CAJ | 학술논문

背景:减肥是防止原发性高血压的重要措施,针灸具有无毒副作用的减肥降压效果.目的:探讨针灸治疗肥胖症并发原发性高血压的作用机制.设计:以诊断为依据的病例对照研究.地点、对象和方法:选择南京中医药大学专家门诊患者,将针灸治疗肥胖症并发原发性高血压和肥胖症无并发症的患者作为研究对象,与正常人相比较,观察针灸治疗前后症状、体征、肥胖指标、血压、植物神经平衡指数(Y值)、胰岛素、胰岛素敏感指数(insulin activationindices,IAI)、瘦素、一氧化氮、一氧化氮合酶(nitricoxide synthase,NOS)水平的变化.主要观察指标:痰湿壅盛、肝火亢盛、阴虚阳亢和阴阳两虚四型肥胖症并发原发性高血压患者、胃肠实热、肝郁气滞和脾虚湿阻三型肥胖症无并发症患者与正常健康人针灸前后肥胖指标、植物神经功能、血糖、胰岛素、瘦素、一氧化氮、NOS的比较.结果:针灸治疗肥胖症并发原发性高血压和肥胖症均可降低肥胖指标参数、瘦素和胰岛素水平(P＜0.05和P＜0.01);还可升高IAI、一氧化氮和NOS水平(P＜0.01);前者Y值结果明显回降(P＜0.05)而后者Y值显著回升(P＜0.01).针灸后植物神经功能[针灸治疗后神经功能参数分别为(2.19±0.61),(0.98±0.48)],胰岛素[69.88±91.12),(121.16±52.52)mU/L],瘦素[(111.28±49.25),(78.33+22.16)μg/L],一氧化氮[(55.38±19.53),(89.39±23.25)μmol/L]均较治疗前有改善(P＜0.05～0.01).结论:针灸对肥胖症并发原发性高血压患者植物神经功能、胰岛素、瘦素、一氧化氮水平有良性调整作用,这可能是实现减肥和降低血压的效应的重要机制.
배경:감비시방지원발성고혈압적중요조시,침구구유무독부작용적감비강압효과.목적:탐토침구치료비반증병발원발성고혈압적작용궤제.설계:이진단위의거적병례대조연구.지점、대상화방법:선택남경중의약대학전가문진환자,장침구치료비반증병발원발성고혈압화비반증무병발증적환자작위연구대상,여정상인상비교,관찰침구치료전후증상、체정、비반지표、혈압、식물신경평형지수(Y치)、이도소、이도소민감지수(insulin activationindices,IAI)、수소、일양화담、일양화담합매(nitricoxide synthase,NOS)수평적변화.주요관찰지표:담습옹성、간화항성、음허양항화음양량허사형비반증병발원발성고혈압환자、위장실열、간욱기체화비허습조삼형비반증무병발증환자여정상건강인침구전후비반지표、식물신경공능、혈당、이도소、수소、일양화담、NOS적비교.결과:침구치료비반증병발원발성고혈압화비반증균가강저비반지표삼수、수소화이도소수평(P＜0.05화P＜0.01);환가승고IAI、일양화담화NOS수평(P＜0.01);전자Y치결과명현회강(P＜0.05)이후자Y치현저회승(P＜0.01).침구후식물신경공능[침구치료후신경공능삼수분별위(2.19±0.61),(0.98±0.48)],이도소[69.88±91.12),(121.16±52.52)mU/L],수소[(111.28±49.25),(78.33+22.16)μg/L],일양화담[(55.38±19.53),(89.39±23.25)μmol/L]균교치료전유개선(P＜0.05～0.01).결론:침구대비반증병발원발성고혈압환자식물신경공능、이도소、수소、일양화담수평유량성조정작용,저가능시실현감비화강저혈압적효응적중요궤제.
BACKGROUND: Losing weight is the essential measure on the prevention of primary hypertension. Acupuncture acts on weight losing and blood pressure reducing without toxic side effects.OBJECTIVE: To probe into the mechanism of acupuncture on the treatment of obesity complicated with hypertension.DESIGN: The control research was carried out on the cases based on the diagnosis.SETTING, PARTICIPANTS and INTERVENTION: The patients were selected from the expert clinic of Nanjing University of Traditional Chinese Medicine. The objects in the research were the patients with obesity complicated with primary hypertension and the patients with obesity without complication. All of the patients were treated with acupuncture and compared with the normal persons to observe the changes of the symptoms, physical signs, obese indices, blood pressure, vegetative indices(Y value), insulin,insulin activation indices(IAI), the levels of leptin, NO and nitricoxide synthase(NOS) before and after acupuncture treatments.MAIN OUTCOME MEASURES: To observe the changes of obese indices,vegetative function, blood sugar, insulin, leptin, NO, NOS in the patients with obesity complicated with primary hypertension in the types of excessive phlegm damp, hyperactivity of liver fire, yang hyperactivity due to yin deficiency and deficiency of both yin and yang, and in the patients with obesity without complications in the types of excess-beat of stomach and intestines,the stagnation of liver qi and the retention of damp due to spleen deficiency,comparing with the normal beulthy persons before and after acupuncture.RESULTS: By the treatment of acupuncture for the group of obesity complicated with primary hypertension and the group of obesity, the obese indices and the levels of leptin and insulin were reduced( P ＜ 0. 05 and P ＜0. 01 ), the levels of IAI, NO and NOS increased( P ＜ 0. 01 ), the results of Y value in the former group remarkably reduced ( P ＜ 0. 05) and in the latter group significantly increased( P ＜ 0.01 ). After acupuncture, there were improvements(P ＜ 0.05-0.01) compared with the conditions before acupuncture in the aspects of vegetative function[the vegetative indices after acupuncture treatment were (2.19±0.61), (0.98±0.48)], insulin [(169.88±91.12), (121.16±52.52) mU/L], leptin [(111.28±49.25), (78.33 ± 22. 16) μg/L] and NO[ (55.38 ± 19.53), (89. 39 ±23.25) μ mol/L].CONCLUSION: Acupuncture acts on effective regulations on the levels of vegetative function, insulin, leptin and NO in the patients with obesity complicated with primary hypertension, which is probably the essential mechanism in achieving the effects on weight losing and blood pressure reducing.