【作者】 郭英普；

【导师】 王清海；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2010， 硕士

【摘要】 原发性高血压病(Essential hypertension, EH)是一种以动脉血压升高为主的临床综合征,是常见的心血管疾病,易并发心、脑、肾等靶器官损害,具有较高的致残率,严重威胁人们的健康。中医药在防治EH有较好的作用,是目前研究的热点,因此,合理利用中医药发挥其优势有着重要的意义。研究目的：1.通过临床病例调查,探索高血压病五脏相关性及中医证型分布规律。2.在五脏相关性理论指导下,运用中药干预治疗高血压病,观察其疗效。研究方法：1.高血压病五脏相关性研究：进行前瞻性高血压病病例调查收集2009年1月至2010年3月广东省第二中医院门诊或住院高血压病例200例,填写高血压五脏相关调查表,分析高血压病五脏相关的临床症状。2.高血压病中医证型分布规律调查：对广东省第二中医院和中山市中医院近10年高血压病患者住院病例进行回顾性收集,填写调查表,分析高血压病中医证型分布规律。3.中药干预治疗高血压病：收集2009年6月至2010年3月广东省第二中医院门诊或住院高血压病例120例,其中30例中医辨证属气虚痰浊的患者进行复方芪麻胶囊干预研究,30例中医辨证属肝火亢盛的患者进行平肝胶囊干预研究,另外60例其中气虚痰浊型和肝火亢盛型各30例作为对照组,对照组予基础治疗(硝苯地平缓释片20mg,2次／日和／或卡托普利12.5mg/25mg,3次／日),治疗组气虚痰浊型在对照组的基础治疗上加用复方芪麻胶囊(由黄芪、天麻等药物组成)2粒,3次／日；治疗组肝火亢盛型在对照组的基础治疗上加用平肝胶囊(龙胆草、栀子等药物组成)2粒,3次／日；每周随访一次,4周后观察治疗前后患者收缩压(SBP)、舒张压(DBP)、脉压差,头晕、头痛等临床症状,总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)等血脂指标的变化,以及不良反应情况。填写观察表,最后进行资料统计分析。评估中药制剂干预对调节血压、缩小脉压差、降低血脂、改善临床症状的治疗效果。研究结果：1.高血压病五脏相关性研究结果显示：高血压病患者临床表现多与心、肝、脾关系较为密切,这种现象符合邓老“五脏相关理论”的思想,表明高血压病五脏相关性客观存在。2.高血压病中医证型分布规律调查结果：高血压病四类中医证型与各组间年龄分层有显著性差异(P<0.05),与性别无显著性差异(P>0.05),高血压病患者中以痰浊内阻型最为多见(56.8%),其次为肝火亢盛型(22.6%)、阴虚阳亢型(4.8%)和其他证型(15.7%)。3.复方芪麻胶囊治疗气虚痰浊型高血压病临床疗效观察结果显示：治疗组降压总有效率为93.0%,对照组总有效率为88.3%,与对照组比较,治疗组疗效有显著性差异(P(0.05),治疗组症候总有效率为96.7%,对照组总有效率为93.3%,与对照组比较,治疗组症候疗效有显著性差异(P<0.05)；治疗组降低TC、TG,升高HLD总有效率为83.3%、83.3%、93.3%,对照组分别为30.0%、43.3%、40.0%,与对照组比较,治疗组调脂疗效均有显著性差异(P<0.01),与治疗前比较,治疗组及对照组血压疗效、症候疗效均有显著性差异(P<0.01),治疗组血脂疗效有显著性差异(P<0.01),对照组血脂疗效无显著性差异(P>0.05)。4.平肝胶囊治疗肝火亢盛型高血压病临床疗效观察结果显示：治疗组降压总有效率为93.3%,对照组总有效率为83.3%,与对照组比较,治疗组疗效有显著性差异(P<0.05),治疗组症候总有效率为96.7%,对照组总有效率为83.3%,与对照组比较,治疗组症候疗效有显著性差异(P<0.05)；治疗组降低TC、TG,升高HLD总有效率为73.3%、80.0%、80.0%,对照组分别为26.7%、33.3%、36.7%,与对照组比较,治疗组调脂疗效均有显著性差异(P<0.01),与治疗前比较,治疗组及对照组血压疗效、症候疗效均有显著性差异(P<0.01),治疗组血脂疗效有显著性差异(P<0.01),对照组血脂疗效无显著性差异(P>0.05)。结论：1.高血压病五脏相关性客观存在,运用这一理论指导临床治疗高血压病有着确切的疗效。2.高血压病中医证型分布按比例依次为痰浊内阻型>肝火亢盛型>阴虚阳亢型>其他证型。3.复方芪麻胶囊和平肝胶囊分别在治疗气虚痰浊型高血压病和肝火亢盛型高血压病有着确切的疗效,考虑与其在降血压、缩小脉压差、调脂、改善症状等方面的疗效有关。更多还原

