摘要
目的：观察中西医结合方案对老年高血压病早期肾损害干预的疗效。方法：将60例符合标准的高血压病早期肾损害患者随机分为对照组30例,研究组30例。对照组仅给予常规西药治疗,研究组在常规西药的基础上根据中医辨证分型(痰瘀阻络型、阴虚阳亢型、肾虚型)加用相应的中药治疗,观察治疗前后诊室血压、24小时动态血压和肾损害指标变化。结果：临床研究表明,研究组血压降低显著(P<0.05),降压总有效率为93.3%；研究组中医症候疗效明显优于对照组(P<0.05)；在患者早期肾损害的评价中,研究组的各项指标的改善明显优于对照组(P<0.05-0.01)。结论：中西医结合方案是治疗高血压病及改善早期肾功能损害的有效方法,在西药治疗的基础上,根据中医辨证分型(痰瘀阻络型、阴虚阳亢型、肾虚型)予以相应的中药不仅能提高的降压疗效、缓解临床症状,而且能改善患者的肾功能,减轻和延缓老年高血压病患者早期肾损害的发生。
Objective:Observing the efficacy of the intervention program of Combined Chinese and Western Medicine in elderly hypertensive patients with early renal damage. Methods: 60 cases met the standards of elderly hypertensive patients with early renal damage were randomly divided into 30 cases of Control Group,30 cases of the Study Group. Control Group only received conventional western medicine, and Study Group plus traditional Chinese medicine with the appropriate treatment on the basis of conventional western medicine according to TCM syndrome differentiation type (phlegm and blood stasis blocking network type, deficiency of Yin and hyperactivity of Yang type, kidney-type), then observed changes in clinic blood pressure before and after treatment,24-hour ambulatory blood pressure and indicators of renal injury. Results:Clinical studies have shown that Study Group significantly reduced blood pressure (P<0.05), and the antihypertensive efficacy was 93.3%; The efficacy of TCM symptom of Study Group was better than Control Group (P<0.05); In the evaluation of patients with early renal damage, all indicators of Study Group improved significantly better than the Control Group (P<0.05～0.01). Conclusion:Chinese and Western medicine combined program is an effective method of treating hypertension and improving early renal dysfunction. Traditional Chinese medicine with the appropriate treatment on the basis of conventional western medicine according to TCM syndrome differentiation type (phlegm and blood stasis blocking network type, deficiency of Yin and hyperactivity of Yang type, kidney-type) can not only enhance the antihypertensive efficacy, relieve symptoms, but also improve the patient's renal function, reduce and delay the elderly hypertensive patients with early renal damage occurring.
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]中国老年高血压治疗共识专家委员会.心脑血管病防治.2009,9(1)：1-5.
[3]郑筱萸.中药新药临床研究指导原则(试行),北京：中国医药科技出版社,2002;1：73-77.
[4]李春梅,陈运贞.老年高血压的发病机制[J].重庆医科大学学报.1991;18(3)：259-262.
[5]STERZEL R B, LUFT F C, GAO Y, et al. Renal disease and the development of hypertension in salt-sensitive Dahl rats [J]. Kidney Int,1988;33 (6): 1119-1129.
[6]李招云等.高血压病患者肾脏早期损害指标的探讨.中华检验医学杂志,2001;24(5)：282-284.
[7]丁有钦.高血压病的中西医诊治[J].新中医,2000,32.
[8]李剑,史亚飞,严灿等.原发性高血压中医病机及其从痰瘀论治的机理探讨[J].江西中医药,2003：34(245)：11.
[9]鞠大宏,韩学杰,谢雁鸣等.高血压病从络论治探讨[J].中国中医基础医学杂志,2001：7(9)：43.
[10]陈可冀.岳美中老中医治疗老年病的经验[M].北京：科学技术文献出版社,1978：27-28.
[11]李晓辉.从肾论治老年高血压病134例临床观察[J].国医论坛,2007;22(5)：26.
[12]刘力生,龚兰生,孔华宇主编.临床高血压病学[J].天津科学技术出版社,1990：310-316.
[13]蔡师敏.中西医结合治疗原发性高血压病疗效观察[J].光明中医,2006;21(8)：85-86.
[14]麦志广,朱琳,杨群玉.双石汤对高血压病血管内皮功能保护作用的临床研究[J].湖北中医杂志,2006：28(7)：11-12.
[15]杜林.中西医结合治疗顽固性原发性高血压40例[J].国医论坛,2004;19(3)：36-37.
[16]赵文明,李浩,刘剑刚,崔玲等.降压胶囊治疗老年单纯收缩期高血压及改善患者生存质量的临床观察[J].世界中医药学会联合会老年医学专业委员会成立大会暨第一届学术会议论文集,2008：176-183.
[17]李浩,刘宇,于振宣等.降压胶囊联合尼莫地平治疗老年单纯收缩期高血压的疗效及其对患者生存质量的影响[J].世界中医药学会联合会老年医学专业委员会成立大会暨第一届学术会议论文集,2008：137-143.
