摘要
目的：观察加味杞菊地黄汤辨治妊娠期高血压-子痫前期（阴虚肝旺证）对母婴结局的影响及对细胞毒性因子-血管内皮功能的影响。方法：将160例患者采用SAS软件生成,随机按数字表法分为对照组和观察组各80例。对照组采用25%硫酸镁注射液10 m L＋5%葡萄糖100 m L,静脉滴注,连续使用7 d至病情稳定;口服盐酸拉贝洛尔片,100 mg/次,3次/d。观察组在对照组治疗的基础上采用内服加味杞菊地黄汤,1剂/d。两组疗程均为连续观察至妊娠终止前1 d。记录孕妇妊娠结局,并计算自然流产、妊娠期高血压心脏病、胎盘早剥、羊水过少、产后出血及死亡等7种不良妊娠结局累积发生率;记录死胎死产、胎儿窘迫及低出生体质量、新生儿窒息及新生儿死亡等胎儿不良结局的累积发生率;进行治疗前后血压水平和阴虚肝旺证评估;检测治疗前后白细胞介素-6（IL-6）,肿瘤坏死因子-α（TNF-α）,血清胱抑素C（Cys C）,神经肽Y（NPY）,血清内皮素-1（ET-1）,一氧化氮（NO）,同型半胱氨酸（Hcy）,血管性血友病因子（v WF）水平。结果：对照组孕妇不良妊娠结局累积发生率30.77%,高于观察组的13.16%（χ2=6.940,P〈0.01）;观察组早产率15.79%,低于对照组的25.64%,但组间比较差异无统计学意义,观察组足月分娩率78.95%,高于对照组的62.82%（χ2=4.841,P〈0.05）;对照组胎儿不良结局的累积发生率为32.05%,高于观察组的17.11%（χ2=4.626,P〈0.05）;治疗后观察组收缩压（SBP）和舒张压（DBP）水平均低于对照组,阴虚肝旺证评分低于对照组（P〈0.01）;治疗后观察组患者IL-6,TNF-α,Cys C,NPY,ET-1,v WF和Hcy水平均低于对照组（P〈0.01）,NO水平高于对照组（P〈0.01）;观察组临床综合疗效总有效率为94.74%,高于对照组的83.33%（χ2=5.097,P〈0.05）。结论：在西医常规治疗的基础上,服用加味杞菊地黄汤辨证,且进一步控制了患者的血压,减轻了临床症状,降低了母婴不良结局,提高了综合治疗效果,并能改善血管内皮功能,减轻细胞毒性因子的损伤。
Objective：To observe the effect of modified Qiju Dihuang Tang based on syndrome differentiation in treating patients with hypertensive disorder complicating pregnancy（syndrome of hyperactivity of liver due to Yin deficiency） at preeclampsia and cytotoxic factor-vascular endothelial function.Method：One hundred and sixty patients were randomly divided into control group（80 cases） and observation group（80 cases）by random number table.Patients in control group were injected with 25% magnesium sulfate（10 m L） and 5%glucose（100 m L） for successively 7 days,and orally given labetalol hydrochloride tablets,100 mg/time,3 times/days.In addition to the therapy of control group,patients in observation group got modified Qiju Dihuang Tang based on syndrome differentiation,1 dose/day.The treatment continued until the day before termination of pregnancy.And the outcome of pregnancy was recorded,and the cumulative incidence of spontaneous abortion,hypertensive heart disease complicating pregnancy,placental abruption,oligohydramnios,postpartum hemorrhage and dead were calculated.And the cumulative incidence of stillbirth,neonatal respiratory distress syndrome,low body weight after birth,asphyxia of newborn and neonatal death were also recorded.Before and after treatment,the blood pressure level and syndrome of hyperactivity of liver due to Yin deficiency were evaluated,and levels of interleukin-6（IL-6）,tumor necrosis factor-α（TNF-α）,serum cystatin C（Cys C）,neuropeptide Y（NPY）,serum endothelin-1（ET-1）,nitric oxide（NO）,homocysteine（Hcy）,von Willebrand factor（v WF） were detected.Result：The cumulative incidence rate of adverse pregnancy outcomes in pregnant women in observation group was 13.16%,which was lower than 76.92% in control group（χ2= 6.940,P 〈 0.01）.The premature birth rate in observation group was 15.79%,which was lower than 25.64% in control group.The term delivery rate in observation group was 78.95%,which was higher than 62.82% in control group（χ2= 4.626,P 〈 0.01）.The cumulative incidence rate of fetal adverse outcomes in control group was 32.05%,which was higher than 17.11%in observation group（χ2= 4.626,P 〈 0.05）.After treatment,levels of SBP and DBP in observation group were lower than those in control group,and scores of syndrome of hyperactivity of liver due to Yin deficiency was lower than that in control group（P 〈 0.01）.Levels of IL-6,TNF-α,Cys C,NPY,ET-1,vWF and Hcy were lower than those in control group（P 〈 0.01）.The total effect rate of disease in observation group was 94.74%,which was higher than 83.33% in control group（χ2= 5.097,P 〈 0.05）.Conclusion：In addition to the therapy of routine western medicine,modified Qiju Dihuang Tang based on syndrome differentiation can control blood pressure of patients,relieve clinical symptoms,reduce maternal and infantile adverse outcomes,improve the comprehensive treatment effect,ameliorate vascular endothelial function and relieve injury caused by cytotoxic factor.
作者
许浪萍
潘群玉
陈艳丹
XU Lang-ping;PAN Qun-yu;CHEN Yah-dan(Sanya Traditional Chinese Medicine Hospital, Sanya 572000, Chin)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2018年第9期196-201,共6页
Chinese Journal of Experimental Traditional Medical Formulae
基金
海南省自然科学基金面上项目(20168341)
关键词
妊娠期高血压
子痫前期
杞菊地黄汤
血管内皮功能
血清胱抑素C
神经肽
同型半胱氨酸
hypertensive disorder complicating pregnancy
preeclampsia
Qiju Dihuang Tang
vascular endothelial function
serum cystatin C
neuropeptide
homocysteine
