【作者】 李娜；

【导师】 韩学杰；

【作者基本信息】 中国中医科学院 ， 中医内科学， 2011， 硕士

【摘要】 目的：从炎症因子变化的角度探讨高血压病痰瘀互结的病因研究,观察高血压病患者血清炎症因子表达的差异,寻找与高血压病痰瘀互结证有关的炎症因子,并观察高血压病痰瘀互结患者经中药痰瘀同治干预后的降压疗效以及中医证候改善情况。方法：收集自2007年4月19日至2010年8月31日中国中医科学院中医门诊部高血压病患者146例,其中痰瘀互结证患者116例,占79.46%,肝阳上亢患者30例,占20.55%。痰瘀互结组用痰瘀同治、解毒通络方(莱菔子、泽泻、川芎、水蛭等),肝阳上亢组用滋阴潜阳的天麻钩藤饮加减方(天麻、钩藤、生栀子、黄芩、桑寄生等)。治疗3个疗程(1个月为1疗程),采集治疗前后高血压病患者的四诊信息、、血压、心脏、颈动脉超声指标,监测肝、肾功能和血脂变化,应用3D-MRA光波检测全身各系统功能变化,分析中药干预后的降压有效率以及中医证候改善情况。并在治疗后随机选取痰瘀互结组、肝阳上亢组各6例患者的早晨空腹血样,用细胞因子抗体芯片检测血清40种炎症因子指标。分析炎症因子在两种证类治疗前后的差异,分析其相关性。结果：1.超声结果显示：①颈动脉检测异常：痰瘀互结组45例,占38.79%,肝阳上亢组8例,占26.67%。其异常主要表现为颈动脉粥样硬化、粥样硬化斑块及颈动脉狭窄；②心脏超声检测异常：痰瘀互结组44例,占37.93%,肝阳上亢组11例,占36.67%,主要表现为左室舒张功能降低及左室肥大。2.抗体芯片检测结果显示：①痰瘀互结组治疗前后比较,TGF-betal(转化生长因子)和PDGF-BB(血小板衍化生长因子)治疗后均有明显降低,经统计学处理有显著差异(p<0.05)：肝阳上亢组治疗前后比较,I-309(人T细胞分泌的种趋化因子)、IL-1 alpha、IL-16、IL-17、M-CSF(非分泌性巨噬细胞集落刺激因子)、MIG、IL-1(?)台疗后均有明显降低,经统计学处理有显著差异(p<0.05)。②中药干预过程中痰瘀互结组患者的N0含量水平有升高趋向。随着治疗时间的延长,痰瘀互结患者的TNF-a浓度含量有下降趋向,趋向于正常水平3.经中药治疗后,降压总有效率为88.82%,证候改善总有效率为88.78%。患者停、减降压西药的比例达到42.36%,治疗过程中停服降压西药的共36人,占入组时服药人数的36.36%。结论：1.在高血压病痰瘀互结证患者中颈动脉内-中膜增厚、斑块形成等动脉粥样硬化性改变及心脏舒张功能减低、左心室肥大等病变,其发生率明显多于肝阳上亢证患者。2.高血压病痰瘀互结组治疗前后在血清炎症因子的表达方面有差异。其中CRP, NO, TNF-α, TGF-beta 1和PDGF-BB与高血压病痰瘀互结证有相关性。因此,检测高血压病治疗前后这些细胞因子的水平变化对了解高血压病分级、评价临床疗效、推测预后具有重要的指导意义,为高血压病病因学研究提供生物学依据,对进一步探索高血压病的发病机理奠定了基础。3.临床观察发现高血压病患者经过中药干预,降压总有效率为88.82%,证候改善总有效率为88.78%,部分患者可以停、减西药用量,因此痰瘀同治、解毒通络法治疗高血压病疗效确切,值得推广更多还原

【Abstract】 Objective:From the Angle of inflammatory factor change to Explore the Etiological of hypertension combination phlegm and blood stasis, observe hypertension patient serum inflammatory factor differences, Looking for hypertension combination phlegm and blood stasis related inflammatory factor, and observe the antihypertensive effects and Improve syndromes of TCM intervention.Methods:146 patients with hypertension were selected in The Clinic Of China Academy Of Chinese medical sciences from April 19, 2007 to August 31,2010, including 116 case of combination phlegm and blood stasis which was accounted 79.46% and 30 case of Yin deficiency and Yang hyperactivity which was accounted 20.55%. Clinical Application of Method Combined Synchronic Treating Phlegm and Blood Stasis on combination phlegm and blood stasis, and method nouring Yin and Checking exuberance of Yang on Yin deficiency and Yang hyperactivity. After three therapy course(one month as a course), through collecting the information from the TCM four diagnostic methods、Blood Pressure、values of cardiac ultrasound and Carotid Ultrasound, hepatic and renal function、Blood Lipid were measured before and after the treatment. The antihypertensive effects and Improve syndromes of TCM intervention are analyzed. The fasting blood samples were chosen, each group had 36 cases (combination phlegm and blood stasis、Yin deficiency and Yang hyperactivity、normal). To investigate the expression of inflammatory cytokines in patients by using an antibody chip.Results:1. Result of ultrasound:①the abnormal manifestation of Carotid Ultrasound:45 case(38.79%) of combination phlegm and blood stasis.8 case(26.67%) of Yin deficiency and Yang hyperactivity. They are mainly reflected in carotid atherosclerosis、Atherosclerotic Plaque and Carotid Artery Stenosis;②the abnormal manifestation of cardiac ultrasound:44 case(37.93) of combination phlegm and blood stasis,11 case(36.67%) of Yin deficiency and Yang hyperactivity. They are mainly reflected in Left Ventricular diastolic function and left ventricular hypertrophy.2. Result of antibody chip:①The level of IL-11、GM-CSF and IL-1beta in combination phlegm and blood stasis was lower than that of normal group(p<0.05); The level of IL-10 and IL-15 in Yin deficiency and Yang hyperactivity was lower than that of normal group(p<0.05); The level of IL-11 in Yin deficiency and Yang hyperactivity was lower than that of combination phlegm and blood stasis (p<0.05).②There was a great difference in TGF-beta 1 and PDGF-BB between pre and post treatment(P<0 05) in combination phlegm and blood stasis; There was a great difference inⅠ-309、IL-1 alpha、IL-16、IL-17、M-CSF、MIG、IL-1 between pre and post treatment(P<0 05) in Yin deficiency and Yang hyperactivity.3. After TCM Treatment, the total effective rate was 88.82% in reducing hypertension. The total effectiveness was 88.78% in improving the symptoms. Some 42.36% patients stop or reduce using the western medicine to reduce hypertension. Altogether has 36 people to stop the use of the western medicine to reduce hypertension accounted for 36.36%.Conclusion:1. The patients with combination phlegm and blood stasis are obviously more than the patients with Yin deficiency and Yang hyperactivity in some lesions, such as carotid intima-media thickening、atherosclerotic plaque、left ventricular diastolic function and left ventricular hypertrophy.2. There was a great difference in inflammatory factors between pre and post treatment combination phlegm and blood stasis. The change of CRP, NO, TNF-α, TGF-beta 1 and PDGF-BB was closely positively correlated with combination phlegm and blood stasis.3. This study discovered that after TCM Treatment the total effective rate was 88.82% in reducing hypertension and 88.78% in improving the symptoms. Partly patients stop or reduce using the western medicine to reduce hypertension. Therefore, the method that called synchronic treating phlegm and blood stasis has definite therapeutic effect.更多还原