综合康复治疗对高血压伴代谢综合征患者的影响

Comprehensive Rehabilitation for 143 Patients with Hypertension Complicated with Metabolism Syndrome

目的:比较高血压伴代谢综合征患者单纯药物治疗与综合康复治疗在降低心血管病危险因素,防治新发心血管病方面的效果。方法:轻、中度高血压伴代谢综合征患者143例分为综合组75例与药物组68例,均接受常规药物治疗,综合组同时加强卫生宣教、有氧运动等综合康复治疗。治疗前后观察2组患者新发心血管病情况及体重指数(BMI)、脉压(PP)、血糖(FBG)、血甘油三脂(TG)、尿酸(UA)、颈动脉内膜中层厚度等变化。结果:随访1.5年,新发心血管病,综合组9例,药物组13例(P<0.05);与药物组及治疗前比较,综合组治疗后TG下降14.7%,向心性肥胖减少16.7%,UA下降21.6%(均P<0.05),颈动脉内膜中层厚度明显改善。心血管病危险因子(TG、向心性肥胖、高UA和PP)在新发心血管病与未发心血管病患者的构成比分别为91%、87%、96%、83%与90%、74%、88%、47%,其中未发心血管病患者的PP明显低于前者(P<0.01)。4种危险因素同时存在,综合组为31%、药物组为70%(P<0.01)。结论:脉压升高、高尿酸血症、高TG、向心性肥胖同时存在是高血压合并代谢综合征患者发生心血管病最主要危险因素,开展综合康复治疗对预防心血管病发生及代谢异常有明显改善作用。

Objective： To explore the effectiveness of combination of both medication and comprehensive rehabilitation in deceasing risk factors related to cardiovascular disease and preventing from events of cardiovascular system in the treatment of hypertension complicated with metabolism syndrome. Methods： The patients with mild and moderate hypertension complicated with metabolism syndrome were randomly assigned into two groups： rehabilitation group and control group, treated with both routine medication and rehabilitation, and routine medication respectively. The changes of new cardiovascular events, body mass index （BMI）, PP, blood glucose, plasma triglyeride （TG）, urine acid （UA） and medial thickness of intima in carotid artery were compared before and after the treatments. Results： There were 22 new cardiovascular events in both groups with 9 in experiment group and 13 in the control, but the difference did not reach statistical significance due to limited numbers of cases. Compared with the control group and those before treatment, the level of TG was decreased by 14.7% （P〈0.05）, central obesity was decreased by 16.7% （P〈0.05）, the elevated urine acid decreased by 21.6% （P〈0.05）, and medial thickness of intima in carotid artery improved apparently in rehabilitation and after treatment. After one and half years of treatment, the risk factors （elevated TG, central obesity, elevated UA and PP） were made up of 91%, 87%, 96% and 83% in the new events occurring group and 90%, 74%, 88% and 47% in non-event group, respectively, of which composition of PP had statistically significant difference （P〈0.01）. The co-existence percentage of 4 risk factors was 70% and 31% in rehabilitation group and control group respectively （P〈0.01）. Conclusion; The co existence of the elevated PP, high level of UA and TG, and central obesity is the major risk factor for development of cardiovascular diseases. Nevertheless, simultaneous rehabilitation can benefit for prevention of cardiovascular diseases and improvement of metabolic abnormality.