[1]陆 新,龙 瑾.中医药辨证治疗难治性高血压病的系统评价[J].医学信息,2022,35(20):24-31.[doi:10.3969/j.issn.1006-1959.2022.20.006]
　LU Xin,LONG Jin.Systematic Evaluation on Treatment of Refractory Hypertension with Chinese Medicine[J].Journal of Medical Information,2022,35(20):24-31.[doi:10.3969/j.issn.1006-1959.2022.20.006]
点击复制

中医药辨证治疗难治性高血压病的系统评价()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
35卷
期数:
2022年20期
页码:
24-31
栏目:
论著
出版日期:
2022-10-15

文章信息/Info

Title:
Systematic Evaluation on Treatment of Refractory Hypertension with Chinese Medicine
文章编号:
1006-1959（2022）20-0024-08
作者:
陆 新; 龙 瑾
（广西国际壮医医院内科，广西 南宁 530001）
Author(s):
LU Xin; LONG Jin
(Department of Internal Medicine,Guangxi International Zhuang Hospital,Nanning 530001,Guangxi,China)
关键词:
难治性高血压病; 中医药辨证治疗; 肱踝脉搏波传导速度; 颈动脉内膜
Keywords:
Refractory hypertension; Chinese medicine dialectical treatment; Brachial ankle pulse wave velocity; Carotid intima
分类号:
R259
DOI:
10.3969/j.issn.1006-1959.2022.20.006
文献标志码:
A
摘要:
目的 系统评估中医药辨证治疗难治性高血压病的有效性和安全性。方法 计算机检索中国生物医学文献数据库、中文科技期刊数据库、中国学术期刊数据库、维普数据库、万方数据库、中国知网发表的中医药辨证治疗难治性高血压病的随机对照试验，检索时间从建库至2022年5月15日。使用Cochrane协作网评估工具进行文献资料评价提取，选取降压疗效、收缩压、舒张压、血压达标率、远期降压疗效、肌酐、尿素氮、血尿酸、尿微量白蛋白/肌酐、左心室体积指数、肱踝脉搏波传导速度、踝肱指数、颈动脉内膜中膜复合体厚度及不良反应为评价指标，采用Rev Man 5.3软件进行Meta分析，并根据GRADE指南评价证据等级，评价其安全性。结果 最终纳入4项研究，患者572例，其中治疗组354例，对照组218例；纳入的研究方法学质量均不高；Meta分析显示：相比对照组，治疗组能提高临床疗效[RR=-0.17，95%CI（-0.25，-0.09），P＜0.0001]、血压达标率[RR=0.36，95%CI（0.13，1.02），P=0.05]、远期疗效[RR=0.25，95%CI（0.17，0.35），P＜0.00001]，降低舒张压[SMD=-1.22，95%CI（-1.55，-0.89），P＜0.00001]和收缩压[MD=-17.56，95%CI（-22.58，-12.72），P＜0.00001]，改善患者中医临床症状[RR=0.51，95%CI（0.32，0.82），P=0.005]、左心室体积指数[MD=-0.81，95%CI（-13.23，-2.79），P=0.003]、肱踝脉搏波传导速度[MD=-196.73，95%CI（-323.63，-69.83），P=0.002]、踝肱指数[MD=0.11，95%CI（0.04，0.18），P=0.001]、颈动脉内膜中膜复合体厚度[MD=-0.24，95%CI（-0.41，-0.07），P=0.005]和不良反应[RR=0.45，95%CI（0.17，1.20），P=0.11]；两组改善尿素氮、血尿酸、肌酐、尿微量白蛋白/肌酐水平比较，差异无统计学意义（P＞0.05）；依据GRADE指南标准，总有效率、远期疗效、临床症状、舒张压为中级证据，收缩压、血压达标率、肌酐、尿素氮、血尿酸、尿微量白蛋白/肌酐、左心室体积指数、肱踝脉搏波传导速度、踝肱指数、颈动脉内膜中膜复合体厚度、不良反应为极低级证据；证据质量适宜推荐。结论 中医药辨证治疗难治性高血压病可改善患者临床症状、左心室体积指数、肱踝脉搏波传导速度、踝肱指数、颈动脉内膜中膜复合体厚度，有效降低患者的舒张压和收缩压，有较好的远期疗效、血压达标率，从而提高了临床疗效，不良反应低，适宜临床应用。
Abstract:
Objective To systematically evaluate the efficacy and safety of traditional Chinese medicine in the treatment of refractory hypertension.Methods Randomized controlled trials (RCTs) of TCM syndrome differentiation and treatment of refractory hypertension published in Chinese biomedical literature database, Chinese scientific journal database, Chinese academic journal database, VIP database, Wanfang database and China National Knowledge Infrastructure (CNKI) were retrieved by computer. The retrieval time was from the establishment of the database to May 15,2022. Cochrane collaboration network evaluation tool was used to evaluate and extract the literature. The antihypertensive efficacy, systolic blood pressure, diastolic blood pressure, blood pressure compliance rate, long-term antihypertensive efficacy, creatinine, urea nitrogen, serum uric acid, urinary microalbumin/creatinine, left ventricular volume index, brachial-ankle pulse wave velocity, ankle brachial index, carotid intima-media complex thickness and adverse reactions were selected as evaluation indexes. Rev Man 5.3 software was used for Meta analysis, and the evidence level was evaluated according to GRADE guidelines to evaluate its safety.Results Finally, 4 studies were included, with 572 patients, including 354 patients in the treatment group and 218 patients in the control group; the methodological quality of the included studies was not high ; meta-analysis showed that compared with the control group, the treatment group could improve the clinical efficacy [RR=-0.17,95%CI(-0.25,-0.09), P<0.0001], blood pressure compliance rate [RR=0.36,95%CI(0.13,1.02),P=0.05], long-term efficacy [RR=0.25,95%CI(0.17,0.35),P<0.00001], reduction of diastolic blood pressure [SMD=-1.22,95%CI(-1.55,-0.89),P<0.00001] and systolic blood pressure [MD=-17.56,95%CI(-22.58,-12.72),P<0.00001], improvement of TCM clinical symptoms [RR=0.51,95%CI(0.32,0.82),P=0.005], left ventricular volume index [MD=-0.81,95%CI(-13.23,-2.79),P=0.003], brachial-ankle pulse wave velocity [MD=-196.73,95%CI(-323.63, -69.83),P=0.002], ankle-brachial index [MD=0.11,95%CI(0.04,0.18),P=0.001], carotid intima-media complex thickness [MD=-0.24,95%CI(-0.41,-0.07),P=0.005] and adverse reactions [RR=0.45,95%CI(0.17,1.20),P=0.11]; there was no significant difference in the improvement of urea nitrogen, serum uric acid, creatinine and urinary microalbumin/creatinine between the two groups(P>0.05). According to the GRADE guidelines, the total effective rate, long-term efficacy, clinical symptoms, and diastolic blood pressure were intermediate evidence. Systolic blood pressure, blood pressure compliance rate, creatinine, urea nitrogen, serum uric acid, urinary microalbumin/creatinine, left ventricular volume index, brachial-ankle pulse wave velocity, ankle-brachial index, carotid intima-media thickness, and adverse reactions were extremely low-level evidence. The quality of evidence was recommended.Conclusion Traditional Chinese medicine dialectical treatment of refractory hypertension can improve the clinical symptoms, left ventricular volume index, brachial ankle pulse wave conduction velocity, ankle brachial index, carotid intima-media complex thickness, effectively reduce the patient ’s diastolic blood pressure and systolic blood pressure, have better long-term efficacy, blood pressure compliance rate, thereby improving the clinical efficacy, low adverse reactions, suitable for clinical application.

