益心降压胶囊对阴虚阳亢血瘀证型2级原发性高血压左室质量指数及血浆神经肽Y的影响(英文)

Effect of yixin jiangya capsule on left ventricular mass index and plasma neuropeptide Y of primary grade 2 hypertensive patients with hyperactivity of yang due to yin deficiency blood stasis

背景:原发性高血压引起的左室肥厚是发生各种心血管并发症具有独立作用的危险因子,逆转左室肥厚已成为当前高血压治疗的重要目标之一。血浆神经肽Y有内皮源性缩血管作用,通过对血管内皮细胞的作用发挥对血管舒缩功能的调节作用而参与高血压的发病和维持。目的:观察益心降压胶囊对阴虚阳亢血瘀证型2级原发性高血压左室肥厚患者左室质量指数及神经肽Y含量的影响。设计:以患者为观察对象,病例分析。单位:解放军济南军区总医院中医科;山东中医药大学附属医院内科。对象:选择2003-03/2005-08解放军济南军区总医院、山东中医药大学附属医院93例自愿参加本实验的阴虚阳亢血瘀证型2级原发性高血压左室肥厚患者。采用随机数字表将患者分为两组。观察组62例,男40例,女22例;年龄46～70岁,平均58.94岁;病程2～19年,平均8.93年。对照组31例,男19例,女12例;年龄44～69岁,平均59.27岁;病程2.5～18年,平均9.11年。另设健康组30例,均来自健康体检人群。方法:两组患者均口服依那普利片,每次10mg,每日1次。观察组加服益心降压胶囊(药物组成为:生地黄、生首乌、桑寄生、川牛膝、钩藤、石决明、夏枯草、天麻、牡丹皮、赤芍药、地龙、穿山龙等,按比例配方,提取浓缩,装入胶囊,每粒0.5g,每克含生药4.65g,由山东济南宏济堂制药有限责任公司提供,批号:021214),每次5粒,每日3次。两组疗程均为24周。采用超声心动图仪和放射免疫分析法分别测定两组患者治疗前后左室质量指数和血浆神经肽Y含量。同时测定健康组上述指标作对照。主要观察指标:左室质量指数和血浆神经肽Y含量变化;血压变化;不良事件及副反应。结果:93例患者均进入结果分析。①治疗前观察组和对照组患者左室质量指数和血浆神经肽Y含量均较健康组显著升高[(147.2±16.9),(146.7±17.2),(101.8±22.4)g/m2;(135.4±33.2),(133.8±31.1),(78.6±24.5)ng/L;P<0.01];②治疗24周后两组患者左室质量指数和血浆神经肽Y含量均显著降低,且观察组优于对照组[(103.9±24.6),(122.6±19.9)g/m2;(82.9±25.2),(113.7±26.2)ng/L;P<0.05～0.01]。③观察组治疗后左室质量指数和血浆神经肽Y含量与健康组比较差异无显著性(P>0.05),对照组仍高于健康组(P<0.01)。④观察组和对照组收缩压、舒张压下降幅度比较差异无显著性[(137.4±12.8),(134.2±11.9)mmHg;(80.1±8.3),(81.7±7.4)mmHg,P>0.05]。两组患者治疗前后血常规和肝肾功能均无明显变化,治疗过程均未出现不良反应。结论:阴虚阳亢血瘀证型2级原发性高血压左室肥厚患者左室质量指数和血浆神经肽Y含量显著高于健康人;在依那普利应用基础上服用益心降压胶囊具有较好的逆转左室肥厚和降低血浆神经肽Y含量的作用。

BACKGROUND： Left ventricular hypertrophy induced by primary hypertension is a risk factor which has a dependent effect on various cardiovascular complications. Reversal left ventricular hypertrophy has been a key object for treating hypertension currently. Plasma neuropeptide Y has endothelium-derived contracting blood vessel, and has adjusting effect on vasomotor function through endothelial cell to participate in onset and maintenance of hypertension. OBJECTIVE： To investigate effect of yixin jiangya capsule on left ventricular mass index （LVMI） and content of neuropepfide Y of primary grade 2 hypertensive patients with left ventricular hypertrophy of hyperactivity of yang due to yin deficiency blood stasis. DESIGN： Case analysis on the basis of patients. SETTING： Department of Traditional Chinese Medicine, General Hospital of Jinan Military Area Command of Chinese PLA; Department of Internal Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine. PARTICIPANTS： Totally 93 primary grade 2 hypertensive patients with left ventricular hypertrophy of hyperactivity of yang due to yin deficiency blood stasis were selected from General Hospital of Jinan Military Area Command of Chinese PLA and Affiliated Hospital of Shandong University of Traditional Chinese Medicine from March 2003 to August 2005. All cases were divided into two groups according to random digital table. There were 62 cases in observational group including 40 males and 22 females aged from 46 to 70 years with mean age of 58.94 years and coursed from 2 to 19 years with mean course of 8.93 years. There were 31 cases in control group including 19 males and 12 females aged from 44 to 69 years with mean age of 59.27 years and coursed from 2.5 to 18 years with mean course of 9.11 years. Another 30 people were regarded as healthy group. METHODS： Patients in both groups were treated with enalaprol orally with 10 mg each time of once a day. Patients in observational group were also treated with yixin jiangya capsule （component： shengdihuang, shengshouwu, sangjisheng, chuanniuxi, gouteng, shijueming, xiakucao, tianmo, mudanpi, chishaoyao, dilong, chuanshanfia, etc. mixed according to ratio, extracted, concentrated, made of capsule, 0.5 g/pill, 4.65 g/raw drug, provided by Shandong Jinan Hongjitang Pharmacy Limited-liability Company, batch number. 021214）, 5 pills once for 3 times every day. Courses in both groups were 24 weeks respectively. LVMI and content of neuropeptide Y were measured with ultrasonic cardiograph and radio-immunity analysis method before and after treatment.Meanwhile, indexes mentioned above were also measured in healthy group so as to regard as the controls. MAIN OUTCOME MEASURES： LVMI, content of neuropeptide Y, changes of blood pressure, adverse events and side effects. RESULTS： Totally 93 patients entered the final analysis. ① LVMI and content of neuropeptide Y were increased both observational group and control group before treatment [（147.2±16.9）, （146.7±17.2）, （101.8±22.4） g/m^2; （135.4±33.2）, （133.8±31.1）, （78.6±24.5） ng/L; P 〈 0.011. ② LVMI and content of neuropeptidc Y were decreased both observational group and control group after 24-week treatment, and those in observational group were superior to those in control group [（103.9±24.6）, （122.6±19.9） g/m^2;（82.9±25.2）, （113.7±26.2） ng/L; P 〈 0.05-0.01]. ③ LVMI and content of neuropeptide Y in observational group were not significantly different from those in healthy group increased both in observational group and control group after treatment （P.〉 0.05）, and those in control group were higher than those in healthy group （P 〈 0.01）. ④ Descent levels of systolic pressure and diastolic pressure were not significantly different between observational group and control group [（137.4±12.8）, （134.2±11.9） mm Hg; （80.1±8.3）, （81.7±7.4） mm Hg, P 〉 0.05]. Blood routine and liver-kidney function were not changed obviously both groups before and after treatment, and side effect was not observed during the process. CONCLUSION： LVMI and content of neuropeptide Y of primary grade 2 hypertensive patients with left ventficular hypertrophy of hyperactivity of yang due to yin deficiency blood stasis are higher than those of healthy people. Yixin jiangya capsule can deteriorate left ventricular hypertrophy and decrease Ihe content of neuropeptide Y on the basis of application of enalaprel.