| Objective:In this Research,the main methodology in the treatment of atherosclerotic renal artery stenosis of hypertension is to utilize rosuvastatin combined with traditional Chinese medicine Xuezhikang capsule.Based on the outcome throughout the treatment,the efficacy and security is also properly addressed,justified and reviewed.Methods:In June 2015 to June 2016 90 hypertension patients were selected from the Second Hospital of Jilin University,among which,75 individuals were detected with ARAS after renal artery color Doppler ultrasound and renal artery CTA diagnosis.Three patients in the renal artery stenosis were withdrawn during the treatment(One occurred with unilateral renal artery occlusion,and the rest two proceeded with renal artery PCI treatment).The remaining 72 patients completed 12-month of treatment,The hypertensive patients met the inclusion criteria were divided into renal artery stenosis group(15 cases)and renal artery stenosis group(72 cases).According to the different treatment regimen,72 patients with renal artery stenosis were categorized into following groups: Group N: control(Only antihypertensive drugs were applied,and the sample size is 18)? Group A: Western medicine treatment group(Antihypertensive drug together with rosuvastatin(10mg)sample size is 18)?Group B: Chinese medicine treatment group(Antihypertensive drugs + Xuezhikang(1200mg)sample size is 18)? Group C: Combination of Chinese and Western medicine treatment applied with little dose on each individual(antihypertensive drug,rosuvastatin(5mg)and Xuezhikang(1200mg),sample size is 18).With the above sorted groups,the research carried out with the designated methodologies and processes with the below purposes1)Exploring the pathogenesis of renal atherosclerosis hypertension,and establishing a theoretical foundation for the clinical application of lipid-lowering drugs in the treatment of renal atherosclerosis hypertension.2)The levels of lipids and atherosclerosis inflammatory cytokines(Hcy?MPO?ET-1?NO and renin)were tested,and the correlation curves were drawn to observe whether they were related to the extent of renal artery stenosis.3)Lipids,blood pressure,Cr,GFR,AST,ALT and CK levels in patients in N?A?B?C four groups were observed at a variety of time intervals(i.e 1st months,6th months and 12 th months).Parameter movements including myeloperoxidase(MPO),homocysteine(Hcy),serum NO,endothelin-1(ET-1)were also observed at the 12 th months,and the level of renal artery stenosis was evaluated via renal artery color Doppler ultrasound or renal artery CTA.4)Evaluating the level of security of each treatment regimen and therefore propose the best optimal treatment for renal atherosclerosis hypertension patients.Results:1)In the hypertension with renal artery stenosis group,the control group(N group),the western medicine group(group A),the chinese medicine treatment group(group B),the Small dose of Chinese and Western medicine combined treatment group(group C)of age,sex,weight,BMI,smoking history,history of diabetes mellitus,stroke,coronary heart disease and the ratio of ACEI to CCB were not statistically significant(P>0.05).The number of people with history of smoke diabetes mellitus,stroke,coronary heart disease in hypertensive patients with renal artery stenosis in each group was significantly higher than those without renal artery stenosis,and the difference was statistically significant(P <0.05).2)Among the 72 patients with renal artery stenosis the the average SBP reaches around(172.89 ± 21.68)mm Hg,and the mean for DBP is average(94.60 ± 12.03)mm Hg;In the 15 patients with no renal artery,SBP had an mean of(157.60 ± 18.33)mm Hg,and the average DBP reaches(93.67 ± 14.86)mm Hg;There was significantdifference between the two groups in SBP(P<0.05),but there was no significant difference between the two groups in DBP(P>0.05).3)The levels of SBP and DBP in the patients with hypertension and renal artery stenosis(group N,A,B,C)were significantly lower than those before treatment,(P<0.05).The levels of SBP in group A,B and C were significantly lower than those in group N at 6 months and 12 months(P<0.01);The levels of DBP in group A,B and C were significantly lower than those in group N at 6 months(P<0.01).At the 12 th months,the DBP of group A and C decreased more significantly than that of group N and B(P <0.01).The decrease of DBP among group A and C,group N and B is not statistically significant.