天麻钩藤饮结合苯磺酸氨氯地平片治疗肝阳上亢型高血压病伴左心室肥厚临床研究

Clinical study on Tianma Gouteng Decoction combined with amlodipine besylate tablets in the treatment of hypertension of liver-yang hyperactivity with left ventricular hypertrophy

目的评价天麻钩藤饮结合苯磺酸氨氯地平片治疗肝阳上亢型高血压病伴左心室肥厚(LVH)患者的疗效。方法将符合入选标准的2019年6月-2021年1月本院80例肝阳上亢型高血压病伴LVH患者,按随机数字表法分为2组,每组40例。对照组口服苯磺酸氨氯地平片,观察组在对照组基础上加服天麻钩藤饮免煎颗粒。2组均连续治疗2个月。分别于治疗前后进行中医证候评分,以血压计测量诊室血压,以彩色多普勒超声诊断仪测量室间隔厚度(IVST)、左心室后壁厚度(PWT)、左心室内径(LVDd)、左心室重量指数(LVMI),以ELISA法检测同型半胱氨酸(Hcy)、胱抑素C(Cys-C)水平,以全自动生化分析仪检测尿酸(UA)水平,评价临床疗效。结果观察组总有效率为95.0%(38/40)、对照组为77.5%(31/40),2组比较差异有统计学意义(χ^(2)=5.17,P=0.023)。治疗后,观察组头晕目眩、头痛、失眠多梦、心烦健忘评分及总分均低于对照组(t值分别为10.06、14.47、15.47、8.74、、14.50,P值均<0.001),收缩压、舒张压均低于对照组(t值分别为6.30、8.79,P值均<0.001);IVST[(9.36±1.32)mm比(11.23±1.07)mm,t=6.96]、PWT[(8.89±1.14)mm比(10.03±1.02)mm,t=4.71]、LVDd[(40.36±4.29)mm比(47.62±4.19)mm,t=7.66]、LVMI[(112.39±22.29)g/m^(2)比(148.26±21.39)g/m^(2),t=7.34]均低于对照组(P<0.01);Hcy[(12.87±3.11)μmol/L比(19.85±3.67)μmol/L,t=9.18]、UA[(276.29±19.56)μmol/L比(338.52±17.07)μmol/L,t=16.65]、Cys-C[(0.86±0.15)mg/L比(1.10±0.17)mg/L,t=6.70]水平均低于对照组(P<0.01)。结论天麻钩藤饮可有效改善肝阳上亢型高血压病伴LVH患者的临床症状,控制血压,减轻左心室肥厚,改善肾功能。

Objective To evaluate the clinical efficacy of Tianma Gouteng Decoction combined with amlodipine besylate tabletsin treating patients with hypertension of liver-yang hyperactivity complicated with left ventricular hypertrophy(LVH).Methods A total of 80 patients with hypertension of liver-yang hyperactivity complicatedwith LVH,who met the inclusion criteria and were treated in the hospital between June 2019 and January 2021,were divided into two groups,with 40 in each group according to the random number table method.The control group was treated with amlodipine besylate tablets orally,and the observation group was treated with granules of Tianma Gouteng Decoction on the basis of the control group.Both groupswere treated for 2months.Before and after treatment,the TCM syndromes were scored and the office blood pressure was measured with sphygmomanometer,and color Doppler ultrasonic diagnostic apparatus was adopted to detect the interventricular septum thickness(IVST),left ventricular posterior wall thickness(PWT),left ventricular end diastolic diameter(LVDd)and left ventricular mass index(LVMI),and the levels of homocysteine(Hcy)and Cystatin C(Cys-C)were determined by ELISAand the level of uric acid(UA)was determined by fully automatic biochemical analyzer.The clinical efficacy was evaluated.Results The total effective ratewas 95.0%(38/40)in the observation group and that of the control groupwas 77.5%(31/40)(χ^(2)=5.17,P=0.023).After treatment,the scores of dizziness,headache,insomnia and dreaminess and vexation and forgetfulness and total score of the observation group were significantly lower than those in the control group(t=10.06,14.47,15.47,8.74,14.50,all Ps<0.001),and the systolic blood pressure and diastolic blood pressurewere significantly lower than those in the control group(t=6.30,8.79,P<0.001).The IVST[(9.36±1.32)mmvs.(11.23±1.07)mm,t=6.96],PWT[(8.89±1.14)mmvs.(10.03±1.02)mm,t=4.71],LVDd[(40.36±4.29)mm vs.(47.62±4.19)mm,t=7.66]and LVMI[(112.39±22.29)g/m^(2) vs.(148.26±21.39)g/m^(2),t=7.34]were significantly lower compared to the control group(P<0.01).The levels of Hcy[(12.87±3.11)μmol/L vs.(19.85±3.67)μmol/L,t=9.18],UA[(276.29±19.56)μmol/L vs.(338.52±17.07)μmol/L,t=16.65]and Cys-C[(0.86±0.15)mg/L vs.(1.10±0.17)mg/L,t=6.70]were significantly lower than those in the control group(P<0.01).Conclusion The Tianma Gouteng Decoction can improve the clinical symptoms,control the blood pressure,relieve the left ventricular hypertrophy and improve the renal function of patients with hypertension of liver-yang hyperactivity complicated with LVH.