摘要
目的 观察调脂通脉颗粒对原发性高血压伴颈动脉粥样硬化(CAS)患者血脂水平及血清视黄醇结合蛋白-4(RBP-4)、富含半胱氨酸的酸性分泌蛋白(SPARC)的影响.方法 前瞻性选取2021年5月至2023年5月于北京中医药大学房山医院收治的116例原发性高血压伴CAS患者作为研究对象,按照随机数字表法将其分为对照组和试验组,每组各58例.两组均给予苯磺酸氨氯地平片、辛伐他汀片治疗,试验组在常规基础上给予调脂通脉颗粒治疗,对照组在常规基础上给予安慰剂治疗,连续用药4周.检测并比较两组治疗前和治疗4周后的血脂[总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、RBP-4、SPARC、脂蛋白相关磷脂酶A2(Lp-PLA2)、颈动脉血流动力学[颈总动脉舒张期峰流速(EDV)、收缩期峰流速(PSV)、搏动指数和阻力指数]水平、颈动脉内膜中层厚度(IMT)、斑块厚度及中医症状评分,并记录两组患者治疗期间的不良反应发生情况.结果 治疗4周后,试验组总胆固醇、甘油三酯、LDL-C水平分别为(4.21±0.69)、(1.87±0.31)、(2.21±0.42)mmol/L,均低于对照组[(4.89±0.81)、(2.24±0.39)、(2.67±0.54)mmol/L],HDL-C 水平为(1.32±0.30)mmol/L,高于对照组[(1.21± 0.27)mmol/L],差异均有统计学意义(P＜0.05).治疗4周后,试验组RBP-4、SPARC、Lp-PLA2水平分别为(36.58 ±5.77)mg/L、(2.16±0.35)ng/mL、(163.32±38.74)ng/L,均低于对照组[(43.86±6.95)mg/L、(2.31±0.40)ng/mL、(180.74±45.61)ng/L],差异均有统计学意义(P＜0.05).试验组治疗4周后EDV、PSV分别为(24.52±2.27)、(67.27±5.27)cm/s,均高于对照组[(22.14±2.30)、(59.13±5.04)cm/s],搏动指数、阻力指数分别为 0.65±0.21、0.55±0.15,均低于对照组(0.87±0.25、0.73±0.21),差异均有统计学意义(P＜0.05).试验组治疗4周后IMT、斑块厚度、中医症状评分分别为(0.86±0.11)mm、(1.63±0.32)mm、(8.02±1.12)分,均低于对照组[(0.95±0.14)mm、(1.87±0.36)mm、(11.48±1.36)分],差异均有统计学意义(P＜0.05).两组不良反应发生率比较,差异无统计学意义(P＞0.05).结论 调脂通脉颗粒治疗原发性高血压伴CAS可改善脂代谢和颈动脉血流,降低血清RBP-4、SPARC的表达,这可能是其治疗原发性高血压伴CAS的重要机制.
Abstract
Objective To observe the effects of Tiaozhitongmai Granules on blood lipid level,serum retinol-binding protein-4(RBP-4)and secreted protein acidic and rich in cysteine(SPARC)in patients with essential hypertension and carotid atherosclerosis(CAS).Methods A total of 116 patients with essential hypertension and CAS admitted to Fangshan Hospital,Beijing University of Chinese Medicine from May 2021 to May 2023 were prospectively selected as the study subjects.They were divided into the control group and the experimental group according to the random number table method,with 58 cases in each group.Both groups were treated with amlodipine besylate tablets and simvastatin tablets,the experimental group was treated with Tiaozhitongmai Granules on the basis of routine treatment,and the control group was treated with placebo on the basis of routine treatment for 4 weeks.The blood lipid[total cholesterol,triglycerides,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)],RBP-4,SPARC,lipoprotein-associated phospholipase A2(Lp-PLA2),carotid hemodynam-ics[end diastolic flow velocity(EDV),peak systolic flow velocity(PSV),pulsatile index,and resistance index]level,carotid intima-media thickness(IMT),plaque thickness,and TCM symptom score before treatment and after 4 weeks of treatment were detected and compared between the two groups.The occurrence of adverse reactions during treatment was recorded for both groups of patients.Results After 4 weeks of treat-ment,the total cholesterol,triglycerides,and LDL-C levels in the experimental group were(4.21±0.69),(1.87±0.31),and(2.21±0.42)mmol/L,respectively,which were lower than those in the control group[(4.89±0.81),(2.24±0.39),and(2.67±0.54)mmol/L],the HDL-C level was(1.32±0.30)mmol/L,which was higher than that in the control group[(1.21±0.27)mmol/L],and the differences were statistically significant(P＜0.05).After 4 weeks of treatment,the levels of RBP-4,SPARC,and Lp-PLA2 in the experimental group were(36.58±5.77)mg/L,(2.16±0.35)ng/mL,and(163.32±38.74)ng/L,respectively,which were lower than those in the control group[(43.86±6.95)mg/L,(2.31±0.40)ng/mL,and(180.74±45.61)ng/L],and the differences were statistically significant(P＜0.05).After 4 weeks of treatment,the EDV and PSV of the experimental group were(24.52±2.27)and(67.27±5.27)cm/s,respectively,which were higher than those of the control group[(22.14±2.30)and(59.13±5.04)cm/s].The pulsatile index and resistance index were 0.65± 0.21 and 0.55±0.15,respectively,which were lower than those of the control group(0.87±0.25 and 0.73±0.21),and the differences were statistically significant(P＜0.05).After 4 weeks of treatment,the IMT,plaque thickness,and traditional Chinese medicine symptom score of the experimental group were(0.86±0.11)mm,(1.63±0.32)mm,and(8.02±1.12)points,respectively,which were lower than those of the control group[(0.95±0.14)mm,(1.87±0.36)mm,and(11.48±1.36)points],and the differences were statistically significant(P＜0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Tiaozhi Tongmai Granules can improve lipid metabolism and carotid blood flow in the treatment of essential hypertension with CAS,reduce the ex-pression of serum RBP-4 and SPARC,which may be an important mechanism for its treatment of essential hypertension with CAS.
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