【作者】 徐向青；

【导师】 林慧娟；

【作者基本信息】 山东中医药大学 ， 中医内科学， 2003， 博士

【摘要】 目的：本研究在中医理论的指导下，结合导师临床经验，提出肾中精气不足，血脉瘀阻是中老年高血压病的重要发病机制，确立补肾活血为本病的治疗大法，并据此拟定桑仙颗粒。旨在通过临床和实验两方面的研究，全面评价桑仙颗粒对高血压患者生活质量的影响，为中药疗效评价提供新的思路与方法；同时探讨其肾保护作用及机理，以期为中医药在此领域作出有益的探索。方法：临床研究选择80例肾虚血瘀型中老年高血压病患者，40例予桑仙颗粒治疗，40例予卡托普利作阳性对照组，分别对其进行系统临床观察及生活质量评价；动物实验选择自发性高血压大鼠（SHR），观察桑仙颗粒的降压及肾保护作用。结果：临床研究表明，桑仙颗粒可有效控制血压，降压总有效率为90.0％，改善症状总有效率为95％。同时能降低尿微量白蛋白、β₂—微球蛋白排泄，改善肾脏血流动力学，保护肾脏。在生活质量的评价中，试验组治疗前后在生理症状、躯体化症状、性功能失调、睡眠状况、活力、焦虑、工作状态、认知能力等方面均有明显改善。多项指标优于对照组。实验研究显示，桑仙颗粒即时、14天连续给药后，SHR血压都有明显下降。桑仙颗粒能明显增加正常大鼠及水负荷大鼠的排尿量，有一定的利尿作用；能增加大鼠肾组织的血流量；降低SHR肾组织中AngⅡ水平；抑制AT₁，受体的表达；下调转化生长因子基因表达。病理观察显示桑仙颗粒能减轻肾小球毛细血管基底膜增厚及系膜细胞增生，延缓肾小球硬化。结论：补肾活血是治疗中老年高血压病的重要治法。桑仙颗粒不仅有确切的降压疗效，而且能保护肾脏，改善患者的生活质量。为中医药治疗高血压病及全面评价中药疗效提供了新的思路与方法。更多还原

【Abstract】 Objective: According to the TCM theory and the turtor’s clinical experiences, a viewpoint was put forward that deficiency of kidney and stagnation of blood is the essential pathogenesis in senile hypertension. So strengthening kidney and promoting blood circulation are regarded as the therapeutic rules. The prescription of SangXian granule (SX) was developed in treating senile hypertension. This research try to evaluate SX’s influence to the quality of life (QoL) of patients with senile hypertension and it’s protective effect on kidney through clinical and experiental study, so as to make a beneficial attempt in this field in traditional Chinese medicine.Methods: 80 cases of senile hypertension belong to the sydrome of deficiency of kidney and stagnation of blood were observed in clinical trial. 40 cases were treated by SX and 40 cases by captopril. All cases have been maken systemic observations and assessments of QoL. Simultaneously, SX’s protective effect on kidney was observed through SHR models in experimental study.Results: The clinical research showed that SX can evidently control blood-pressure and improve clinical symptoms. It’s total rate of antihypertensive effect is 90.0%. It can also reduce ALB and P2-MG in urine and improve blood dynamics parameters, so as to protect kidney. In the assessments of QoL, SX can improve physical symptoms, body symptoms, sexual dysfunction, sleep dysfunction, energy, psycological state, work state and congnitive function in senile patients with hypertension. It’s effect on QoL is better than control group. Experimental study showed that SX can control blood-pressure of SHRmodels, increase the quantum of urine and improve quantum of blood in kidney of normal rats, decrease the level of Ang II in kidney of SHR and inhibit the expression of AT1 and TGF-β1 mRNA in kidney. Pathological research showed that SX can reduce the damage and postpone sclerosis in kidney of SHR.Conclusion: Strengthening kidney and promoting blood circulation is a important therapeutic rule in treating senile hypertension. SX has good antihypertensive effect and protective effect on kidney, and can improve QoL as well. This research give a new idea and method in treating senile hypertension and evaluating the curative effect of antihypertensive medication in traditional Chinese medicine.更多还原