益气活血法对高血压合并糖尿病前期患者颈动脉粥样硬化的影响

Effect of Therapy of Strengthening Qi and Activating Blood on Carotid Atherosclerosis in Hypertension Patients Complicated with Prediabetes

【目的】评价益气活血法对高血压合并糖尿病前期患者颈动脉粥样硬化的影响。【方法】采用随机、对照试验设计,将83例原发性高血压合并糖尿病前期患者随机分为常规降压组(对照组)40例和益气活血组(治疗组)43例。对照组予以常规降压方案治疗,治疗组在对照组治疗的基础上加用脑心通胶囊治疗,2组均随访治疗6个月。监测2组的血压、血糖、血脂水平,应用彩色多普勒超声诊断仪对患者进行双侧颈动脉斑块大小及性质探查,并测量双侧颈总动脉内膜中层平均厚度(intimal-medial thickness,IMT)。【结果】(1)治疗6个月后,2组患者的血压、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)及餐后2 h血糖水平均显著降低,高密度脂蛋白胆固醇(HDL-C)水平均显著升高,与治疗前比较差异均有统计学意义(P<0.01);且治疗组在改善TG、HDL-C及餐后2 h血糖水平方面作用优于对照组,与对照组比较差异有统计学意义(P<0.05或P<0.01)。(2)治疗6个月后,2组患者的颈动脉IMT及斑块积分均显著下降,与治疗前比较差异均有统计学意义(P<0.01),且治疗组的下降幅度更明显,2组差值比较差异均有统计学意义(P<0.05);不稳定斑块检出率方面,对照组治疗后有下降趋势,但差异无统计学意义(P>0.05),治疗组治疗后有显著下降,差异有统计学意义(P<0.05)。【结论】采用益气活血法治疗高血压合并糖尿病前期患者,不但能够减轻动脉粥样硬化程度,同时还具有稳定颈动脉斑块的作用,而改善患者糖脂代谢可能是其重要机制之一。

Objective To investigate the effect of therapy of strengthening qi and activating blood on carotid atherosclerosis in hypertension patients complicated with prediabetes. Methods A randomized and controlled trial was carried out in 83 hypertension patients complicated with prediabetes. The patients were randomized into control group （N=40） and observation group （N=43） . Both groups were given conventional therapy fordecreasing blood pressure, and the observation group was given Naoxintong Capsules additionally. Treatment in both groups lasted for 6 months. Blood pressure, blood glucose, and blood lipid levels were monitored in both groups. Color Doppler diasonography was adopted for investigating arterial plaque mass and property in bilateral carotid arteries, and for detecting the intimal-medial thickness （IMT） of bilateral carotid arteries. Results （1） After treatment for 6 months, blood pressure, total cholesterol （TC）, triglyceride （TG）, low- density lipoprotein cholesterol （LDL-C） and 2-hour postprandial blood glucose （2hPBG） were decreased, while high-density lipoprotein cholesterol （HDL-C） was increased in both groups, the differences being significant compared with those before treatment （P〈0.01） . The improvement of TG, HDL-C and 2hPBG in the observation group was superior to that in the control group （P〈0.05or P〈0.01） . （2） After treatment for 6 months, IMT and arterial plaque scores were decreased obviously in both groups, the differences being significant compared with those before treatment （P〈0.01） . The decrease of IMT and arterial plaque scores in the observation gronp was more obvious than that in the control group （P〈0.05） . The detection rate for unstable arterial plaque showed decreasing trend in the control group （P〉0.05） , while was decreased obviously in the observation group （P 〈0.05） after treatment. Conclusion Therapy of strengthening qi andactivating blood is effective for the treatment of hypertension patients complicated with prediabetes through relieving carotid atherosclerosis and stabilizing the plaque mass, and regulating glucose and lipid metabolism may be one of its therapeutic mechanisms.