[18]于向东,周文泉,崔玲,崔军.络活胶囊对高血压病患者动态血压和生活质量的影响[J].中医杂志,2003：44(12)：912-915.
[19]周文泉,高普,谢雁鸣,崔玲等.长生降压液对老年肾虚证[J].中国中西医结合杂志,1995：9：532-535.
[20]傅良雄.心血管病前沿研究.上海：上海科学技术文献出版社,1993：157.
[21]吴青.中华医学老年医学会全国老年人高血压研讨会纪要.中华老年医学杂志,1995：12(1)：4.
[1]Porush JG. Hypertension and chronic renal failure:the use of ACE inhibitors.Am J Kidney Dis,1998;31(1):177.
[2]钱桐荪,李成进,崔世维.老年高血压病的肾损害.实用老年医学,1996；1：13-15.
[3]Cooper M E. Pathogenesis,prevention and treatment of diabetic nephropathy, [J]. Lancet,1998;352(6):213-219.
[4]Anderson W P, Kett M M, Evans R G, et al.Preglomerular structural changes in the renal vasculature in hypertension [J].Blood Press,1995;2(11):74-80.
[5]黄峻,陆凤翔.实用内科诊疗规范.[M].南京：江苏科学技术出版社,2003,228～230.
[6]徐国宾,李志艳.应重视实验室检查在慢性肾病早期诊断中的应用.[J].中华医学检验杂志,2006,29(11)：961-965.
[7]Grubb A, Simonsen O, Sturfelt G, et al. Acta Med Scand,1985;218:499-503.
[8]Newman DJ, Thakkar H, Edwards RG, et al. Kidney Int,1994;46:S20-S21.
[9]Kyhse Andersen J, Schmidt C, Nordin G, et al. Clin Chem,1994;40:1921-1926.
[10]Filler G, Witt I, Priem F, et al. Clin Chem,1997;43:1077-1078.
[11]Parving HH, Jenser HA, Mogensen CE, et al. Increased urinary albumin Excretion rate in benign essential hypertension [J].Lancet,1974;1:1190.
[12]Christensen CK, Rapidly reversible albumin and β2-microglobulinhyper-excretion in recent severe essential hypertension [J].Hyper-tens,1983;1:45.
[13]Cerasola G, Cottone S, Dlgnoto G, et al.Microalbuminuria, renal dysfution and cardiovascular complication in essential hypertension [J].Hype-rtens,1996; 14(7): 915-920.
[14]Ming J,Sheng LL, Zhang LG, et al. Abnormal renal functionin isolated systolic hypertension correlation with ambulatory blood pressure [J].Int J Cardiol, 1993;41(1):69.
[15]李招云等.高血压病患者肾脏早期损害指标的探讨.中华检验医学杂志,2001；24(5)：282-284.
[16]李玉冰,李海珍,莫丽丽等.高血压患者血压昼夜节律变化与肾损害关系的探讨.广西医学,2003；25(12)：2375-2376.
[17]孟秋云,高云,孙虹.高血压病患者血压昼夜节律改变与高血压肾损害的关系.临床内科杂志,2002；19(4)：273-279.
[18]Berlyne GB, Brooklyn NY, et al. Contributions to Nephrology.1989;75:108-116.
[19]陈香美,李岩,李文歌等.血管紧张素转化酶抑制剂减轻肾小球硬化机制的探讨.中华肾脏病杂志,1998；14：139-142.
[20]徐向青,郑三霞.高血压病肾损害病机简析.中医药学刊,23(1)：312-313.
[21]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)：364-366.
[22]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),78-79.
[23]程广书.高血压肾损害的中医药治疗思路.河南中医,2001；21(1)：31.
[24]范群丽,赵东杰,唐蜀华.降压益肾颗粒治疗高血压病早期肾损害临床观察.南京中医药大学学报,2003；4(5)：273-275.
[25]何有为.益肾活血法治疗高血压肾损害临床观察.湖北中医杂志,2007；29(5)：32.
[26]王清海,卢桂梅,李爱华,等.血压健胶囊治疗气虚痰浊型高血压的临床研究.新中医,1998；30(1)：35-36.
[27]陈政光.固本降压合剂治疗中老年高血压临床研究.山东中医杂志,2002；21(2)：72-73.
[28]朱喜英,刘龙民.心脑喜康对EH患者血压及β2-微球蛋白的作用研究.辽宁中医杂志,2001；28(5)：277-278.
[29]刘龙民,朱喜英.心脑喜康对非勺型高血压的血压及肾损害影响.中医药学刊,2001；19(5)：450.
[30]汪绍兴,华杰.中西医结合治疗高血压病肾损害32例.湖北中医杂志.2002；24(12)：19.
[31]吴云霞,李元善,张国欣等.早期肾损伤的检测及氨杞精口服液对其的疗效观察.中国中医药科技,1998；5(2)：115-116.