调冲降压汤结合针刺治疗围绝经期高血压冲任失调证的临床分析

目的:观察调冲降压汤结合针刺治疗围绝经期高血压冲任失调证的疗效及对神经递质和性激素水平的影响。方法:将160例患者采用随机按数字表法分为西医组和中医组;西医组口服琥珀酸美托洛尔缓释片,47.5 mg/次,1次/d;中医组采用调冲降压汤内服和针刺(取百会,合谷,太冲,曲池等穴位)治疗。两组疗程均为8周。检测患者治疗前后血压水平,不同日随机测量3次,取平均值计算;检测治疗前后冲任失调证评分;围绝经期综合征的症状采用Kupperman评分,治疗前后各1次;检测治疗前后神经肽Y(NPY),神经降压素(NT),血清雌二醇(E2),睾酮(T),孕酮(P),性激素结合蛋白(SHGB)水平。结果:中医组临床血压疗效有效率为91.89%,高于西医组的82.67%,但差异无统计学意义;中医组中医证候总有效率为93.24%,高于西医组的72%(P0.01);治疗后两组患者的SBP和DBP均明显下降(P0.01),治疗后两组患者SBP和DBP组间比较,差异无统计学意义;治疗后中医组冲任失调证评分和Kupperman评分均低于西医组(P0.01);治疗后中医组NPY,NT,P,T水平均低于西医组,E2和SHGB水平均高于西医组(P0.01)。结论:调冲降压汤联合针刺治疗冲任失调型围绝经期高血压患者的疗效与琥珀酸美托洛尔缓释片相当,并能明显改善患者的临床症状,其作用机制可能是通过调节患者的神经递质和性激素水平来实现的。

Clinical Analysis of Tiaochong Jiangya Decoction Combined with Acupuncture for Menopausal Hypertension with Syndrome of Disturbance of Chong and Ren

Objective: To investigate the efficacy of Tiaochong Jiangya decoction combined with acupuncture in treating menopausal hypertension with syndrome of disturbance of Chong and Ren, and observe its effect on neurotransmitter and levels of sex hormone. Method: One hundred and sixty patients with menopausal hypertension were selected and divided into western medicine group and traditional Chinese medicine (TCM) group according to random number table. Patients in western medicine group took metoprolol succinate sustained-release tablets, 47.5 mg/time and qd. The patients in TCM group were treated with Tiaochong Jiangya decoction combined with acupuncture (Bahui, Hegu, Taichong,Quchi acupoints). The treatment course was 8 weeks for both groups. The blood pressure levels were detected for 3 times before and after treatment, to get mean value. Chong-Ren symptom scores and Kupperman scores were compared between two groups pre-post treatment. The levels of neuropeptide Y (NPY), neurotensin (NT), serum estradiol (E₂), testosterone (T), progesterone (P) and sex hormone binding globulin (SHBG), were detected in two groups both before and after treatment. Result: The clinical effective rate was 91.89%for blood pressure in TCM group, higher than 82.67%in western medicine group, but there was no statistically significant difference. The total effective rate was 93.24%in TCM group, higher than 72%in western medicine group (P<0.01). After treatment, there was no statistically significant difference in SBP and DBP levels between two groups. After treatment, Chong-Ren disturbance symptom scores and Kupperman scores in TCM group were lower than those in western medicine group (P<0.01). After treatment, the levels of NPY, NT, P, and T in TCM group were lower than those in western medicine group, but levels of E₂ and SHGB were higher than those in western medicine group (P<0.01). Conclusion: Tiaochong Jiangya decoction combined with acupuncture has equivalent efficacy with metoprolol succinate sustained-release tablets in treating menopausal hypertension with disturbance of Chong and Ren, and the mechanism of action may be associated with regulating neurotransmitter and levels of sex hormone.