Clinical Study on the Effect of Qianyang Yuyin Granules on Vascular Elasticity Function of Hypertension Combined with Hyperlipidemia with Yin Deficiency and Yang Excess Syndrome
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摘要: 目的 探讨潜阳育阴颗粒对阴虚阳亢型高血压合并高脂血症患者颈动脉血管弹性功能的影响。方法 选择符合纳入标准的阴虚阳亢型高血压合并高脂血症患者80例, 随机分为观察组及对照组各40例。对照组给予钙通道阻滞剂氨氯地平+阿托伐他汀钙片标准治疗, 观察组在对照组治疗基础上联用潜阳育阴颗粒, 疗程均为12周, 观察患者治疗前后中医证候积分及临床疗效、血压血脂水平[低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、总胆固醇(TC)、甘油三酯(TG)]、炎症因子水平[C反应蛋白(CRP)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)]、凝血功能指标[部分活化凝血酶原时间(APTT)、凝血酶原时间(PT)]、血液流变学指标[全血高切、全血中切、全血低切、红细胞沉降率(ESR)]、颈动脉内膜中层厚度(cIMT)、极速成像脉搏波传导速度[双侧颈动脉收缩起始脉搏波速度(PWV-BS)、收缩末期脉搏波速度(PWV-ES)]以及安全性指标的变化。结果 治疗后, 2组中医证候积分及临床疗效均有所改善(P < 0.01), 观察组优于对照组(P < 0.05)。2组血压明显降低(P < 0.01)，LDL、HDL、TC、TG、CRP、IL-6、TNF-α、APTT、PT、全血高切、全血中切、全血低切、ESR均有所改善(P < 0.05，P < 0.01), 其中观察组TC、LDL、TNF-α、APTT、ESR改善优于对照组(P < 0.05，P < 0.01)；2组PWV-BS、PWV-ES均有所改善(P < 0.05，P < 0.01)。结论 潜阳育阴颗粒联合基础治疗可提高阴虚阳亢型高血压合并高脂血症患者临床疗效，改善血压血脂水平、炎症状态、凝血功能、血液流变学及动脉弹性功能。Abstract: OBJECTIVE To investigate the clinical efficacy of Qianyang Yuyin granules on carotid artery vascular elasticity function in patients with yin-deficiency-yang-excess hypertension combined with hyperlipidemia.METHODS A total of 80 patients with yin-deficiency-yang-excess hypertension combined with hyperlipidemia who met the inclusion criteria were randomly divided into observation group and control group, 40 cases each. In the control group, calcium antagonist amlodipine and atorvastatin calcium tablets were given as standard treatment. While in the observation group, Qianyang Yuyin granules were given on the basis of the treatment in the control group with a 12-week treatment course. In addition, we observed the traditional Chinese medicine (TCM) syndrome score and clinical efficacy, blood pressure and cholesterol level [low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol (TC), triglycerides (TG)], inflammation C-reactive protein (CRP), interleukin 6 (IL-6), tumor necrosis factor α (TNF-α)], coagulation indexes [activated partial thromboplastin time (APTT), prothrombin time (PT)], hemodynamic indexes [whole blood high shear viscosity, whole blood medium shear viscosity, whole blood low shear viscosity, erythrocyte sedimentation rate (ESR)], carotid intima-media thickness (cIMT), ultrafast imaging pulse wave velocity [bilateral carotid artery beginning-systolic pulse wave velocity (PWV-BS), end-systolic pulse wave velocity (PWV-ES)] and safety indicators.RESULTS After treatment, the TCM syndrome score and clinical efficacy improved in both groups, while the results in the observation group were better than those in the control group (P < 0.05). The treatments in both groups showed blood pressure-reducing effects (P < 0.01). LDL, HDL, TC, TG, CRP, IL-6, TNF-α, APTT, PT, whole blood high shear viscosity, whole blood medium shear viscosity, whole blood low shear viscosity, ESR were all improved in the two groups (P < 0.05, P < 0.01). In the observation group, the results of TC, LDL, TNF-α, APTT and ESR were better than those in the control group (P < 0.05, P < 0.01). In addition, PWV-BS and PWV-ES improved in both groups (P < 0.05, P < 0.01).CONCLUSION Combining basic treatment with Qianyang Yuyin granules can improve the clinical efficacy of hypertension combined with hyperlipidemia in patients with yin deficiency and yang hyperactivity, reduce blood pressure and lipid level, and improve inflammation status, coagulation function, blood rheology, as well as arterial elasticity function.
