活血祛痰、平肝益气法治疗高血压左室肥厚的研究

【作者】 王剑；

【导师】 邓中炎；

【作者基本信息】 广州中医药大学 ， 中医基础理论， 2000， 硕士

【摘要】 高血压左心室肥厚（Essential Hypertension-Left VentricularHypertrophy EH-LVH）被认为是一种独立的心血管病危险因素，其伴发心绞痛、心律失常、心衰的发生率较非左室肥厚的高血压患者明显升高。肥厚左室组织发生异构，表现为心肌细胞的肥大及心肌间质的纤维化。除血压因素外，尚存在众多神经、体液因子影响着心肌组织的肥厚化进程。目前的西医学治疗在控制血压和降低左室重量方面疗效较好，但在逆转心肌间质纤维化方面疗效不尽人意。 归纳高血压左室肥厚患者的临床表现，我们发现患者多为中年以上年龄，病程较长，不但存在头痛、头晕、易怒、脉弦等肝阳上亢症状，且多伴有乏力、腿软、胸闷、舌质淡暗等气虚血瘀痰阻表现，而五心烦热、腰酸耳鸣、潮热盗汗、口干等肝肾阴虚症状多见于早期高血压病人，少见于伴左室肥厚患者。 肝阳上亢证高血压病患者整体肾素-血管紧张素系统（RAS）功能及去甲肾上腺素（NE）和肾上腺素（E）含量明显高于正常人和其他证型患者。研究发现，左室肥厚的主要成因是心肌局部RAS功能亢进及去甲肾上腺素含量增高，从局部微观辩证出发，此病因可能亦属于中医学中的肝阳上亢，从而导致心肌组织内各种细胞处于一种紧张、应激与亢奋的状态，如血管平滑肌细胞的收缩、心肌细胞的代偿性肥大、成纤维细胞的增生等；而肥厚心肌细胞内能量代谢降低及其导致的变化，与中医学中气虚的特征相类通；此外心肌间质所存在着的微循环的紊乱与中医学中的血瘀特点相类通；心肌间质积聚的粘多糖可能属于中医学中痰证病理变化。左室肥厚属有形改变，从宏观上把握亦是痰瘀为患。因此立治则为活血祛痰、平肝益气。 按照上述治则制成心肌康水丸剂，用于高血压左室重构患者。通过对照组和中药治疗组三个月的治疗观察，我们发现心肌康可降低患者的血压，降低左室重量指数，逆转间质的纤维化进程指标（Ⅲ型前胶原、透明质酸）改变，改善血液流变学，且可较好改善患者的生活质量。中文槽耍 颤二页 进一步的实验研究发现：心肌康治疗可改善自发性高血压大鼠离体心脏收缩和舒张功能，降低左室重量，减少心肌间质胶原含量、透明质酸含量和血管紧张素＊含量，提高心肌细胞膜＊ ＼M4“Ahase、Na＋－K＋ATPase活力，降低膜脂质过氧化作用。从而部分说明了活血祛痰、平肝益气法逆转EH－LVH的机理。更多还原

【Abstract】 Study of the therapy principle (activating the blood circulation, removing the phlegm, lowering the liver Yang and invigorating Qi) on essential hypertension with left ventricular hypertrophy. Essential hypertension with left ventricular hypertrophy (EH-LVH) was considered as an independent cardiovascular dangerous factor. The rates of angina, arrhythmia and heart failure in EH patients with LVH were significantly higher than those in EH patients without LVH. The tissue of left ventricular remodeled, comprising the hypertrophy of cardiocyte and the fibrosis of interstitial of heart. Besides blood pressure, there exists more nervous and body fluid factors which influences the development of LVH. The current therapy of western medicine was fairly good at lowering blood pressure and left ventricular mass index (LVMI), however was not quite good at recovering the course of fibrosis. It could be discovered that most of the patients of EH-LVH were middle-aged and the course of the disease was long. The symptoms include headache, whirl, testiness, and string pulse et al, which belonged to the syndrom of up-floating of the liver-Yang, it also include atony, stuffy of the chest, white and dim tongue, et al, which belongs to the syndrome of Qi deficient, blood stasis and phlegm assembling. The symptoms of deficiency of Liver-Yin and Kidney-Yin such as feverish sensation of five centers, soreness of waist, tinnitus, hectic fever, night sweat and dry taste, et al, were common in early stage EH patients, but seldom in EH-LVH patients. The activity of RAS (renin-angiotensin system) and the content of noradrenaline(NE) in the patients of EH-LVH with state of up-floating of liver-Yang was significantly higher than ~4i~ that in the others. By combining the view of Traditional Chinese Medicine (TCM) with the study of western medicine on pathophysiology of LVH, we think the rise of the content of NE and the function of RAS in cardiot issue were similar with the syndrome of up floating of the liver Yang of TCM. Because the RAS caused the cells of cardio in a stasis of tense and stress, such as the contract of vascular smooth muscular cell, the hypertrophy of cardiocyte, and the increment of fibroblast. The depression of energy metabolism and the changes caused by it in hypertrophy cardiocyte was similar with the deficiency of Qi of TCM. Furthermore, the turbulence of microcirculation in cardio interstitial was similar with the blood stasis of TCM. The accumulation of mucopolysaccharides in cardio interstitial possibly belongs to the pathophysiology of phlegm syndrome. On the basis of analysis above, the therapy principal as activating the blood circulation, removing the phlegm, lowering the liver Yang and invigorating Qi were adopted.XingJiKang(XJK) pill was made for the patients with EH-LVH. Seventy patients were divided into observation group (treated by XJK) and control group (treated by Betaloc). All patients received treatment for three months. It indicated that XJK could lower the blood pressure and LVMI, improve the fibrosis index including serum procollagen typeⅢ (PCⅢ) and hyaluronic acid (HA), hemorheology index, and the life quality. The further experiment study showed that XJK could improve both the systolic and diastolic function of the isolated heart of spontaneous hypertension rat, reduce the content of collagen, HA and angiotensin Ⅱ, could improve the activity of enzyme of更多还原