天麻钩藤饮加减对重度子痫前期患者微炎症状态、凝血功能及肾功能影响
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摘要
目的:探讨重度子痫前期(sPE)应用天麻钩藤饮加减治疗的临床效果。方法:选取我院2017年4月—2018年2月收治的114例sPE患者,采取随机数字表法将这114例患者随机分成观察组(n=57)与对照组(n=57)。对照组予以硫酸镁治疗,观察组在此基础上联合天麻钩藤饮加减治疗。比较两组临床疗效,治疗前后微炎症指标[白介素(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF-α)]、凝血功能指标[血管性血友病因子(vWF)、血小板α-颗粒膜蛋白(GMP-140)、凝血酶原时间(PT)]及肾功能指标[肌酐(Cr)、胱抑素C(Cys-C)、尿酸(UA)]水平变化,不良反应发生情况。结果:治疗7 d后,观察组总有效率为89.5%(51/57),较对照组[75.4%(43/57)]明显升高(P<0.05)。与治疗前对比,两组治疗后各微炎症指标(IL-6、hs-CRP、TNF-α)血清水平及血清Cr、Cys-C、UA浓度均显著降低(P<0.05);且观察组下降更显著(P<0.05)。两组治疗后血清vWF水平和外周血GMP-140含量较治疗前均显著减少(P<0.05),PT均显著延长(P<0.05);且观察组改善更显著(P<0.05)。观察组不良反应率为7.0%(4/57),与对照组[3.5%(2/57)]相比,差异无统计学意义(P>0.05)。结论:sPE应用天麻钩藤饮加减治疗可明显减轻患者症状,抑制微炎症状态,调节凝血功能,保护肾功能,疗效确切,患者耐受性好。
Objective:To explore the clinical efficacy of modified Tianma Gouteng Decoction on severe preeclampsia(sPE). Methods:The subjects of this study,114 patients with sPE admitted in our hospital from April 2017 to February 2018,were divided into observation group(n=57)and control group(n=57)on the basis of random number table. The control group was treated with magnesium sulfate,while the observation group modified Tianma Gouteng Decoction in addition to what was applied to the control group. The clinical efficacy,changes of micro-inflammatory indicators [interleukin(IL-6),hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor(TNF-α)] and coagulation function indexes [von Willebrand factor(vWF),granule membrane protein(GMP-140),prothrombin time(PT)] as well as renal function parameters [creatinine(Cr),cystatin C(Cys-C),uric acid(UA)] before and after treatment,and adverse reactions were compared between the two groups. Results:After 7 days of treatment,the overall effective rate of the observation group was 89.5%(51/57),much higher than the control group 75.4%(43/57)(P<0.05). Compared with those before treatment,the micro-inflammatory indicators(IL-6,hs-CRP,TNF-α)level and concentration of serum Cr,Cys-C,UA of both groups after treatment were significantly lower(P<0.05),and the decrease the observation group obtained in above indexes was more significant(P<0.05). After treatment both groups saw a great drop in serum vWF level and GMP-140 concentration(P<0.05),but longer PT as compared with those before treatment(P<0.05),and the improvement of the observation group was more remarkable(P<0.05). The incidence of adverse reactions of the observation group was 7.0%(4/57),seeing no big difference from 3.5%(2/57)in the control group(P>0.05). Conclusion:In treating sPE,modified Tianma Gouteng Decoction can significantly relieve the symptoms in patients,inhibit micro-inflammatory state,regulate blood coagulation function and protect renal function in patients,proves to be effective and well tolerated.
Objective:To explore the clinical efficacy of modified Tianma Gouteng Decoction on severe preeclampsia(sPE). Methods:The subjects of this study,114 patients with sPE admitted in our hospital from April 2017 to February 2018,were divided into observation group(n=57)and control group(n=57)on the basis of random number table. The control group was treated with magnesium sulfate,while the observation group modified Tianma Gouteng Decoction in addition to what was applied to the control group. The clinical efficacy,changes of micro-inflammatory indicators [interleukin(IL-6),hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor(TNF-α)] and coagulation function indexes [von Willebrand factor(vWF),granule membrane protein(GMP-140),prothrombin time(PT)] as well as renal function parameters [creatinine(Cr),cystatin C(Cys-C),uric acid(UA)] before and after treatment,and adverse reactions were compared between the two groups. Results:After 7 days of treatment,the overall effective rate of the observation group was 89.5%(51/57),much higher than the control group 75.4%(43/57)(P<0.05). Compared with those before treatment,the micro-inflammatory indicators(IL-6,hs-CRP,TNF-α)level and concentration of serum Cr,Cys-C,UA of both groups after treatment were significantly lower(P<0.05),and the decrease the observation group obtained in above indexes was more significant(P<0.05). After treatment both groups saw a great drop in serum vWF level and GMP-140 concentration(P<0.05),but longer PT as compared with those before treatment(P<0.05),and the improvement of the observation group was more remarkable(P<0.05). The incidence of adverse reactions of the observation group was 7.0%(4/57),seeing no big difference from 3.5%(2/57)in the control group(P>0.05). Conclusion:In treating sPE,modified Tianma Gouteng Decoction can significantly relieve the symptoms in patients,inhibit micro-inflammatory state,regulate blood coagulation function and protect renal function in patients,proves to be effective and well tolerated.
