氨氯地平贝那普利联合通脉养心丸治疗高血压合并冠心病的临床研究

Amlodipine benazepril combined with Tongmai Yangxin Pill in treatment of hypertension complicated by coronary heart disease:a clinical study

目的探讨氨氯地平贝那普利片(Ⅱ)联合通脉养心丸治疗高血压合并冠状动脉粥样硬化性心脏病(冠心病)的临床疗效。方法选取2017年1月至2019年12月于抚顺市中医院心内科收治的94例高血压合并冠心病患者作为研究对象,随机分为对照组和观察组,每组各47例。对照组给予氨氯地平贝那普利片(Ⅱ)治疗,观察组给予氨氯地平贝那普利联合通脉养心丸治疗,比较两组患者治疗前后的心率和血压水平、血管内皮功能和炎症因子水平、心功能指标以及中医症候等情况。结果治疗前两组患者的心率、血压水平组间比较差异无统计学意义(P>0.05);治疗后两组患者收缩压、舒张压均较治疗前均显著降低,且观察组平均心率低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者血清血管内皮素-l(ET-l)、一氧化氮(NO)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平比较差异无统计学意义(P>0.05);治疗后,两组患者ET-1、IL-6、TNF-α水平低于治疗前,NO水平高于治疗前,差异有统计学意义(P<0.05);观察组患者的ET-1、IL-6、TNF-α水平明显低于对照组,而NO水平明显高于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者心功能指标:左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)及6 min步行距离比较差异均无统计学意义(P>0.05);治疗后,两组患者的LVEF较治疗前升高,LVEDD、LVESD较治疗前均降低,6 min步行距离延长(P<0.05);观察组LVEF明显高于对照组,LVEDD、LVESD明显低于对照组,6 min步行距离明显优于对照组(P<0.05)。观察组胸痛、眩晕、心悸、胸闷、汗出的患者数较对照组明显减少(P<0.05)。两组不良反应发生率分别为4.25%和2.12%,差异无统计学意义。结论氨氯地平贝那普利片(Ⅱ)联合通脉养心丸治疗高血压合并冠心病,在平稳控制患者血压的同时,对改善患者血管内皮功能和炎症因子水平、心功能及自主神经症状等方面均有较好疗效。

Objective To discuss the clinical efficacy of amlodipine benazepril(Ⅱ)combined with Tongmai Yangxin Pill in treatment of hypertension complicated by coronary heart disease(CHD).Methods The patients with hypertension complicated by CHD(n=94)were chosen from Department of Cardiology in Hospital of Traditional Chinese Medicine of Fushun City from Jan.2017 to Dec.2019,and randomly divided into control group and observation group(each n=47).The control group was treated with amlodipine benazepril(Ⅱ)and observation group was treated with amlodipine benazepril combined with Tongmai Yangxin Pill.The heart rate(HR),blood pressure level,vascular endothelial function,inflammatory factors,indexes of heart function and symptoms of traditional Chinese medicine(TCM)were compared in 2 groups before and after treatment.Results The difference in HR and blood pressure level had no statistical significance between 2 groups(P>0.05)before treatment,and after treatment,systolic blood pressure and diastolic blood pressure decreased significantly,and mean HR was lower in observation group than that in control group(P<0.05).The difference in levels of ET-l,NO,IL-6 and TNF-αhad no statistical significance between 2 groups(P>0.05)before treatment,and after treatment,levels of ET-1,IL-6 and TNF-αwere lower and NO level was higher in 2 groups than before(P<0.05).The levels of ET-1,IL-6 and TNF-αwere significantly lower and NO level was significantly higher in observation group than those in control group(P<0.05)after treatment.Before treatment,the difference in indexes of heart function,including LVEF,LVEDD,LVESD and 6-minute walk distance(6MWD),had no statistical significance between 2 groups(P>0.05).After treatment,LVEF increased,LVEDD and LVESD decreased,and 6MWD increased in 2 groups(P<0.05).LVEF was significantly higher,LVEDD and LVESD were significantly lower,and 6MWD was significantly superior in observation group than those in control group(P<0.05).The patients with chest pain,dizziness,palpitation,chest tightness and sweating decreased significantly in observation group compared with control group(P<0.05),and incidence rate of adverse reaction was 4.25%in control group and 2.12%in observation group without statistical significance.Conclusion Amlodipine benazepril(Ⅱ)combined with Tongmai Yangxin Pill can control blood pressure as well as improve vascular endothelial function,inflammatory factor level,heart function and autonomic symptoms in with hypertension complicated by CHD.