益气化痰法对高血压合并颈动脉斑块形成的疗效及其对血清骨桥蛋白的影响

Curative Effect of Tonifying Qi and Resolving Phlegm Method on Hypertension Complicated with Carotid Artery Plaque Formation and the Effects on OPN

目的:探讨益气化痰法对高血压合并颈动脉斑块形成的疗效及其对血清骨桥蛋白(osteopontin,OPN)的影响。方法:选取2016年3月至2017年3月广州市中医院心血管科收治的高血压合并颈动脉斑块形成患者62例,按照随机数字表法将患者分为观察组与对照组,每组31例。对照组给予苯磺酸氨氯地平和(或)厄贝沙坦控制血压,用阿托伐他汀钙调节血脂;观察组则在对照组控制血压方案上,给予益气化痰方治疗。2组连续治疗3个月。观察2组患者的临床症状和血压情况,采用中医证候评分进行总体评价。颈动脉彩色多普勒检查2组患者治疗前后颈动脉内膜-中层厚度。检测2组患者治疗前后血清总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A1和载脂蛋白B以及OPN。检测2组患者治疗前后血清谷草转氨酶与谷丙转氨酶水平。结果:观察组患者总有效率为93.55%(29/31),对照组总有效率则为70.96%(22/31),差异有统计学意义(P<0.05)。观察组治疗后颈动脉内膜-中层厚度明显小于对照组,(1.17±0.28)mm比(1.43±0.26)mm,差异有统计学意义(P<0.05)。观察组治疗后斑块面积亦明显小于对照组,(3.12±0.73)cm^2比(3.94±0.96)cm^2,差异有统计学意义(P<0.05)。观察组治疗后血清TC(4.29±1.52)mmol/L比(5.37±0.87)mmol/L、TG(1.74±0.43)比(2.65±0.68)mmol/L与LDL(1.65±0.89)mmol/L比(2.87±1.12)mmol/L均低于对照组,差异有统计学意义(P<0.05)。而观察组治疗后血清HDL(1.94±0.41)mmol/L比(1.23±0.38)mmol/L水平则高于对照组,差异有统计学意义(P<0.05)。疗程结束后2组外周血OPN水平均较治疗前有所下调,观察组优于对照组(P<0.05)。结论:益气化痰方能够显著改善高血压合并颈动脉斑块形成患者的临床证候,不仅能够抑制颈动脉内膜-中层增厚,且能通过减少TC、TG、LDL及OPN的水平和提高HDL水平,从而起到抑制脂质斑块形成及保护颈动脉器官损伤的作用。

Objective： To study the curative effect of tonifying qi and resolving phlegm method on hypertension complicated with carotid artery plaque formation.Methods： A total of 62 patients with hypertension complicated with carotid artery plaque formation who treated in cardiovascular division of Guangzhou hospital during March,2016 to March 2017,were divided into observation group and control group according to random number table method,with 31 cases in each group.The control group had amlodipine besylate tablets and/or irbesartanto control blood pressure,the atorvastatin calcium to regulate blood lipids; The observation group had tonifying qi and resolving phlegm method on the basic of blood pressure solution of the control group.Both of the two groups had continuous treatment for 3 months.The clinical symptoms and blood pressure conditions,proceed overall evaluation by using TCM syndrome scores of two groups were observed.Carotid artery color doppler examination was used to check carotid intima-middle thickness in the two groups before and after treatment.The serum total cholesterol,triglycerides,high-density lipoprotein cholesterol,low density lipoprotein cholesterol and apolipoprotein A1 and apolipoprotein B levels and serum osteopontin（ OPN） of two groups of patients before and after treatment were detected.The contents of serum glutamic-oxaloacetic transaminase and glutamicpyruvic transaminase levels in the two groups before and after treatment were detected.Results： 1） The total effective rate of observation group was 93.55%（ 29/31）,and total effective rate of the control group was 70.96%（ 22/31）.The differences were statistically significant（ P〈0.05）.2） After treatment,carotid intima-middle thickness of the observation group was significantly less than control group（ 1.17 ± 0.28 vs 1.43 ± 0.26 mm）,and the differences were statistically significant（ P〈0.05）.The plaque area of observation group was significantly smaller than that of the control group（ 3.12 ± 0.73 vs 3.94 ± 0.96 cm^2） after treatment,and the differences were statistically significant（ P〈0.05）.3） In the observation group after treatment,serum TC（ 4.29 ±1.52 vs 5.37 ± 0.87 mmol/L）,TG（ 1.74 ± 0.43 vs 2.65 ± 0.68 mmol/L） and LDL（ 1.65 ± 0.89 vs 2.87 ± 1.12 mmol/L）levels were lower than the control group,and the differences were statistically significant（ P〈0.05）.In the observation group after treatment,serum levels of HDL（ 1.94 ± 0.41 vs 1.23 ± 0.38 mmol/L） were higher than that of control group,and the differences were statistically significant（ P〈0.05）.4） After the course of treatment,peripheral blood concentrations of OPN reduced in both of the two groups,and the observation group were superior to that of control group（ P〈0.05）.Conclusion： Tonifying qi and resolving phlegm method can significantly improve clinical syndrome of patients with hypertension complicated with carotid artery plaque,not only can inhibit carotid intima-middle thickening,but also can inhibit lipid plaque formation and protect carotid artery from damage by reducing the levels of TC,TG,LDL and OPN and raising the HDL levels.