【作者】 关冬梅；

【导师】 林松波； 周国英；

【作者基本信息】 福建中医学院 ， 中西医结合临床（内科）， 2000， 硕士

【摘要】 背景：血液中一些化学物质对心肌和血管平滑肌的活动发生影响，从而对血压起调节作用，可能参与原发性低血压的发病。 目的：研究内皮素、一氧化氮、儿茶酚胺、空腹血糖、血清胰岛素及电解质水平的改变在原发性低血压发病中所起作用，为原发性低血压病及中医分型提供现代实验室参考依据。 资料与方法：按WHO诊断标准及中医辨证标准，选择原发性低血压患者50例（其中男18例，女32例），平均年龄36.07±7.52岁（26-45岁）。中医辨证气虚16例，血虚10例，肝郁12例，阴虚12例，偶测血压平均值88.5±6.5/56.4±6.7mmHg。正常对照组30例（其中男11例，女19例）平均年龄34.12±8.46岁（24-44岁）。采用放免法检测血浆内皮素（ET）；采用铬还原比色法测定一氧化氮（NO）；采用改良荧光法测定血浆去甲肾上腺素（NE）及肾上腺素（E）；采用自动生化分析仪测定空腹血糖（FPG），血Na⁺、K⁺、Ca²⁺；采用放射免疫法测定胰岛素（FIN）；采用以空腹血糖与血清胰岛素乘积的倒数作为胰岛 素敏感性指数。 结果：1．原发性低血压组NO水平高于正常对照组，差异非 常显著u＜0．01人ET水平显著高于对照组u．05人NO与 ‘ET比值较对照组有显著差异u＜0．05)；2．原发性低血压组血 中儿茶酚胺浓度与对照组比较未见差异；3．原发性低血压组 Na丫K”显著高于对照组，具统计学意义吓 t 0．01人 4．原发性 低血压组空腹血糖、血清胰岛素较对照组升高，具统计学意义 。O＜0．05)；5．四组 NO水平均显著高于对照组，气虚组与肝郁 组尤为显著仔＜0．of人 且气虚组 NO水平显著高于阴虚组和血 虚组O＜0．05，P＜0．of人 气虚组叮水平显著高于对照组u ＜0．05人 组间比较未见显著差异；6．肝郁组儿茶酚胺较对照组 明显增高，组间比较未见明显差异；7，气虚组、血虚组、阴 虚组血K“浓度低于对照组；其中气虚组和阴虚组Na丫K”高于对＿＿照组，均具统计学显著意义吓＜0．of，Pwto．05人 但组间比较 ‘差异不明显；8．气虚组、血虚组和阴虚组空腹血糖及血清胰岛 素均显著低于对照组但组间比较差异不明显。9．经直线相关分 析得出，原发性低血压患者的收缩压和舒张压均与NO． ET。 NO砸T、血K”显著相关u＜0．01入 10．经逐步回归分析后得出 与收缩压关系最密切的是NO、FPG、NE，与舒张压关系最密切 的是NO、K”、FPG、Na”。 ·结论：血浆一氧化氮、内皮素水平的改变可能参与原发性 低血压的发病，同时也为原发性低血压中医分型提供物质基础 和现代实验室诊断参考指标。更多还原

【Abstract】 w ABSTRACT Background: Some chemicals in blood can modulate blood pressure by exerting an effect on cardiac myocyte and vascular smooth muscle, which may be involved in the pathogenesis mechanism of essential hypotension. Objectives: To provide modem laboratory reference for essential hypotension and its TCM types by researching the change of plasma endothelin(ET), nitric oxide(NO), adrenaline(E) and norepinephrine(NE), fasting plasma glucose(FPG), fasting insulin(FIN) and insulin sensitive index(ISI) level. Materials and Methods: According to WHO diagnosis criteria and TCM differentiation criteria. We selected 50 cases (18 male, 32 female) the average age is 36.07?7.52, among them 12 cases in liver-Qi stagnation group, 16 cases in Qi deficiency group, 10 cases in blood deficiency group and 12 cases in essence deficiency group. 30 healthy people (11 male, 19 female), were taken as the control group. Their average age is 34.12?8.46.We detected plasma ET by RIA method, NO by colorimeteric method, plasma E, NE by fluorimetric method, FPG, electrolytes by the glucose oxidase method, and take the reverse of the product of FPG and FIN as ISI. Results: 1 .Compared with the control group, the level of NO was very significantly higher than that in treatment group (PKO.Ol); the level of ET and the ratio of NO/ET increased significantly, too. 2.There were no obvious difference between the treatment group and the control group in the level of E and NE. 3.The ratio of Na~/K~ in treatment group was obviously higher than that in control group, which had statistic meaning. 4. The level of FPG, FIN increased significantly, which had statistical meaning.5. The level of NO in the four group were significantly higher than that in the control group and there were obviously difference among Qi deficiency group, essence deficiency group and blood deficiency group. 6.There were no significant difference among the four groups in the levels of E, NE, FPG, FIN, ISI and among the four groups and the control group.7. The level of K~ in the Qi deficiency group, essence deficiency group and blood deficiency group is lower than that in the control group, but there was no clinical meaning. 8.There was a close negative correlation between the blood pressure and NO, NO[ET, K~. 9.The main factors which affect diastolic blood pressure (DBP) is NO, FPG, Nat. The main factors which affect systolic blood pressure are NO, FPG, NE. Conclusion: The change of ET and NO level may play an important role in the pathogenesis of essential hypotension and may provide material basis for essential hypotension TCM pattern types and reference index of modem laboratory.更多还原