【Abstract】 Essential Hyertension (EH) refers to a syndrome with characteristics of increased aortic blood pressure, which frequently being complicated by injuries of targeted organs such as brain, heart, kidney and etc,is a common cardiovascular disease as the main thereaten factor to the human health with high disability rate and seaverely decreases the life quality of human being.TCM has a dood effect in the prevention of EH, and has became the focus of modern research. Therefore, reasonable utilization of TCM exert its advantages has important significance.Objective1. Through clinical cases investigation, exploration Five zang-organ-related theory of hypertension and TCM syndrome type distribution.2. Under the guidance of Five zang-organ-related theory, using the TCM treatment of hypertension, observe intervention.Methods1. Prospective investigation and collection of cases hypertension between January 2009 to March 2010 in the second TCM Hospital of Guangdong Province outpatient or in hospital hypertension 200 cases, fill in Questionnaire of hypertension Five zang-organ-related, Analysis of the relevant organs of hypertension symptoms.2. All cases of patient records were selected from the 2nd TCM Hospital of Guangdong Province and TCM Hospital of Zhongshan County fill in cases were collected and analyzed the hypertension TCM syndrome type distribution.3. Collecting 120 cases hypertension patients from second Guangdong hospital outpatient or in hospital between June,2009 to March,2010 30 cases of TCM syndrome differentiation of Qi deficiency and phlegm syndrome with the Compound Qima capsule intervention study,30 cases of TCM dialectical patients of Overabundant Liver-Fire syndrome, with the Pinggan capsule intervention study, Another 60 cases of Qi deficiency and phlegm syndrome and Overabundant Liver-Fire syndrome of 30 patients suffered various as control group, the control group treated by Nifedipine Sustained-release Tablets 20mg Bid and/or Captopril Tablets 12.5mg/25mg Tid;the treatment group treated with fthe same and add the Compound Qima Capsule 2 pill Tid or the Pinggan Capsule 2 pill Tid,and observe the indexes of improvement in clinical symptoms blood pressure controlling condition, four items test of blood lipid and side-effect occurrences.Results1. Hypertension Five zang-organ-related research results show that the essential hypertensive patients with clinical manifestations of heart, liver, spleen, this kind of phenomenon closely "Five zang-organ-related theory" by DengLao in the core idea of spleen center, That hypertension Five zang-organ-related theory exists objectively.2. Hypertension TCM syndrome type distribution survey results:Hypertension four types of TCM syndrome type between age groups has significant differences (P (0.05), and gender has no significant difference (P> 0.05). Hypertension patients with Phlegm stasis syndrome (56.6%) on the most frequent Secondly is Overabundant Liver-Fire syndrome (22.6%). Yin Vacuity Due to Yang Hyperactivity (4.8%) and the other types (15.7).3. The therapeutic efficacy result of Compound Qima Capsule for Qi deficiency and phlegm syndrome of hypertension indicate that therapeutic efficacy on blood pressure of the treatment group is 93.0%and that of the control group is 88.3%, there is statistic difference between them (P (0.05).Corres-ponding to the clinical treatment effect rate with 96.7%in comparison to 93.3%(P (0.05).the treatment group was superior to the control group in reducing TC、TG level and the former could enhance HDL index relating to the therapeutic effect on reducing blood lipid (P (0.01).4. The therapeutic efficacy result of Pinggan Capsule for Qi deficiency and phlegm syndrome of hypertension indicate that therapeutic efficacy on blood pressure of the treatment group is 93.3%and that of the control group is 83.3%, there is statistic difference between them (P (0.05).Corresponding to the clinical treatment effect rate with 96.7%in comparison to 83.3%(P (0.05). the treatment group was superior to the control group in reducing TC、TG level and the former could enhance HDL index relating to the therapeutic effect on reducing blood lipid (P (0.01)Conclusions1. The hypertension Five zang-organ-related theory exists objectively, using this theory to guide clinical treatment of hypertension is exactly curative effect.2. Hypertension TCM syndrome type distribution according to the proportion in order is Phlegm stasis、Overabundant Liver-Fire syndrome、Yin Vacuity Due to Yang Hyperactivity and the other types.3. Compound Qima capsule and Pinggan capsule respective in the treatment of Qi deficiency and phlegm syndrome and h Qi deficiency and phlegm syndrome of hypertension has suffered exactly curative effect, Considering its blood pressure、narrowing pulse blood pressure、cholesterol-lowering、improve symptoms related aspects of the curative effect.更多还原