| 曹岩,周正,方芳.益气化瘀平肝滋肾方辅助常规西医治疗对高血压性视网膜病变病人心肾微循环及心肾功能的影响[J].安徽医药,2022,26(3):607-612. |
| 益气化瘀平肝滋肾方辅助常规西医治疗对高血压性视网膜病变病人心肾微循环及心肾功能的影响 |
| Effects of Yiqi Huayu Pinggan Zishen Recipe combined with conventional Western medicine on cardiorenal microcirculation and cardiorenal function in patients with hypertensive retinopathy |
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| DOI：10.3969/j.issn.1009-6469.2022.03.044 |
| 中文关键词: 高血压性视网膜病变 抗高血压药 微循环 利钠肽，脑 肌酸酐 每搏输出量 益气化瘀平肝滋肾方 |
| 英文关键词: Hypertensive retinopathy Antihypertensive agents Microcirculation Natriuretic peptide, brain Creatinine Stroke volume Yiqi Huayu Pinggan Zishen Recipe |
| 基金项目:河北省中医药管理局科研计划项目( 2018314) |
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| 目的探讨益气化瘀平肝滋肾方辅助常规西医治疗对高血压性视网膜病变( HRP)病人心肾微循环及心肾功能的影响。方法选取 2017年 6月至 2019年 6月唐山市中医医院收治的 160例 HRP病人，抽签分为两组，各 80例。对照组给予常规西医治疗(口服硝苯地平控释片、维生素 E、复方芦丁片，静脉推注前列地尔)，观察组在此基础上给予益气化瘀平肝滋肾方，比较两组治疗后总有效率、收缩压、舒张压、视力变化、心肾微循环指标［N-乙酰-β-D-氨基葡萄糖苷酶( NAG)、组织因子途径抑制物( TFPI)、组织因子、血浆内皮素 -1(ET-1)、神经肽 Y、血栓素 A2］、心肾功能指标［脑钠肽、心脏射血分数( LVEF)、左室质量指数( LVMI)、血肌酐、尿微量白蛋白( MAU)、尿白蛋白 /尿肌酐比值( UACR)、尿 β2-微球蛋白( β2-MG)、内生肌酐清除率( Ccr)］、不良反应，采用 Pearson相关性分析心肾微循环指标与心肾功能指标的相关性。结果观察组治疗后总有效率( 93.75%)高于对照组( 80.00%)(P<0.05)；观察组治疗后收缩压［( 126.97±8.77)mmHg］、舒张压［( 74.09±5.43)mmHg］低于对照组［( 139.65±9.39)mmHg、(82.55±6.42)mmHg］(P<0.05)；两组治疗后视力分布情况比较，差异有统计学意义( P<0.05)；观察组治疗后 NAG［( 8.14±1.25)U/L］、组织因子［( 50.73±7.06)ng/L］、 ET-1［( 105.38±15.09)ng/L］、神经肽 Y［( 116.50±19.83)ng/L］、血栓素 A2［( 178.29±26.45)μg/L］低于对照组［( 12.37±2.49)U/L、(61.45±8.33)ng/L、(123.59±17.30)ng/L、(126.49±20.63)ng/L、(193.57±31.29)μg/L］TFPI［(157.42±30.14)μg/L］高于对照组［(140.39±25.78)μg/L］(P<0.05)；观察组治疗后脑钠肽［(205.04±18.53)ng/L］、 MAU［( 227±1.94)mg/L］、 UACR［( 21.05±3.73)mg/g］、 β2-MG［( 3.12±0.51)mg/L］低于对照组［( 239.65±23.71)ng/L、(24.77±11.83)mg/L、(26.20±3.65)mg/g、(3.84±0.59)mg/L］， LVEF［( 56.59±2.42)%］、 Ccr［( 92.22±6.04)mL/min］高于对照组［( 53.87±2.96)%、(87.55±6.39)mL/min］(P<0.05)； NAG、组织因子、 ET-1、神经肽 Y、血栓素 A2均与脑钠肽、 MAU、UACR、β2-MG呈正相关，与 LVEF、Ccr呈负相关( P<0.05)； TFPI均与脑钠肽、 MAU、UACR、β2-MG呈负相关，与 LVEF、Ccr呈正相关( P<0.05)；观察组不良反应发生率 1.25%(1/80)与对照组 3.75%(3/80)相比，差异无统计学意义( P>0.05)。结论益气化瘀平肝滋肾方辅助常规西医治疗 HRP，可降低血压，提高视力，改善心肾微循环和心肾功能，疗效显著，安全可靠，且心肾微循环可影响心肾功能，可能是心肾功能受损的一个潜在作用靶点。 |
| 英文摘要: |
| Objective To investigate the effect of Yiqi Huayu Pinggan Zishen Recipe combined with conventional Western medicine treatment on cardiorenal microcirculation and cardiorenal function in patients with hypertensive retinopathy (HRP).Methods A total of 160 HRP patients admitted to Tangshan Hospital of Traditional Chinese Medicine from June 2017 to June 2019 were selectedand divided into two groups by lottery, with 80 cases in each group. The control group was given conventional Western medicine treatment (oral nifedipine controlled-release tablets, vitamin E, compound rutin tablets, intravenous injection of alprostadil), and the observation group was given Yiqi Huayu Pinggan Zishen Recipe on this basis. The total effective rate, systolic blood pressure (SBP), diastolicblood pressure (DBP), visual acuity changes, cardiorenal microcirculation indexes [N-acetyl-β-D-glucosidase (NAG), tissue factor path way inhibitor (TFPI), tissue factor (TF), plasma endothelin-1 (ET-1), neuropeptide Y (NPY), thromboxane A2 (TXA2)], cardiorenal function indexes [brain natriuretic peptide (BNP), cardiac ejection fraction (LVEF), left ventricular mass index (LVMI), serum creatinine(Cr), microalbuminuria (MAU), urinary albumin/urine creatinine ratio (UACR), urinary β2-microglobulin (β2-MG), endogenous creatinine clearance rate (Ccr)], and adverse reactions were compared between the two groups after treatment. Pearson correlation was used toanalyze the correlation between cardiorenal microcirculation indexes and cardiorenal function indexes.Results The total effective rate of the observation group after treatment (93.75%) was higher than that of the control group (80.00%) (P < 0.05); the SBP [(126.97±8.77)mmHg] and DBP [(74.09±5.43) mmHg] of the observation group after treatment lower than the control group [(139.65±9.39) mmHg,(82.55±6.42) mmHg] (P < 0.05); the visual acuity distribution of the two groups after treatment was compared, and the difference was statistically significant (P < 0.05); after treatment, the NAG, TF, ET-1, NPY, TXA2 in the observation group [(8.14±1.25) U/L, (50.73±7.06) ng/L, (105.38±15.09) ng/L, (116.50±19.83) ng/L, (178.29±26.45) μg/L] were lower than those in the control group [(12.37±2.49)U/L, (61.45±8.33) ng/L, (123.59±17.30) ng/L, (126.49±20.63) ng/L, (193.57±31.29) μg/L], while TFPI [(157.42±30.14) μg/L] was higher than those in the control group [(140.39±25.78) μg/L] (P < 0.05); after treatment, the BNP, MAU, UACR, and β2-MG in the observation group [(205.04±18.53) ng/L, (22.17±1.94) mg/L, (21.05±3.73) mg/g, (3.12±0.51) mg/L] were lower than those in the control group[(239.65±23.71) ng/L, (24.77±1.83) mg/L, (26.20±3.65) mg/g, (3.84±0.59) mg/L], while LVEF [(56.59±2.42)%] and Ccr [(92.22±6.04)mL/min] were higher than those in the control group [(53.87±2.96)%, (87.55±6.39) mL/min] (P < 0.05); NAG, TF, ET-1, NPY and TXA2 were positively correlated with BNP, MAU, UACR and β2-MG, and negatively correlated with LVEF and Ccr (P < 0.05); TFPI was negatively correlated with BNP, MAU, UACR and β2-MG, and positively correlated with LVEF and Ccr (P < 0.05); the incidenceof adverse reactions in the observation group was 1.25% (1/80) compared with 3.75% (3/80) in the control group, with no significant difference (P > 0.05).Conclusions Yiqi Huayu Pinggan Zishen Recipe combined with conventional Western medicine can lower bloodpressure, improve vision, and improve cardiorenal microcirculation and cardiorenal function, with significant curative effects, safetyand reliability. Cardiorenal microcirculation can affect cardiorenal function, suggesting that this may be a potential target for impairedcardiorenal function. |
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