益气化瘀平肝滋肾方联合阿托伐他汀治疗高血压视网膜病变的效果及其对微循环、臂踝脉搏波传导速度、血清CysC、APN表达的影响

Effect of Yiqi Huayu Pinggan Zishen Recipe Combined with Atorvastatin on the Microcirculation,Brachial Ankle Pulse Wave Conduction Velocity and the Expression of Serum Cystatin C and Adiponectin in Patients with Hypertensive Retinopathy

目的探讨益气化瘀平肝滋肾方联合阿托伐他汀治疗高血压视网膜病变的效果及其对微循环、臂踝脉搏波传导速度(baPWV)及血清胱抑素C(CysC)、脂联素(APN)表达的影响。方法选取2017年2月—2019年9月我院高血压视网膜病变病人108例,以简单随机化法分为联合组、对照A组、对照B组,各36例。常规治疗基础上,对照A组予以阿托伐他汀,对照B组予以益气化瘀平肝滋肾方,联合组予以益气化瘀平肝滋肾方联合阿托伐他汀,均治疗2个月。比较3组治疗前、治疗2个月后血压(舒张压、收缩压)、视力、眼底荧光血管造影定量指标[视网膜黄斑部拱环内微血管密度(MD)、视网膜毛细血管交换时间(CET)、视网膜静脉充盈时间(VFT)、视网膜动脉显影时间(ADT)]、视觉电生理参数[闪光视网膜电图(FERG)中a波、b波的潜伏期(La、Lb)、振幅(Aa、Ab)]、baPWV、血清CysC、APN水平。结果治疗2个月后,3组舒张压、收缩压较治疗前降低,且联合组低于对照A组、对照B组(P<0.05);视力较治疗前提高,且联合组高于对照A组、对照B组(P<0.05);3组MD及FERG中Aa、Ab水平较治疗前增高,且联合组高于对照A组、对照B组;CET、VFT、ADT、baPWV及FERG中La、Lb水平较治疗前降低,且联合组低于对照A组、对照B组(P<0.05);血清CysC水平较治疗前降低,且联合组低于对照A组、对照B组(P<0.05);血清APN水平较治疗前增高,且联合组高于对照A组、对照B组(P<0.05)。结论益气化瘀平肝滋肾方联合阿托伐他汀治疗可降低高血压视网膜病变病人血压与baPWV,调节血清Cys-C、APN水平,改善视网膜病变与微循环状况,提高视力。

Objective To investigate the effect of Yiqi Huayu Pinggan Zishen Recipe combined with atorvastatin on microcirculation,brachial ankle pulse wave conduction velocity(baPWV),serum cystatin C(Cys-C),and adiponectin(APN)expression in patients with hypertensive retinopathy(HR).Methods From February 2017 to September 2019,one hundred and eight patients with HR in our hospital were divided into combination group,control group A,and control group B,with 36 patients in each group.On the basis of conventional treatment,the patients in control group A were given atorvastatin,the patients in control group B were given Yiqi Huayu Pinggan Zishen Recipe,and the patients in combination group were treated with Yiqi Huayu Pinggan Zishen Decoction combined with atorvastatin,all patients were treated for 2 months.The diastolic blood pressure(DBP),systolic blood pressure(SBP),visual acuity,and fundus fluorescein angiography quantitative indicators[microvessel density(MD)in the macular arch of the retina,retinal capillary exchange time(CET),retinal vein filling time(VFT),retinal artery development time(ADT)],visual electrophysiological parameters[a wave,b wave latency(La,Lb)in flash electroretinogram(FERG),amplitude(Aa,Ab)],baPWV,serum Cys-C,APN levels were compared before and after treatment in the 3 groups.Results After 2 months of treatment,the levels of DBP and SBP in the 3 groups were lower than those before treatment,and DBP and SBP in combination group were lower than those in control group A and control group B,and the vision in the 3 groups was higher than that before treatment,and the vision in combination group was higher than that in control group A and control group B(P<0.05).After 2 months of treatment,the levels of Aa and Ab in MD and FERG in the 3 groups were higher than those before treatment,and the levels of Aa and Ab in MD and FERG in combined group were higher than those in control group A and control group B,the levels of CET,VFT,ADT,baPWV,and La and Lb in FERG were lower than those before treatment,and the combination group was lower than that in control group A and control group B(P<0.05).After 2 months of treatment,the serum Cys-C levels in the 3 groups were lower than those before the treatment,and the serum Cys-C level in combination group was lower than those in control group A and control group B,serum APN levels in the 3 groups were higher than those before treatment,and the APN level in combination group was higher than those in control group A and control group B(P<0.05).Conclusion Yiqi Huayu Pinggan Zishen Recipe combined with atorvastatin can reduce blood pressure and baPWV,regulate serum Cys-C and APN levels,improve the status of retinopathy and microcirculation,and improve vision.