通脑活心汤对原发性高血压瘀血内阻证患者血压变异性的影响

Effect of Tongnao Huoxin Decoction on Blood Pressure Variability in Patients with Primary Hypertension with Syndrome of Internal Blockade of Static Blood

目的:探讨通脑活心汤治疗原发性高血压病瘀血内阻证患者的疗效以及对血压变异性和血清同型半胱氨酸(Hcy)和25-羟基维生素D[25(OH)D]水平的影响。方法:本组研究共完成110例患者,按数字表法随机分为对照组和治疗组各55例;对照组给予口服苯磺酸氨氯地平片,5 mg/次,1片/d;和马来酸依那普利片,10 mg/次,1片/d。治疗组在对照组治疗的基础上加用通脑活心汤内服,1剂/d,常规水煎煮,分早晚2次服用;两组疗程均为2个月。比较两组治疗前后血液流变学指标和血压变异性指标;分析两组治疗后临床疗效;检测两组血清Hcy和25(OH)D水平。结果:治疗组治疗后患者全血高切、中切、低切黏度以及血浆黏度均显著低于对照组(P<0.01);治疗组临床总有效率为92.73%,对照组为76.36%,治疗组优于对照组(P<0.05);治疗组治疗后24 h舒张压标准差(24 h DSD),白天舒张压标准差(d DSD),白天收缩压标准差(d SSD)以及夜间舒张压标准差(n DSD)均明显低于对照组(P<0.01);治疗后治疗组血清Hcy水平明显低于对照组,而25(OH)D高于对照组,比较差异均有统计学意义(P<0.01)。结论:在西医治疗的基础上,加用通脑活心汤治疗原发性高血压病瘀血内阻证患者可明显改善血液黏度和血压变异性,提高临床治疗效果,降低血清Hcy水平和25(OH)D水平。

Objective： To investigate the efficacy of Tongnao Huoxin decoction in treatment of primary hypertension with syndrome of internal blockade of static blood and observe its effect on blood pressure variability and levels of homocysteine（ HCY） and 25-hydroxyvitamin D [25（ OH） D]in serum. Method： One hundred and ten patients were randomly divided into control group and treatment group（ 55 cases in each group） according to random number table in the study. Patients in control group were treated with amlodipine besylate tablets（ 5 mg /time,1 tablet / day） and enalapril maleate tablets（ 10 mg / time,1 table / day）. Patients in treatment group were treated with Tongnao Huoxin decoction orally based on the treatment in control group（ 1 dose / day,bid）. The treatment course was two months in both groups. Changes of hemorheology indexes and blood pressure variability indexes pre-post treatment were compared between two groups. Clinic effects of two groups after treatment were analyzed. Levels of Hcy and 25（ OH） D in serum of two groups were detected. Result： The whole blood high shear viscosity, middle shear viscosity, low shear viscosity and plasma viscosity in treatment group were significantly lower than those of control group after treatment（ P〈0. 01）. The total effective rate was 92. 73% in treatment group,higher than 76. 36% in control group（ P〈0. 05）. Standard deviation of diastolic blood pressure in 24 h（ 24 h DSD）,standard deviation of daytime diastolic blood pressure（ d DSD）,standard deviation of daytime systolic blood pressure（ d SSD）,and standard deviation of nighttime diastolic blood pressure（ n DSD） in treatment group were significantly lower than those of control group after treatment（ P〈0. 01）. After treatment,the level of Hcy in serum of treatment group was significantly lower than that of control group,while 25（ OH） D level was significantly higher than that of control group,with statistically significant difference（ P〈0. 01）. Conclusion：Tongnao Huoxin decoction based on western medicine could significantly improve blood viscosity,blood pressure variability and raise clinical effects in treatment of primary hypertension with syndrome of internal blockade of static blood,and the mechanism may be associated with reducing the level of Hcy in serum and elevating 25（ OH） D level.