Journal of research in viet nam traditional medicine and pharmacy No 41 - 2014
^ D A N H G I A T A C DUNG CUA NU^OfC SAC N A M H O N G CHI TREN BENH N H A N T A N G HUYET AP NGUYEN P H A T DO I
Assessment of the effects of ganderma lucidum decoction on patients with primary hypertension stage 1
* Nguyen Huy Gia ', ** Nguyen Nhugc Kim ^ ' Truomg Dgi hoc Y Thdi Binh, ^ Truang Dgi hoc Y Hd Ndi Tom Tit:
Muc tieu: Ddnh gid tdc dung hg huyit dp cua nude sdc ndm Hdng chi tren benh nhdn THA nguyen phdt do 1 vd theo doi tdc dung khdng mong mudn cua thudc. Phuang phdp: Thiit ki nghien cuu theo phuang phdp thie nghiem ldm sdng md, so sdnh trudc vd sau diiu tri. Kit qua: Ndm Hdng chi ldm gidm huyit dp: 100% sd benh nhdn vdi HATT; 85,11% sd benh nhdn vdi HATTr, vd 100%
sd benh nhdn vdi huyit dp trung binh. Hi$u qud diiu tri: 70,21% logi tdt, 25,35% logi khd vd 4,26% logi trung binh. Su thay ddi trudc vd sau diiu tri cd y nghia thdng ke (p<0,01). Ndm Hdng chi cdn cd tdc dung dieu chinh rdi logn lipid mdu: vdi cholesterol todn phdn, thudc ldm gidm 13,88% so vcri tri sd ban ddu; vdi triglycerit thudc ldm gidm duac 24%, vai LCL-C thudc ldm gidm 20,30% vd ldm tdng 14,75% HDL-C. Su thay ddi trudc vd sau diiu tri cd y nghia thdng ke (p<0,01).
Tur khoa: Nim Hdng chi. Tang huyet ap nguyen phat dp I, Rli loan lipid m^u
Summary
ASSESSMENT OF THE EFFECTS OF GANDERMA LUCIDUM
DECOCTION ON PATIENTS WITH PRIMARY HYPERTENSION STAGE I
Objectives: To evaluate the treatment effect of ganderma lucidum decoction on patients with primary hypertension stage I and following the side effects of this decoctions. Method: Prospective, open and controlled clinical trials. Comparing the result before and after treatment.
Results: Ganderma lucidum decoction has effect of lowering blood pressure on 100% of patients with high systolic pressure, 85,11% of patients with high diastolic pressure and on 100% of patients with average pressure. Effectiveness of the treatment: good result was 70,21%. Fair was 25,35%
and moderate was 4,26%. The difference is stastically significant with p<0,01. Garderma lucidum has also effects on regulating blood lipid levels. Cholesterol concentration reduced 13,88%, triglyceride level reduced 24%, LDL-C decreased 20,36% and HDL-C increased 14,7% after treatment. Conclusion: Ganderma lucidum decoction, with dose of 15gper day, was safe, effective and appropriate for primary hyper tendon stage 1.
Keywords: Ganderma lucidum decoction, hypertention stage 1, dyslipidemia.
Dja chi lien hf: Nguyin Nhugc Kim - Trucmg Dai hpc Y Ha NQI Ng^y nh^ln hki: 24/4/2014 Dja chi email: [email protected] Ngiy ph^n bi^n: 16/5/2014 Phfin bifn khoa h^c: PGS.TS. TrSn Quoc Binh Ngay dSng bio: 27/6/2014
* BSCKII; ** PGS.TS
I. DAT VAN DE
Tang huyet ap (THA) la mgt benh thudng gap d cac nude phat triln. Ty le THA d ngudi trudng thanh theo sd lieu cua JNC VII la khoang 30% dan sd va co tren nua trong s6 do la tren 50 tuoi [3]. Viet Nam ciing kh6ng nam ngoai quy dao
F 1 F
ay. THA nguy hiem bdi cac bien chiing cua nd, cd the gay chet ngudi hoac de lai nhimg di chiing nang ne lam anh hudng tdi chat lugng cugc s6ng ciia ngudi benh va la ganh nang cho gia dinh va xa hdi. Hien nay Y hgc hien dai (YHHD) ciing nhu Y hgc c6 truyen (YHCT) c6 nhieu bien
X
phap phong va dieu trj benh cd hieu qua. Vj thu6c nam H6ng chi da dugc su dung lau ddi trong YHCT dih chira chiing Huyen vung va Dau thong.
Cac chiing nay cd nhieu diem tuong d6ng vdi benh THA ca vl ly luan va thirc tien lam sang [1], [4]. Tuy vay,
F ^
vj thu6c nay chua co nghien ciiu de danh gia mgt each khoa hgc va khach quan. Vi vay, chiing t6i nghien ciiu
X ^ X
de tai nay nham muc tieu:
1. Ddnh gid tdc dung ha huyet dp cua nw&c sdc ndm Hdng chi tren benh nhdn THA nguyen phdt dp 1
F
qua mot so chi tieu ldm sdng vd can ldm sdng.
