补肾平肝方内服加浴足治疗肝火亢盛证难治性高血压47例

Clinical Research of Bushen Pinggan Decoction in Treating 47 Patients with Refractory Hypertension

目的:探讨补肾平肝方内服和浴足配合西医常规疗法治疗难治性高血压肝火亢盛证的疗效及作用机制。方法:将93例患者采用随机按数字法分为对照组46例和观察组47例。对照组采用氯沙坦钾片,50 mg/次,1次/d;硝苯地平片,10mg/次,1次/d;氢氯噻嗪片,25 mg/次,2次/d。观察组在对照组治疗的基础上采用补肾平肝方内服和浴足。两组疗程均为8周。进行治疗前后血压水平测量,并计算治疗后血压达标率,;检测治疗前后一氧化氮(NO),内皮素1(ET-1),血清胱抑素(Cys C)和β2微球蛋白(β2-MG)水平。结果:治疗后观察组收缩压(SBP)和舒张压(DBP)水平低于对照组(P<0.01);经Ridit分析,观察组血压控制疗效优于对照组(P<0.05);治疗后对照组血压达标率为41.3%,低于观察组的65.9%(P<0.05);治疗后观察组Cys C和β2-MG低于对照组(P<0.01);治疗后两组ET-1水平下降,观察组下降更为显著(P<0.01);治疗后两组NO水平均上升,观察组NO上升更明显(P<0.01)。结论:在西医常规治疗的基础上,补肾平肝方内服和浴足能进一步控制难治性高血压(肝火亢盛证)患者的血压水平,提高血压达标率,并对高血压早期肾损害有一定的保护作用,其机制可能与调节血管内皮功能有关。

Objective： To discuss the clinical efficacy and action mechanism of Bushen Pinggan decoction for oral and bath foot combined conventional Western medicine in treating refractory hypertension of overabundant liver-fire syndrome. Method： Ninety-three patients were randomly divided into the control group （46 cases） and the observation group （47 cases） by a random number table. Patients in the control group received 50 mg Losartan Potassium tablets once daily, 10 mg Nifedipine tablets once daily and 25 mg I-Iydrochlorothiazide tablets twice daily based on the non-drug intervention. On the basis of the control group, patients in the observation group added Bushen Pinggan decoction for oral and bath foot. All patients in both two groups received 8 weeks of treatment. Blood pressure levels were measured before and after treatment, blood pressure success rate was recorded. Levels of nitric oxide （NO） , endothelin 1 （ ET-1 ） , serum inhibition （ Cys C） and β2 microglobulin （β2- MG） were detected. Result： Systolic blood pressure （SBP） and diastolic blood pressure （DBP） levels in the observation group were lower than those in the control group （ P 〈 0.01 ）. The blood pressure control efficacy in the observation group was better than that in the control group （P 〈 0.05）. Blood pressure success rate was 41.3% in the control group, which was lower than that of 65.9% in the observation group （P 〈 0.05 ）. The CysC and/3=-MG standards in the observation group were lower than those in the control group （P 〈 0.01 ）. After therapy, the ET-1 level in two groups declined, while the result was more obvious in the observation group （P 〈0.01 ）. However, the NO in both groups went up, while the result was more obvious in the observation group （P 〈0.01 ）. Conclusion： Based on the conventional Western medicine treatment, Bushen Pinggan decoction for oral and bath foot could control the blood pressure level, improve blood pressure success rate in refractory hypertension patients. Besides, it has a certain protective effect on early renal damage of hypertension. The mechanism may be related to regulating endothelial function.