参考文献/References:

[1]中国心血管健康与疾病报告编写组.中国心血管健康与疾病报告2020概要[J].中国循环杂志,2021,36(6):521-545.[2]Schmieder RE,Redon J,Grassi G,et al.Esh Position Paper: Renal denervation -an interventional therapy of resistant hypertension[J].Journal of Hypertension,2012,30(12):2441-2442.[3]邓伟明.难治性高血压痰湿壅盛型与阴虚阳亢型患者临床相关因素的比较[D].上海:上海中医药大学,2019．[4]衣雪锋.豁痰熄风通络方药治疗痰瘀阻络证难治性高血压临床疗效分析[D].长春:长春中医药大学,2015．[5]刘安平.国医大师张学文辨治难治性高血压思路与经验[J].中华中医药杂志,2020,35(7):3421-3424.[6]毛竹青,高帅飞,杨丽,等.李庆海教授运用宣通温补降浊法治疗难治性高血压病的经验[J].中医临床研究,2022,14(15):116-119.[7]林清志,成金汉,陈清华,等.调肝活血法辅助治疗难治性高血压病的临床效果分析[J].中医临床研究,2020,12(20):33-35.[8]么传为,时敏,睢勇,等.难治性高血压患者的中医体质特点研究[J].山东中医杂志,2019,38(6):543-547.[9]Smith PRM,Ware L,Adams C,等.Cochrane及其他系统评价中“无差异”或“无效”声明的意义[J]. 英国医学杂志中文版,2020,23(8):459-461.[10]邓通,汪洋,王云云,等.临床实践指南制订方法——GRADEproGDT在干预性系统评价证据分级中的应用[J].中国循证心血管医学杂志,2019,11(1):1-5.[11]柳树昌,王慧霞,侯小明,等.加味杞菊地黄汤治疗老年难治性高血压病临床研究[J].中国中医急症,2011,20(11):1729-1730.[12]程广书.降压宝蓝片联合西药治疗肝火亢盛型顽固性高血压60例[J].中国中医药现代远程教育,2012,10(12):21-22.[13]于俏,吴焕林,吴瑜.温胆汤加减对难治性高血压患者尿微量白蛋白/肌酐的影响[J].中国实验方剂学杂志,2016,22(12):167-171.[14]高丽君,崔伟锋,范军铭.降压宝蓝片对难治性高血压肝火亢盛型患者靶器官损害的影响[J].光明中医,2021,36(22):3826-3828.[15]吴樱,付婷婷,梁天山.中西医结合治疗对老年难治性高血压患者疗效和血压变异性的影响研究[J].中国医药科学,2020,10(23):15-18.[16]李毅.负电场治疗仪辅助治疗难治性高血压(肝阳上亢型)的临床观察[D].成都:成都中医药大学,2018.[17]Ng Fl,Saxena M,Mahfoud F,et al.Device-based therapy for hypertension[J].Curr Hypertens Rep,2016,18(8):61.[18]葛均波,徐永健,王辰.内科学[M].9版.北京:人民卫生出版社,2018:247-260.[19]曲凡,杨锡燕.五苓散合黄连解毒汤加减治疗难治性高血压的临床效果[J].中国老年学杂志,2020,40(4):692-694.[20]黄宏,肖珉,邹冲,等.基于“心-脑-肠轴”理论概述肠道菌群与难治性高血压的发病[J].中华中医药杂志,2021,36(8):4809-4811.[21]高干,马琦琳,刘伟琪.原发性高血压患者血清vaspin水平与血压及UACR关系的研究[J].临床心血管病杂志,2015,31(3):306-309.

更新日期/Last Update: 1900-01-01