半夏白术天麻汤加减治疗高血压合并颈动脉粥样硬化斑块患者的临床疗效及对其HIF-1α、VEGF、VEGFR2信号通路的影响

CTherapeutic Effect of Modified Banxia-Baizhu-Tianma Decoction on Hyperten-sion Complicated by Carotid Atherosclerotic Plaque and Its Impact on HIF-1α/VEGF/VEGFR 2 Signaling Pathway

目的探讨半夏白术天麻汤加减治疗高血压合并颈动脉粥样硬化斑的疗效及对缺氧诱导因子、血管内皮生长因子、血管内皮生长因子受体(Hypoxia-inducible factor-1 alpha、vascular endothelial growth factor、vas-cular endothelial growth factor receptor 2,HIF-1α、VEGF、VEGFR2)信号通路的影响。方法选取2019年1月—2022年2月期间上海中医药大学附属曙光医院收治的高血压合并动脉粥样硬化斑块患者80例作为研究对象,采用随机数字表法分为对照组和研究组,每组各40例。对照组为常规西医治疗,研究组在对照组基础上联合半夏白术天麻汤加减治疗。连续治疗2个月后,观察比较两组患者治疗前后血压(收缩压和舒张压)、血脂[胆固醇(Cholesterol,TC)、甘油三酯(Triglyceride,TG)、低密度脂蛋白胆固醇(Low density lipoprotein cholesterol,LDL-C)以及高密度脂蛋白胆固醇(High density lipoprotein cholesterol,HDL-C)]、颈动脉内膜中层厚度(Intima-media thick-ness,IMT)、外周血缺氧诱导因子/血管内皮生长因子/血管内皮生长因子受体(Hypoxia-inducible factor-1 alpha、vascular endothelial growth factor、vascular endothelial growth factor receptor 2,HIF-1α、VEGF、VEGFR2)、中医症状积分及两组患者生活质量水平。结果治疗后两组患者收缩压和舒张压均较治疗前降低,差异有统计学意义(P<0.05);且研究组低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血脂TC、TG、LDL-C指标均较治疗前降低,HDL-C指标较治疗前升高,差异有统计学意义(P<0.05);且研究组TC、TG、LDL-C指标低于对照组,HDL-C指标高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者IMT和中医症状积分均较治疗前降低,差异有统计学意义(P<0.05);且研究组低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者外周血HIF-1α、VEGF、VEGFR2水平均较治疗前降低,差异有统计学意义(P<0.05);且研究组低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者心理功能、社会功能、躯体功能和物质生活状态等GQOLI-74评分均较治疗前升高,差异有统计学意义(P<0.05);且研究组高于对照组,差异有统计学意义(P<0.05)。结论对高血压合并颈动脉粥样硬化斑块患者采用半夏白术天麻汤治疗,有助于改善患者的血压及血脂水平,抑制HIF-1α/VEGF/VEGFR 2信号通路,改善患者临床症状,提升其生活质量水平,值得临床推广应用。

Objective To investigate the clinical efficacy of modified Banxia-Baizhu-Tianma Decoction in treating patients with hypertension complicated by carotid atherosclerotic plaque and its effect on hypoxia-inducible factor-1 alpha/vascular endothelial growth factor/vascular endothelial growth factor receptor 2(HIF-1α/VEGF/VEGFR2)signaling pathway.Methods From January 2019 to February 2022,80 patients with hypertension and atherosclerotic plaques admitted to Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were selected as the research objects.The patients were divided into control group and study group by random number table method,with 40 cases in each group.The control group was treated with conventional Western medicine,and the study group received a combination of modified Banxia-Baizhu-Tianma Decoction in addition to the conventional treatment.After two months of continuous treatment,the blood pressure(systolic and diastolic blood pressure),blood lipid[cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)and high density lipoprotein cholesterol(HDL-C)],intima-media thickness(IMT),HIF-1α/VEGF/VEGFR2,traditional Chinese medicine(TCM)symptom score and quality of life of the two groups were compared before and after treatment.Results After treatment,both groups of patients showed a significant decrease in systolic and diastolic blood pressure compared to before treatment,and the difference were statistically significant(P<0.05).The study group exhibited lower blood pressure values than the control group,with statistically significant differences(P<0.05).After treatment,both groups of patients demonstrated a significant decrease in blood lipid indicators(TC,TG,LDL-C)and an increase in HDL-C compared to pre-treatment,and these differences were statistically significant(P<0.05).In addition,TC,TG and LDL-C in the study group were lower than those in the control group,and HDL-C was higher than that in the control group,the difference were statistically significant(P<0.05).After treatment,IMT and TCM symptom score of the two groups were lower than before treatment,and the difference were statistically significant(P<0.05).The study group had lower IMT and symptom scores than the control group,and these differences were statistically significant(P<0.05).After treatment,both groups exhibited a significant decrease in peripheral blood levels of HIF-1α,VEGF and VEGFR2 compared to pre-treatment,and the difference were statistically significant(P<0.05).Moreover,the study group had lower levels than the control group with statistically significant differences(P<0.05).After treatment,GQOLI-74 scores of psychological function,social function,physical function and material life status of patients in two groups were higher than those before treatment,the difference were statistically significant(P<0.05),and the study group had higher scores than the control group,with statistically significant differences(P<0.05).Conclusion The use of Banxia-Baizhu-Tianma Decoction for patients with hypertension and carotid atherosclerotic plaque can improve the blood pressure and blood lipid levels,suppress HIF-1α/VEGF/VEGFR2 signaling pathway,alleviate clinical symptoms,and improve the quality of life.These positive outcomes suggest that this treatment approach is worth considering for broader clinical application.