| Hypertension is one of the most prevalent diseases of cardiovascular diseases, the incidence rate of it keep increasing during the recent years.A number of researches indicate that myocardial fibrosis(MF) will string along with the people who suffered by hypertension, and further more,the researches prove that MF is one of the most important facors attribute to heightening the incidence of the hypertensive heart disease,deformity and mortality. In another hand, since the concept of insulin resistance (IR) was brought forward, the phenomenon of IR was more and more accounted of the function as the common tache among several complicated diseases and gained a lot of research results. IR induce type 2 diabetes mellitus, the latter and hypertension have close relationship. Epidemiological researches indicated that about 50% hypertensive patients accompany IR. Empty hyperinsulinemia and postprandial hyperinsulinemia were found in both of posttreated and pretreated hypertensives.Now IR is regarded as an independent dangerous facor of cardiovascular disease. Insulin resistance, diabetes mellitus hypertension, myocardial fibrosis are all very complicated and involve several systems and many factors of physiological and pathological problems.Concept regarding the human body as a whole and selection oftreatment based on the differential diagnosis are both the most special characteristics of Traditional Chinese Medicine and can do much for the complicated diseases. It is believed that Gastrodia and Uncaria Decoction is of value in not only hypotensive effect but also myocardial fibrosis. To study on the relationship between IR and hypertensive myocardial fibrosis can help find the etiology and how it works. What is more,to study on the effect of Gastrodia and Uncaria Decoction that act on them can search for its new effect and new availability which can also be good to the therapy of Traditional Chinese Medicine in these fields.Part One:literature researchThese years,it has been indicated by the internal and overseas researches that hypertensive myocardial fibrosis is one part of the myocardial remodeling tissue which will due to heart failure and intraventricular arrhythmia that can increase the fatalness of hypertension patients.Now it is believed that IR and hyperinsulinemia are closely related to several cardiolvascular diseases. Because of the close relationship between IR and hypertension, some researchers put forward that IR is not only the progbable etiologic factor of hypertension but also cause MF with possible. Among all the antihypertensive drugs, ACE inhibitor(ACEI) is to be generally accepted as the most effective drug, meanwhile it can improve the insulin sensibility .But because of the side effects such as cough and angioneurotic edema, futher more it is prohitited to the patients of stenosis of renal artery and pregnant women, its clinical using is somewhat limited. Concept regarding the human body as a whole and selection of treatment based on the differential diagnosis are both the most special characteristics of TCM and can do much for the complicated diseases such as hypertension, MF and IR. Gastrodia and Uncaria Decoction is one of the most effective and commonly used prescriptions and has been confirmed to have stable antihypertensiveeffect and less side effective , and it is better in symptom remission than the modern drugs.The epidemiological survey shows that the type of deficiency of the liver and kidney and hyperactivity of the liver yang of hypertension patients take in the greatest proportion of all types of hypertensives, somebody indicate that it can do good to IR by researches.Our previous researches find that Gastrodia and Uncaria Decoction has good effect of reversing MF. We try to probe into the relation between IR and hypertensive myocardial fibrosis.and to observe Gastrodia and Uncaria Decoction' s effect, of reversing MF and improve insulin sensibility, which can be helpful to the application of Gastrodia and Uncaria Decoction in clinic.Part Two:clinical research60 patients that were diagnosed as I and II degree essential hypertension and deficiency of the liver and kidney and hyperactivity of the liver yang type were divided into two groups based on the HOMA-IR, named IR group and non-IR group. Another 20 normal persons compose of the normal group.We judge the relation between IR and MF through the PCIII, LN and HA in serum of the different patients. And all the 60 patients will be randomly divided to the Gastrodia and Uncaria Decoction group, captopril group and captopril+Decoction group by the time when they were observed .After they were treated for 4 weeks, observed the changes of blood pressure, PCIII, LN and HA in serum and HOMA-IR of all patients.From the result of the experiment , we can draw the conclusions: BMI(body mass index) and uric acid(UA) concentration are associated with IR;the disorder of lipid metabolic is more serious in hypertension with IR than in hypertension single and normal (P<0. 01) ; PCIII, LN and HA in serum concentration have a parallel relationship with IR.So we regard that IR is not only the progbable etiologic factor of hypertension but also mainly cause MFwith possible. And the conclusion shows that captopri 1, Gastrodiaand Uncaria Decoction and captopril+Decoction all can decreased the level of systolic pressure and diastolic pressure and improve the clinical symptom, and the effect of captopril+Decoction was the best among the groups,and although the Gastrodia and Uncaria Decoction antihypertensive effect was not as good as captopril but its effect of improve the clinical symptom is better. But maybe the observed object was small so the difference was not significant statistically (P>0.05).And the result also showed that all the groups can reversing MF which maybe relevant to their effects of improving insulin sensibility and lowing insulin , that also testify IR and hyperinsulinemia maybe one of the etiologic factors of hypertensive myocardial fibrosis on the reverse side.Part Three:experimental researchThe fibroblast used in this experiment was taken from the hearts of one-day old SHR and was testified to be true cardiac Fibroblast(cFb).We use the complete blank group as control group, and put different doses of insulin into the cells, and use the biggest dose insulin as another control group , then put different dose of the serum contained Gastrodia and Uncaria Decoction,catopril and blank. Then trough MTT auto color matching microanalytical way, mixing with 3~H-TdR way and flow cytometer quantitative analysis analize the cycle of the cells to observe the different effect to the cFb by dosage of insulin and different dosage of Gastrodia and Uncaria Decoction.The results showed that the small dosage of insulin had little influence on the cFb (P >0.05) while the mass can predispose the proliferation of cFb distinctly (P<0. 01) , yet in the way of MTT the result showed that the effect of the middle dosage and the mass had not a significant difference. The mass dosage maybe work by promoting GO/Gl phase transfer into S phase and such make the synthesis of cell' s DNA more active. The results of MTT indicated that all kind... |
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