益脉降压流浸膏对老年Ⅱ期原发性高血压患者胰岛素抵抗的影响

背景原发性高血压患者普遍存在胰岛素抵抗(insulin resistance,IR),因而增加了发生冠心病的危险性,中药制剂对原发性高血压患者IR的水平有何影响?目的探讨中药制剂益脉降压流浸膏对老年气虚血瘀证型Ⅱ期原发性高血压患者IR的影响.设计病例-对照研究.地点和对象治疗组(n=40)来源于济南军区总医院符合1999年世界卫生组织制定的高血压诊断标准,同时符合中国中西医结合研究会制定的中医虚证辨证标准及血瘀证诊断标准辨证属气虚血瘀证型的高血压患者,对照组(n=30)为同期来济南军区总医院健康体检者,无原发性高血压、糖尿病等疾病.实验指标测定在济南军区总医院中心实验室进行.干预治疗组口服益脉降压流浸膏(药物组成生黄芪、党参、黄精、当归、川芎、生蒲黄、穿山龙等,每毫升含生药2.0 g,由山东济南宏济堂制药有限责任公司提供,批号991218),10 mL/次,3次/d.疗程为8周.分别采用葡萄糖氧化酶法及放射免疫法测定治疗组治疗前后的空腹血糖、空腹血浆胰岛素(fasting plasma insulin,FPI),计算其胰岛素敏感性指数(insulin sensitivity index,ISI),并与对照组的空腹血糖、FPI、ISI进行比较.结果治疗组治疗前空腹血糖(4.97±0.61)mmol/L]与对照组比较,差异无显著性意义(t=1.131,P＞0.05);FPI(13.71±4.79)mIU/L]显著高于对照组,ISI(-5.11±0.32)显著低于对照组,差异有显著性意义(t=5.393,21.714,P＜均0.01).治疗后空腹血糖无明显变化,FPI(9.65±4.58)mIU/L]显著降低,ISI(-3.87 ±0.31)显著升高,较治疗前比较,差异均有显著性意义(t=4.962,16.257,P均＜0.01).治疗后收缩压和舒张压(132.49±20.42)和(85.36±6.08)mm Hg,1 mm Hg=0.133 kPa],与治疗前比较,差异均有显著性意义(t=8.962,12.831,P均＜0.01).结论老年气虚血瘀证型Ⅱ期原发性高血压患者存在高胰岛素血症、胰岛素抵抗;益脉降压流浸膏具有降低血胰岛素水平,提高胰岛素敏感性作用.

Effect of yimai jiangya liujingao on insulin resistance in patients with senile primary hypertension Ⅱ

BACKGROUND: Since it is commonly present in patients with primary hypertension, insulin resistance (IR) greatly threatens to occurrence of coronary heart disease. How do Chinese herbal preparations affect IR level in patients with primary hypertension?OBJECTIVE: To probe into the effect of Chinese herbal preparation, yimai jiangya liujingao on IR in patients with senile primary hypertension Ⅱ of qi deficiency and blood stagnation.DESIGN: Controlled study on cases.SETTING and PARTICIPANTS: The cases( n =40) in treatment group were from General Hospital of Jinan Military Area Command of Chinese PLA. They accorded with Diagnostic Standard on Hypertension determined by WHO in 1999, with Differentiating Diagnostic Standard on Deficiency Syndromes in Chinese Medicine and Diagnostic Standard on Blood Stagnation Syndromes determined by China Research Association of Collaboration of Chinese and Western Medicine. The cases of hypertension were diagnosed as qi deficiency and blood stagnation. The cases( n = 30) in the control were the people from General Hospital of Jinan Military Area Command of Chinese PLA in the same period. By general health checks, they were absent of primary hypertension and diabetes. The experimental measure determination was performed in Central Experimental Room in General Hospital of Jinan Military Area Command of Chinese PLA.INTERVENTIONS: In treatment group, yimai jiangya liujingao (Drug composition: shenghuangqi, dangshen, huangjing, danggui, chuanxiong,shen puhuang, chuangshanjia, etc. Each milliliter contains raw herb 2.0 g;provided by Shangdong Jinan Hongjitang Pharmaceuticals Co. Ltd.,No. 991218) was taken orally, 10 mL/time, 3 times daily and 8 weeks as one course. With glucose-oxidase method and radioimmunoassay, fasting blood sugar (FBS) and fasting plasma insulin(FPI) were determined respectively before and after treatment and insulin sensitivity index(ISI) was calculated. The results of FBS, FPI and ISI were compared between the treatment and the control groups.RESULTS: Compared with the control, the result of FBS(4. 97 ±0. 61)mmol/L] before the treatment in the treatment group did not indicate significant difference(t=1. 131, P＞ 0.05); the result of FPI (13.71± 4.79) mIU/L] was significantly higher, and of ISI ( - 5.11 ± 0. 32) was significantly lower, indicating significant difference( t = 5. 393, 21. 714, P＜ 0. 01 for both) . There was no remarkable change in fasting blood sugar after treatment. FPI (9.65 ± 4.58) mIU/L] was significantly reduced and ISI ( - 3.87 ± 0. 31 ) significantly increased. Compared with the results before treatment, the differences were significant( t =4. 961, 16. 257, P ＜ 0. 01 for both). Compared with the results before treatment, the systolic pressure and diastolic pressure ( 132.49 ± 20.42), (85.36 ± 6.08) mm Hg respectively, 1 mm Hg =0. 133 kPa] after treatment indicated significant difference( t = 8. 962, 12. 831, P ＜ 0. 01 for both).CONCLUSION: Hyperinsulinemia and IR are present in senile primary hypertension Ⅱ of qi deficiency and blood stagnation. Yimai fiangya liujin gao acted on reducing blood insulin and improving insulin sensitivity.