【作者】 黄伟明；

【导师】 冼绍祥；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2008， 硕士

【摘要】 高血压病是人类心血管疾病中发病率最高的一种疾病。据报道,仅高血压可导致全球30%的心血管病患者死亡。近年来,我国高血压病患病率呈逐年上升趋势,目前大约有1.6亿高血压病患者。高血压及其相关疾病不仅影响着患者的生活质量,给家庭及社会带来沉重的负担,而且由此带来的医疗费用更是惊人。如何有效控制和治疗高血压已成为当今的一个重要课题。研究发现,痰湿壅盛是高血压病的主要证型之一,而分析现代人的工作和生活特点,发现“精神紧张”亦是高血压病发病的病机之一。从其发病机制上,国内外学者研究发现慢性炎症在高血压的发病率上扮演重要角色,高血压与血浆中C反应蛋白水平、组织坏死因子alpha等有关。研究目的:应用化痰安神熄风法治疗痰湿壅盛型高血压病患者,观察该法对痰湿壅盛型高血压病患者疗效及生化指标的影响。研究方法:选取符合纳入标准的高血压病患者共100例,采用简单随机化原则分治疗组、对照组各50例。对照组采用西医基础治疗,治疗组则采用西医基础治疗加中医化痰安神熄风法(自拟化痰安神熄风方)治疗,各组治疗时间均为60天。观察治疗前后两组痰湿壅盛证积分、血压、心率、血脂、尿酸、空腹血糖、空腹胰岛素、C反应蛋白的变化,并进行比较。结果:1.治疗后治疗组痰湿壅盛证积分较对照组明显改善(P=0.000);治疗后治疗组痰湿壅盛证疗效评定优于对照组(P=0.000)。2.治疗后治疗组与对照组的血压均有改善,治疗组的血压改善优于对照组(收缩压治疗后组间比较P=0.000,舒张压治疗后组间比较P=0.049);治疗后治疗组的心率较对照组明显改善(P=0.000)。3.治疗后治疗组的空腹血糖、空腹胰岛素、CRP均较对照组明显改善(P分别为0.001、0.000、0.000);尿酸、TC、LDL-C、HDL-C虽与对照组比较无显著性差异(P＞0.05),但自身前后比较差异有显著性(P均为0.000)。TG治疗前组间比较有统计学差异(P=0.049),故没有可比性。结论:在西医治疗的基础上,化痰安神熄风法能更好改善痰湿壅盛型高血压病患者的血压和心率,降低C反应蛋白水平,并可能对血脂、尿酸有一定的改善作用。更多还原

【Abstract】 Essential hypertension(EH)is a disease whose incidence is highest in Cardiovascular Diseases(CVD).It is reported that only hypertension can make 30 percent patients of CVD in the world die.In the past few years, the incidence of EH has climbed year after year.At now,there are about 160 million patients of EH in our country.Hypertension and its correlated diseases not only influence patients’ living quality,and brings heavy burden on family and society,but also brings horrifying cost of medical treatment.How to control and treat hypertension effectively has been an important discussion today.It was found that accumulation of phlegm-wetness is one of major syndromes of EH.And mental stress is one of pathogenesis on incidence of EH through analyzing people’s characteristic in working and life today.On the pathogenesis of EH,the scholars at home and abroad studies find that chronic inflammation plays an important role of incidence of EH,and hypertension is related to C-reactive protein and necrosis factor-alpha.Objective:To treat patients of EH with accumulation of phlegm-wetness with the therapeutic method of eliminating phlegm, tranquilizing and calming wind,then to observe effectiveness of EH and influence on biochemical parameters.Methods:Select 100 cases of EH according to the standard which the patients of EH are brought into.It is randomly divided into 2 groups which are given the same basic Western treatment.50 cases are in treatment group, and 50 cases in control group.The therapeutic method of eliminating phlegm,tranquilizing and calming wind(with recipe of eliminating phlegm, tranquilizing and calming wind)is given to the treatment group.The course of treatment of every group is 60 days.Grade of phlegm-wetness syndrome,blood pressure(BP),rhythm of the heart(HR),fat in blood,uric acid(UA),blood-glucose,fasting Insulin and C-reactive protein of every group are observed respectively before and after treatment,and then to compare.Results:1.After treatment,the grade and the curative effect of phlegm-wetness syndrome in the treatment group have been improved notably in comparison with those in the control group(the former P=0.000,the latter P=0.000).2.The BP in every group have been improved after treatment, and the BP in the treatment group has been improved more than that in the control group(SBP P=0.000,DBP P=0.049).the HR in the treatment group has been also improved notably than that in the control group(P=0.000).3.After treatment,the blood-glucose,fasting insulin and C-reactive protein in the treatment group have been improved notably in comparison with those in the control group(the former P=0.001,the latter two P=0.000).The UA,TC,LDL-C and HDL-C in the treatment group after treatment have been improved in comparison with those before treatment (all P=0.000),but haven’t significant difference in statistics in comparison with the control group(P＞0.05).Because there is significant difference of TG between the two groups before treatment,there is no significance to contrast after treatment.Conclusion:On the basis of Western treatment,the therapeutic method of eliminating phlegm,tranquilizing and calming wind can improve the BP,HR and C-reactive protein more satisfactorily in the patients of EH with accumulation of phlegm-wetness.And it can probably improve the fat in blood and UA to a certain extent.更多还原