引文
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[15]陈华干,李雪丽,杨兴兴,等.凝血指标检测在重度子痫前期的临床意义[J].血栓与止血学,2016,22(4):479-480.
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[18]姜凌宇,姜月华,郭金昊,等.杜仲治疗高血压研究进展[J].山东中医杂志,2017,36(3):249-252.
[19]关健,郑晚霞,叶定慈.子痫前期孕妇动态血压与随机尿蛋白肌酐比、肾功能的关系[J].实用医学杂志,2016,32(21):3593-3595.
[20]粟源,可燕,蒋嘉烨,等.天麻钩藤饮对自发性高血压大鼠血管功能及肾脏蛋白表达的影响[J].中国中西医结合杂志,2015,35(4):481-487.
[2]Shi DD,Yang FZ,Zhou L,et al. Oral nifedipine vs. intravenous labetalol for treatment of pregnancy-induced severe preeclampsia.[J]. J Clin Pharm Ther,2016,41(6):657-661.
[3]Sakae C,Sato Y,Kanbayashi S,et al. Introduction of management protocol for early-onset severe pre-eclampsia[J]. J Obstet Gynaecol Res,2017,43(4):644-652.
[4]Long Q,Oladapo OT,Leathersich S,et al. Clinical practice patterns on the use of magnesium sulphate for treatment of preeclampsia and eclampsia:a multi-country survey[J]. BJOG,2017,124(12):1883-1890.
[5]郭威,郭炜,刘颖.天麻钩藤饮治疗肝阳上亢型原发性高血压随机对照试验的系统评价[J].山东中医杂志,2013,32(11):794-796.
[6]中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南(2015)[J].中华妇产科杂志,2015,50(10):206-213.
[7]张玉珍.中医妇科学[M].北京:中国中医药出版社,2002:263.
[8]孙传兴.临床疾病诊断依据治愈好转标准[M]. 2版.北京:人民军医出版社,2002:515.
[9]Gathiram P,Moodley J. Pre-eclampsia:its pathogenesis and pathophysiolgy[J]. Cardiovasc J Afr,2016,27(2):71-78.
[10]Lotufo FA,Parpinelli MA,Osis MJ,et al. Obstetrician's risk perception on the prescription of magnesium sulfate in severe preeclampsia and eclampsia:A qualitative study in Brazil[J].PLoS One,2017,12(3):e0172602.
[11]邱二娟,顾月丽,刘淑华,等.平肝涤痰法辅助治疗重度子痫前期的疗效及机制[J].中华全科医学,2017,15(12):2099-2101.
[12]王亚军.肾血流动力学、相关标志物和炎性因子评价妊娠高血压疾病患者肾功能的临床研究[J].河北医科大学学报,2016,37(9):1093-1096.
[13]戚慧,江华,王慧艳,等.重度子痫前期与体质量指数、瘦素、血脂、高敏C反应蛋白的相关性研究[J].中国妇幼健康研究,2016,27(8):971-973.
[14]钮玉洁,岑立微,李文会. sFlt-1、PIGF、25-羟基维生素D、v WF及P-选择素与子痫前期的相关性研究[J].临床和实验医学杂志,2018,17(2):192-195.
[15]陈华干,李雪丽,杨兴兴,等.凝血指标检测在重度子痫前期的临床意义[J].血栓与止血学,2016,22(4):479-480.
[16]乔秋杰,王玲,张忠,等.钩藤碱对血栓形成及血液流变学影响的实验研究[J].中医学报,2014,29(3):370-371.
[17]丁诚实,沈业寿,李赓,等.天麻糖蛋白的抗凝与抗栓作用[J].中国中药杂志,2007,32(11):1060-1064.
[18]姜凌宇,姜月华,郭金昊,等.杜仲治疗高血压研究进展[J].山东中医杂志,2017,36(3):249-252.
[19]关健,郑晚霞,叶定慈.子痫前期孕妇动态血压与随机尿蛋白肌酐比、肾功能的关系[J].实用医学杂志,2016,32(21):3593-3595.
[20]粟源,可燕,蒋嘉烨,等.天麻钩藤饮对自发性高血压大鼠血管功能及肾脏蛋白表达的影响[J].中国中西医结合杂志,2015,35(4):481-487.