(P>0.05).4)The TC and LDL-C levels for 72 patients with hypertension and renal artery stenosis were significantly higher than those without renal artery stenosis(P <0.05);The levels of TC,TG and LDL-C in group A,B and C were significantly lower than those before treatment at the 12 thmonth,and the difference was statistically significant(P<0.05);The levels of TC in group A and C were lower than those in group B at the6 thmonth and 12 thmonth of the treatment,the difference was statistically significant(P<0.05);The levels of TC in group A and C were lower than those in group B at the 12 th month,the difference was statistically significant(P<0.05);The levels of LDL-C in group C were lower than those in group A and B at the 6thmonths and 12 thmonths of the treatment,the difference was statistically significant(P<0.05);The HDL-C level for the three groups,which were given lipid-lowering therapy,had no significant difference before and after the treatment(P>0.05).The level of PSV in patients with hypertension and renal artery stenosis group(group N,A,B and C)was significantly lower than that before treatment(P<0.05);Group A,B and C were more significant than those in group N(P<0.05).And the improvement of group A and C was better than group B(P <0.05);There was no significant difference between group A and group C(P> 0.05).5)The level of PSV in patients with hypertension and renal artery stenosis group(group N,A,B and C)has lowered significantly than that before the treatment(P <0.05);Compared with Group N,the PSV decreases even more significantly in Group A,B and C was even(P<0.05).And the improvement of group A and C was better than group B(P <0.05);It has been observed that patients in group A and Chealed better than group B in terms of this parameter,and there is no significant difference in regards to the other symptoms of these patients from group A and C.(P>0.05).6)Within the 72 cases with hypertension and renal artery stenosis,there were28 patients diagnosed with renal artery stenosis with renal artery CTA diagnosed.According to renal artery stenosis,the 28 cases were categorized into the following levels: mild(<50%),moderate(50%-75%)and severe(76-99%);After 1year follow-up therapy and investigation,it has been found that there is no significant variations in terms of the number of patients with severe stenosis,while the number of patients with moderate stenosis decreased than before(P <0.05)Group A is slightly better than group B and C,but the deviation was not statistically significant(P>0.05).The level of MPO was positively correlated with LDL-C level in 72 patients with hypertension and renal artery stenosis(R=0.290,P=0.014).The levels of PSV were positively correlated with SBP and DBP levels in the 72 patients(R = 0.873,P<0.01).7)The levels of NO,ET-1,MPO,renin and Hcy in the 72 patients with hypertension and renal artery stenosis were significantly higher than those in the renal artery without stenosis(P<0.05).Having been provided with lipid-lowering therapy,The levels of NO,ET-1,MPO and Hcy in group A,B and C were significantly lower than those before the treatment(P<0.05);In addition to MPO parameter,the rest indicators within C group were significantly lower than those in group A and B(P<0.05);The levels of MPO in group A and C was significantly lower than that in group B(P<0.05).8)It is observed that before the treatment commenced,the level of MPO was positively correlated with LDL-C level within 72 patients with hypertension and renal artery stenosis(R=0.290,P=0.014).It is also worthwhile mentioning that The levels of PSV were positively correlated with SBP and DBP levels within these 72 patients(R= 0.873,P <0.01).9)Before the treatment,there was no significant deviations in regards to the proportion of GFR(30 ~ 60 ml / min)in patients with hypertension and renal artery stenosis(group N,A,B,C).After treatment for 1 year,the proportion of GFR moderate in group A,B and C was lower than that before treatment(P<0.05);Whilesuch proportion in group A and C was even lower than that in group B(P<0.05);There was no significant difference between group A and group C(P>0.05).10)There were no significant differences in the levels of ALT,AST before and after the treatment was taken in group N,A,B and C(P>0.05).11)The variations of CK level in 72 patients with hypertension and renal artery stenosis(N,A,B,C)were statistically significant(P<0.05).But compared with that before the treatment,no significant increase in the levels of CK was observed,and there are no patients with irregular symptoms such as muscle pain..12)In the three groups(group A,B,C)of patients who received lipid-lowering drugs,gastrointestinal reactions occurred within only three individuals.Conclusion:1)TC,LDL-C,renin,MPO,Hcy,NO and ET-1 contributed to the formation of renal atherosclerosis hypertension;2)The level of renal artery stenosis in renal atherosclerosis patients was positively correlated with systolic blood pressure(SBP)and diastolic blood pressure(DBP);3)The levels of SBP,DBP,TC,LDL-C,MPO,Hcy,NO and ET-1 were significantly improved in patients with renal atherosclerosis after lipid-lowering,anti-inflammatory and anti-oxidative stress therapy,and the effcacy of low dose of rosuvastatin combined with Xuezhikang was most significant;4)It can be theoretically proved that the security exists in the treatment of applying Low-dose rosuvastatin combined with Xuezhikang in this research... |
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