固肾化浊方治疗高血压早期肾损害

Gushen Huazhuo Decoction in Treating Renal Damage at Early Stage in Hypertension

目的：探讨固肾化浊方治疗高血压早期肾损害患者的临床疗效及对内皮素（ET-1）和一氧化氮（NO）的影响。方法：将高血压早期肾损害患者227例随机按数字表法分为联合组114例和西药组113例。西药组在钙离子拮抗剂治疗的基础上,采用坎地沙坦酯片,4-8 mg/次,1次/d。联合组在西药组治疗的基础上加服固肾化浊方加减治疗。两组疗程均为12周。进行治疗前后24 h动态血压监测;检测治疗前后尿微量白蛋白（MA）,β2-微球蛋白（β2-MG）,尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）,尿转铁蛋白（TRF）和胱抑素（Cys C）水平;检测治疗前后血清尿素氮（BUN）,肌酐（Cr）,ET-1和NO水平。结果：联合组综合疗效总有效率为86.84%,优于西药组的75.22%（P〈0.05）;治疗后联合组24 h平均收缩压（24 h ASBP）,24 h平均舒张压（24 h ADBP）,夜间平均收缩压（n ASBP）和夜间平均舒张压（n ADBP）低于西药组（P〈0.01）;治疗后联合组MA,NAG,β2-MG,TRF和Cys C水平均低于西药组（P〈0.01）;两组治疗前后BUN和Cr变化无统计学意义,治疗后组间比较差异也无统计学意义;治疗后联合组ET-1水平低于西药组,NO水平高于西药组（P〈0.01）。结论：在西医常规治疗的基础上,固肾化浊方能降低高血压早期肾损害患者的血压水平,对高血压肾损害有一定的保护作用,临床疗效优于单纯西药治疗,其作用机制能与调节血管内皮活性有关。

Objective： To discuss the curative effects of Gushen Huazhuo decoction in treating renal damage during the early period in hypertension patients, and to investigate its influence on endothelin （ET-1） and nitric oxide （NO）. Method： Two hundred and twenty seven patients were randomly divided into the combined group （114 cases） and the western medicine group （113 cases）. Patients in the western medicine group received 4-8 mg eandesartan cilexetil tablets once daily based on the treatment of calcium antagonists. Based on the treatment of the western medicine group, patients in the combined group added Gushen Huazhuo decoction. All patients in both two groups received 12 weeks of treatment. 24-hour ambulatory blood pressure was monitored before and after therapy. Levels of urine micro albumin （MA）, β2-microglobulin （β2-MG）, urinary N-acetyl-β-D-amino glucosaminidase （NAG）, urinary transferrin （TRF） and cystatin C （CysC） were tested. Standards of serum blood urea nitrogen （BUN） , creatinine （Cr） , ET-1 and NO were detected before and after treatment. Result： The total comprehensive effective rate of the combined group was 86.84% , which was superior to that of 75.22% in the western group （P 〈 0.05 ）. After treatment, levels of 24-h average systolic blood pressure, 24-h average diastolic blood pressure, nocturnal average systolic blood pressure （nASBP） and nocturnal average diastolic blood pressure （nADBP） in the combined group were lower than those in the western group （P 〈 0.01 ）. Standards of MA, NAG, β2-MG, TRF and CysC in the combined group were inferior to those in the western group （P 〈 0.01 ）. Before and after therapy, BUN and Cr changes in two groups have no statistical significance. ET-1 standard in combined group was lower, while NO level was higher in the combined group than those in the western group （P 〈 0.01 ）. Conclusion： Based on conventional western medicine treatment, Gushen Huazhuo decoction could reduce blood- pressure level in hypertension patients during the early period. It has certain protective effect for hypertensive renal impairment. Besides, the therapy clinical curative effect is superior to using western medicine treatment alone. Its action mechanisms may be related to regulating vascular endothelial activity.