目的 探讨降压益肾颗粒联合硝苯地平对老年原发性高血压病患者的临床疗效,以及对血清糖化血红蛋白(hemoglobin A1c,HbA1c)和肾胺酶表达水平的影响.方法 选择2017年10月—2021年12月在文昌市人民医院心血管内科接受治疗的125例原发性高血压患者,依据随机数字表法分为对照组(40例)、中药组(40例)和联合组(45例),对照组患者给予硝苯地平缓释片,中药组患者给予降压益肾颗粒,联合组患者给予降压益肾颗粒及硝苯地平,连续治疗8周.检测3组患者血压水平,治疗前后血清肾胺酶和HbA1c水平,以及肾功能指标尿微量白蛋白(urine albumin,UA1b)、血肌酐(serum creatinine,SCr)及尿素氮(blood urea nitrogen,BUN)变化,评估两组临床疗效.结果 联合组临床总有效率为88.89％(40/45),高于对照组及中药组[70.00％(28/40)、55.00％(22/40)],差异有统计学意义(P＜0.05).治疗后联合组收缩压变异性指标24 h收缩压标准差(spatial standard deviation,SSD)、24 h收缩压变异系数(spatial coefficient of variation,SCV)、dSSD、dSCV均低于对照组及中药组(P＜0.05),上述指标及nSSD、nSCV均低于治疗前;治疗后联合组舒张压变异性指标 24 h 舒张压标准差(diastolic blood pressure,DSD)、24 h 舒张压变系数(diastolic blood pressure variation coefficient(DCV)、dDSD、dDCV均低于对照组及中药组,上述指标及nDSD、nDCV均低于治疗前,差异有统计学意义(均P＜0.05).治疗后联合组患者UA1b、SCr、BUN、HbA1c水平较治疗前下降,均低于对照组及中药组,差异有统计学意义(均P＜0.05).治疗后联合组肾胺酶水平较治疗前升高,高于对照组及中药组,差异有统计学意义(均P＜0.05).结论 降压益肾颗粒联合硝苯地平治疗老年原发性高血压病可减轻患者的肾损伤,加强降压疗效,降低血清HbA1c水平、升高肾胺酶水平.
Clinical Study of Jiangya Yishen Granule(降压益肾颗粒)Combined with Nifedipine in Treatment of Senile Essential Hypertension
Objective To investigate the clinical efficacy of Jiangya Yishen Granule(降压益肾颗粒)combined with nifedipine on elderly patients with essential hypertension and the effect on serum glycated hemoglobin(HbA1c)and nephrinase expression levels.Methods A total of 125 patients with essential hypertension who were treated in the Department of Cardiovascular Medi-cine of Wenchang People's Hospital from October 2017 to December 2021 were selected and divided into control group(40 ca-ses),traditional Chinese medicine group(40 cases)and the combination group(45 cases)according to the random number table method.The patients in the control group were given nifedipine sustained-release tablets,those in the traditional Chinese medi-cine group were given Jiangya Yishen Granule and those in the combination group were given Jiangya Yishen Granule and nifedip-ine for 8 consecutive weeks of treatment.Blood pressure levels,serum levels of nephrinase and HbA1c before and after treatment as well as changes in indicators of renal function[urinary microalbumin(UA1b),serum creatinine(SCr)and blood urea nitrogen(BUN)]were detected in the three groups,and the clinical effects of the groups were evaluated.Results The total clinical effec-tive rate of the combination group was 88.9％,which was higher than that of the control group and the traditional Chinese medi-cine group(70.00％,55.00％),and the difference was statistically significant(P＜0.05).After treatment,the systolic blood pressure variability indexes[standard deviation of 24-hour systolic blood pressure(24 hSSD),24-hour systolic blood pressure variation coefficient(24 hSCV),day SSD(dSSD)and day SCV(dSCV)]in the combination group were lower than those in the control group and the traditional Chinese medicine group(P＜0.05),and the above indexes,night SSD(nSSD)and night SCV(nSCV)were all lower than those before treatment.The diastolic blood pressure variability in the combination group after treat-ment The indexes[standard deviation of 24-hour diastolic blood pressure(24 hDSD),24-hour diastolic blood pressure variation coefficient(24 hDCV),day DSD(dDSD)and day DCV(dDCV)]were all lower than those in the control group and the tradition-al Chinese medicine group,and the above indexes,night DSD(nDSD)and night DCV(nDCV)were all lower than those before treatment,and the differences were statistically significant(all P＜0.05).After treatment,the levels of UAlb,SCr,BUN and HbAlc in the combination group were lower than those before treatment,which were all lower than those in the control group and the traditional Chinese medicine group,and the differences were statistically significant(all P＜0.05).After treatment,the level of nephrinase in the combination group was higher than that before treatment,which was higher than that in the control group and the traditional Chinese medicine group,and the difference was statistically significant(all P＜0.05).Conclusions Jiangya Yishen Granule combined with nifedipine in the treatment of elderly patients with essential hypertension can reduce the renal damage,en-hance the antihypertensive effect,reduce the serum HbA1c level and increase the nephrinase level.
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