李宁荫+李秀丽+翟晓萍+王琼英+张小卫+赵锋+王小锋+樊剑云+白锋+余静

[摘要]探討黄芪对高血压病（EH）合并代谢综合征（MetS）患者的早期心肾保护作用。将226例18岁以上的EH合并MetS且无明显靶器官受损临床表现的患者，随机分配至对照组、黄芪1组和黄芪2组。对照组使用常规内科药物治疗，在此基础上黄芪1组加用黄芪浸膏胶囊10 g·d^-1，黄芪2组加用黄芪浸膏胶囊5 g·d^-1。应用彩色超声心动仪，经M型、二维及组织多普勒测定等方法评价心脏解剖结构、收缩功能及心脏舒张功能；采用放射免疫分析法评价尿微量白蛋白（MAU），同时计算估测肾小球滤过率（eGFR），随访12个月。研究方案经医院伦理委员会通过，并向中国临床试验注册中心网站注册，所有患者均行知情同意。运用SPSS软件对数据进行统计学分析。结果显示，3组患者的代谢指标治疗前后及组间疗效无明显的差异；3组患者的收缩末期容量（ESV）及左心室收缩末期内径（LVESd） 治疗后均较治疗前改善，但3组间无显著差异；加用黄芪治疗后患者的二尖瓣血流速度（Vp）得到了一定的改善（P<0.05），但3组间无显著差异；黄芪对降低MAU有显著作用（P<0.05），且黄芪1组较对照组和黄芪2组下降更为显著（P<0.05）。黄芪联合内科常规治疗与单纯内科常规治疗相比，有改善EH合并MetS患者心脏结构及收缩舒张功能，并减少MAU水平的趋势，且高剂量黄芪的心肾早期保护作用优于低剂量黄芪。但尚需长时间治疗疗效的观察，以进一步证实黄芪对EH合并MetS患者的疗效。

[关键词]黄芪； 高血压病； 代谢综合征； 心脏舒张功能； 尿微量白蛋白

[Abstract]To explore the effect of Mongolia Astragali Radix produced in Longxi of Gansu province in protecting cardiac and nephritic functions of patients of essential hypertension（EH） with metabolic syndrome（MetS）. A total of two hundred and twenty-six EH patients with MetS aged above 18 were selected. Patients were randomly divided to control group（adopted conventional medical treatment）， Astragali Radix group 1（added Astragali Radix capsules 10 g·d^-1 besides conventional medical treatment） and Astragali Radix group 2（added Astragali Radix capsules 5 g·d^-1 besides conventional medical treatment）. Cardiac anatomy structure， cardiac systolic function and diastolic function were measured by M-mode echocardiography， two-dimensional echocardiography， Doppler echocardiographic determination and tissue Doppler imaging. The level of microalbuminuria（MAU） was evaluated by radioimmunoassay. In addition， the estimated glomerular filtration rate（eGFR） was calculated by modification of diet in renal disease （MDRD） formulas. The changes of relevant indicators for cardiac and nephritic functions before and after treatment were compared during the 12-month follow-up. The study protocol was registered at the website of Chinese clinical trial register and approved by the ethics committee of second hospital of Lanzhou university. Each patient was required to sign an informed consent. SPSS software was used for statistical analysis. According to the result， compare with before treatment， the three groups show no difference in efficacy of metablic indicators. Left ventricular end-systolic volume （ESV） and left ventricular end-systolic dimension （LVESd） of all patients were improved after treatment. However， there was no significant difference among the three groups. After the addition of Astragali Radix， the mitral flow velocity（Vp） of patients was improved to some extent（P<0.05）. However， there was no significant difference among the three groups. Astragali Radix had a significant effect in reducing the MAU（P<0.05）. Moreover， the MAU level of patients in Astragali Radix group 1 decreased more significantly than the other groups（P<0.05）. Compared with conventional therapy， Astragali Radix combined with conventional therapy could improve cardiac structure， left ventricular systolic function， left ventricular diastolic function， and reduce the MAU to a certain extent in EH patients with MetS. Moreover， the effects of high-dose Astragali Radix are better than that of the low-dose Astragali Radix. However， the effect of Astragali Radix on EH patients with MetS shall be further observed to confirm its efficacy.

[Key words]Astragali Radix； hypertension； metabolic syndrome； cardiac diastolic function； urinary microalbuminuria

doi：10.4268/cjcmm20162126

高血压病（essential hypertension， EH）是心脑血管疾病的主要危险因素^[1-3]。代谢综合征（metabolic syndrome， MetS）可使2型糖尿病（type 2 diabetes mellitus， T2DM）和心血管疾病（cardiovascular disease， CVD）的风险增加^[4-5]。EH与MetS并存将使心脑血管并发症的发

生率进一步升高^[6]。

由于MetS是多种代谢异常状态的集合，故其治疗措施及药物种类也因患者所患MetS组成部分的不同而有所不同。EH引起的左室肥厚和舒张功能改变，以及肾脏微量蛋白是早期靶器官损害的重要表现，早期积极治疗可以逆转，从而防止晚期心肾功能衰竭。……