加味防己黄芪汤联合西医治疗高血压早期肾损害的临床研究

Clinical study of Modified Fangji Huangqi Decoction combined with Western Medicine in the treatment of early renal damage in hypertension

[目的]探讨加味防己黄芪汤联合西医治疗高血压早期肾损害的临床疗效及安全性。[方法]选择2017年1月—2019年1月东营市第二人民医院收治的高血压早期肾损害患者100例,依照随机数字表法分为对照组(50例)和观察组(50例)。对照组给予常规西药治疗,观察组给予加味防己黄芪汤联合常规西药治疗,两组均给予连续治疗3个月。治疗后进行临床疗效评价。比较两组治疗前后的中医症状评分、24 h收缩压标准差(24 h SSD)、24 h舒张压标准差(24 h DSD)、24 h平均收缩压(24 h SBP)、24 h平均舒张压(24 h DBP)、尿微量白蛋白(UmALB)、β2微球蛋白(β2-MG)、尿N-乙酰-β-氨基葡萄糖苷酶(NAG)、血胱抑素C(CysC)及血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、转化生长因子-β1(TGF-β1)、纤溶酶原激活物抑制剂-1(PAI-1)水平。记录并比较两组治疗过程中不良反应的发生情况。[结果]观察组的临床总有效率为90.00%(45/50),明显高于对照组的70%(35/50),差异有统计学意义(P<0.05)。两组治疗后的中医证候评分、24 h SSD、24 h DSD、24 h SBP、24 h DBP、UmALB、β2-MG、NAG及CysC均明显低于治疗前(P<0.05),同时观察组治疗后上述指标均明显低于对照组(P<0.05)。两组治疗后的血清TNF-α、IL-1β、TGF-β1及PAI-1水平均明显低于治疗前(P<0.05),同时观察组治疗后的血清TNF-α、IL-1β、TGF-β1及PAI-1水平均明显低于对照组(P<0.05)。两组治疗期间均无严重的不良反应发生。[结论]加味防己黄芪汤联合西医治疗高血压早期肾损害的临床疗效显著,能够明显控制血压水平,减轻肾损伤,且安全性较好。

[Objective]To explore the clinical efficacy and safty of Modified Fangji Huangqi Decoction combined with Western medicine in treatment of early renal damage in hypertension.[Methods]The 100 patients with early renal damage in hypertension admitted to the Second People's Hospital of Dongying from January 2017 to January 2019 were selected.According to the random number table method,they were divided into control group(50 cases)and observation group(50 cases).The control group was treated with routine western medicine.The observation group was treated with Modified Fangji Huangqi Decoction combined with conventional Western medicine.Both groups were given continuous treatment for 3 months.The clinical efficacy was evaluated after treatment.Traditional Chinese medicine(TCM)syndrome scores,standard deviation of 24 h systolic blood pressure(24h SSD),standard deviation of 24 h diastolic blood pressure(24 h DSD),24 h mean systolic blood pressure(24h SBP),24 h mean diastolic blood pressure(24h DBP),urine microalbumin(UmALB),β2-microglobulin(β2-MG),urinary N-acetyl-β-glucosidase(NAG),cystatin C(CysC),and serum levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),transforming growth factor-β1(TGF-β1),plasminogen activator inhibitor-1(PAI-1)before and after treatment were compared between two groups.The incidence of adverse reactions during the treatment was recorded and compared between the two groups.[Results]The total clinical effective rate of the observation group was 90.00%(45/50),which was significantly higher than that of the control group(70%,35/50),the difference was statistically significant(P<0.05).After treatment,TCM syndrome scores,24 h SSD,24 h DSD,24 h SBP,24 h DBP,UmALB,β2-MG,NAG and CysC in both groups were significantly lower than those before treatment(P<0.05),the above indexes in the observation group after treatment were significantly lower than those in the control group(P<0.05).After treatment,the level of serum TNF-α,IL-1β,TGF-β1 and PAI-1 in both groups were significantly lower than those before treatment(P<0.05),and the levels of serum TNF-α,IL-1β,TGF-β1 and PAI-1 in the observation group were significantly lower than those in the control group(P<0.05).No serious adverse reactions occurred during the treatment period in both groups.[Conclusion]Modified Fangji Huangqi Decoction combined with Western medicine has a significant clinical effect in treating early renal damage in hypertension.It can obviously control blood pressure level and reduce renal injury,and has good safety.