin essential hypertensionandnephroangloscleros1s [J].Kidney I n t,1998,53(6):1743—1747.
[19]陈义汉,徐文渊,等。遗传和环境因素对高血压患者肾脏损害的影响[J].上海第二医科大学学报,2000,20(6):521—523.
[20]付治卿,周聊生.高血压肾损害机制的探讨[J].临床荟萃,2004,19(8): 469
[21]杨红霞,朱敏怡.彩色多谱勒超声对高血压肾损害的研究[J].实用医学杂志,2005,21(1):59.
[22]沈莉蕴.老年高血压患者踝臂指数与颈动脉粥样硬化的相关性[J].上海交通大学学报(医学版),2006,28(5):518-5l9.
[23] Ostergren J,Sleight P,Dagenais G,et a1.Impact of ramipril in patients with evidence of clinical or subclinical peripheral arterial disease[J].Eur Heart J,2004, 25(1):17-24.
[24] Boutouyrie P,Tropeano AI,Asmar R,et a1.Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients:a longitudinal study[J].Hypertension,2002,39(1):10-15.
[25] Domanski M, Norman J, Wolz M, et al,Cardiovascular risk assessment using pulse pressure in the first national health and nutrition examination survey [J].Hypertension,200 l,3 8(4):793—797.
[26] Blacher J,Pannier B,Guerin AP,et a1.Carotid arterial stiffness as a predictor of cardiovascular and an cause mortality in end stage renal disease[J].Hypertension,1 998,32(3):570—574.