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表 1 2组患者治疗前后中医证候积分比较(x±s, n=40)
组别 时间 眩晕 头痛 腰酸 膝软 五心烦热 心悸 失眠 耳鸣 健忘 观察组 治疗前 3.95±1.40 4.05±1.47 3.35±1.14 3.25±1.17 3.55±1.24 1.73±0.67 2.05±0.71 1.68±0.61 1.75±0.66 治疗后 1.05±1.01** 1.20±0.99**# 0.95±1.01** 1.10±1.10** 1.15±1.00** 0.57±0.50**# 0.65±0.66** 0.52±0.51** 0.57±0.54** 对照组 治疗前 4.05±1.39 4.15±1.45 3.45±1.19 3.15±1.09 3.35±1.23 1.70±0.64 1.95±0.71 1.65±0.66 1.75±0.70 治疗后 1.55±1.46** 1.75±1.51** 1.45±1.35** 1.50±1.26** 1.45±1.35** 0.83±0.67** 0.85±0.69** 0.73±0.64** 0.83±0.71** 注: 组内比较, **P < 0.01;组间比较, #P < 0.05。 
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表 2 2组患者临床疗效比较(n=40)
组别 显效 有效 无效 总有效率/% 观察组 32 5 3 92.5* 对照组 28 2 10 75.0 注: 2组比较, χ2=4.501, *P < 0.05。
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表 3 2组患者治疗前后血压变化情况比较(x±s, mmHg，n=40)
组别 时间 SBP DBP 观察组 治疗前 141.37±14.29 90.87±9.90 治疗后 125.40±8.59** 79.04±7.98** 对照组 治疗前 141.98±18.32 89.16±9.19 治疗后 128.68±12.51** 79.74±7.63** 注: 组内比较, **P < 0.01。
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表 4 2组患者治疗前后血脂水平比较(x±s, mmol·L-1，n=40)
组别 时间 TC TG LDL HDL 观察组 治疗前 5.19±0.89 1.95±1.10 3.15±0.57 1.45±0.32 治疗后 3.73±0.62**## 1.49±0.88* 2.18±0.60*## 1.79±0.82* 对照组 治疗前 5.58±1.25 2.05±1.21 3.51±1.06 1.60±0.34 治疗后 4.67±1.34** 1.88±0.99* 2.69±1.02** 1.89±2.31* 注: 组内比较, *P < 0.05, **P < 0.01;组间比较, ##P < 0.01。
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表 5 2组患者治疗前后炎症因子水平比较(x±s, mg·L-1，n=40)
组别 时间 CRP IL-6 TNF-α 观察组 治疗前 2.47±1.63 5.84±10.43 4.37±3.38 治疗后 1.55±1.20** 2.34±3.47* 2.16±1.01**# 对照组 治疗前 2.91±2.95 3.90±3.08 4.93±3.70 治疗后 2.05±2.02* 2.71±2.44* 2.92±1.97** 注: 组内比较, *P < 0.05, **P < 0.01;组间比较, #P < 0.05。
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表 6 2组患者治疗前后凝血功能指标比较(x±s, s, n=40)
组别 时间 PT APT 观察组 治疗前 13.09±0.73 36.55±3.13 治疗后 12.71±0.88* 34.78±2.50**# 对照组 治疗前 13.03±0.64 36.84±6.00 治疗后 12.91±0.60* 36.74±4.32* 注: 组内比较, *P < 0.05, **P < 0.01;组间比较, #P < 0.05。
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表 7 2组患者治疗前后血液流变学指标比较(x±s, n=40)
组别 时间 全血高切/(mPa·s-1) 全血中切/(mPa·s-1) 全血低切/(mPa·s-1) ESR/(mm·h-1) 观察组 治疗前 4.74±0.79 6.63±1.39 10.71±2.66 8.73±6.26 治疗后 4.19±0.54** 5.35±0.72** 9.29±3.54* 5.92±5.84*# 对照组 治疗前 4.68±0.96 6.15±1.39 10.80±2.54 10.38±8.44 治疗后 4.22±0.71* 5.39±1.00** 9.75±1.58* 9.40±7.20* 注: 组内比较, *P < 0.05, **P < 0.01;组间比较, #P < 0.05。
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表 8 2组患者治疗前后cIMT比较(x±s, cm, n=40)
组别 时间 左侧颈总动脉 右侧颈总动脉 观察组 治疗前 0.066±0.016 0.064±0.014 治疗后 0.078±0.087 0.080±0.087 对照组 治疗前 0.062±0.011 0.066±0.012 治疗后 0.065±0.012 0.068±0.014
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表 9 2组患者治疗前后颈动脉弹性相关指标比较(x±s, m·s-1, n=40)
组别 时间 PWV-BS PWV-ES 左侧颈总动脉 右侧颈总动脉 左侧颈总动脉 右侧颈总动脉 观察组 治疗前 5.96±1.13 5.43±1.29 8.86±1.71 8.04±1.80 治疗后 5.21±1.15* 4.81±0.98* 7.42±1.64** 6.76±1.54** 对照组 治疗前 5.81±1.52 5.52±1.70 9.00±2.36 7.38±1.41 治疗后 5.24±1.02* 4.89±1.06* 8.06±1.80* 6.68±1.71* 注: 组内比较, *P < 0.05, **P < 0.01。
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