2. Theo doi tdc dung khong mong muon cua thuoc
II. DOI TU'ONG vA PHl/ONG
P H A P N G H I E N ClTU
2.1. Doi tugng nghien cuu:
F
* Thuoc nghien cieu:
- Dung nim H6ng chi (Ganderma Lucidum) ngu6n gi6ng va quy trinh san xuat, thu hai, bao quan theo quy trinh ciia Vien Dugc lieu TW va Vien Di truyen n6ng nghiep [2]
Quy trinh bao quan va che bien tai Khoa Dugc Benh vien YHCT Thai Binh theo tieu chuan Dugc diln Viet Nam. Thu6c dimg dudi dang khd, dugc sac bang may ciia Han Qu6c s6 hieu 130-2401. Thdi gian sac thu6c 3 gid, sau dd nude sac dong
X X
vao tiii nilon bang day chuyen tu d6ng. M6i tiii 100ml thdi gian bao quan 10 ngay. Lieu dung tinh bing dugc lieu khd la 15g/ngay.
* Benh nhdn nghien cieu: G6m 47 benh nhan tang huyet ap nguyen phat do 1, lira chgn mgt each ngau nhien, dieu trj ngi trii tai Benh vien YHCT tinh Thai Binh.
* Tieu chudn chon benh nhdn:
± Theo YHHD: Benh nhan dugc chgn > 40 tu6i dugc chin doan tang huylt ap nguyen phat do 1 theo JNC VII
- Huylt ap tam thu (HATT) tir 140-159 mmHg
- Huylt ap tam truong (HATTr) tir 90-99mm Hg
Journal of research in viet nam traditional medicine and pharmacy No 41 2014
Benh nhan da thuc hien diing che do phdng THA trong an udng, luyen tap, sinh boat ma huylt ap khdng giam (thirc hien 2 tuin trudc khi nghien ciiu) va ciing ngung diing cac loai thudc anh hudng den huyet ap trudc 2 tuan nghien ciiu
± Theo YHCT: Thi dam thip:
ngudi beo beu, reu luoi trang nhdn, ludi beu, mach boat sap.
* Tieu chudn loai trir:
Tang huyet ap thii phat, benh THA tir do II trd len (theo INC Vll)
- Phu nil cd thai va cho con bii - Khdng chap hanh diing cac quy djnh cua quy trinh nghien ciiu
Cac the lam sang khac cua YHCT: The Can duong thugng khang, Can than am hu... di chung tning phong
* Dia diem vd th&i gian nghien cd'u: Benh vien YHCT Thai Binh, tir thang 3/2010-8/2010
2.2. Phuong phap nghien cuu
F F
* Thiet ke nghien cieu: Thii nghiem lam sang md, so sanh trudc va sau dieu trj
* Chon mau: Chgn mau theo mau thuan tien
* Tiin hdnh nghien cieu ldm sdng: Nhirng benh nhan dii dieu kien nghien ciiu, dugc nhap vien dilu trj ndi tni, thdi gian dilu trj 30 ngay va dugc theo ddi sau 30 ngay ngimg
F
thudc.
Thudc dugc sic liy 200ml chia lam 2 lan udng vao trudc bira an trua va tdi 2 gid hang ngay
Chi tieu theo ddi: Huylt ap, mach, nhiet do, an, ngii, dai tiiu tien va cac bieu hien khac dugc ghi diy dii vao phieu nghien ciiu
* Can ldm sdng: Cac chi djnh xet nghiem: Sd lugng h6ng ciu, bach
X •) X ^
cau, tieu cau. C6ng thiic bach cau, cholesterol toan phan, triglycerid, HDL-C, LDL-C, glucose, ure, creatinin, protein nieu, tru nieu, can, ALT, AST, xquang tim ph6i, dien tam d6, soi day mit
F
* Phieo'ng phdp ddnh gid ket qud + Danh gia tac dung ha huyet ap:
tieu chuan danh gia
- So sanh huyet ap sau khi dieu
F X ^ ^
trj (T30) vdi huyet ap ban dau (TO) - Dua vao hieu s6 T0-T30 cua HATB (HATB = 2 HATTr +
I F F
HATT/3) de xep loai ket qua:
Tot (loai A): HATB giam 15 mmHg
Kha (loai B): HATB giam 10-14 mmHg
Trung binh (loai C): HATB giam 5-9 mmHg
Kem (loai D): HATB giam <5 mmHg hoac khong giam hoac tang
Phuong phap danh gia: Do huyet ap hang ngay vao thdi gian
F X '
nhat djnh (9h sang) r6i lay trung binh
ngay thii 10 (TlO), thii 20 (T20), thu 30 (T30)
+ Danh gia tac dung tren cac chi
F
sd can lam sang
+ Theo ddi tac dung khdng mong
F F •»
mudn ciia thudc: Phat ban, man ngiia, dau bung, di ngoai Idng, ndn...
F 'F
Bang 3.1. Phan bd theo tudi
+ Xu ly so lieu: So lieu thu thap dugc xu ly bing toan thing ke y sinh hgc ciia chuong trinh SPSS 15,0
III. KET QUA NGHIEN ClTU
3.1. Ket qua nghien cuu tren lam sang
Nhdm tudi 40-50 51-60
>61
1 F
Tong SO Tudi trung binh
Sd benh nhan 5
20 22 47
%
10,6 42,6 46,8 100 61,9 ±8,9
F ,,
Nhan xet: Trong sd 47 benh nhan nghien ciiu, chia lam 3 nhdm, thi nhdm tu6i
>60 chilm ty le cao nhit (46,8%), tuli trung binh trong nhdm nghien ciiu la 61,9 ± 8,9. Benh nhan it tuoi nhit la 43 tuoi, nhilu tuoi nhit la 77 tuoi
@Nam
• NO
Bieu do 1: Phan bo theo gidi
Qua bilu do 1 ta thiy: Benh nhan nam chilm ty le 55,3%, benh nhan nir chilm 44,7%
Journal of research in viet nam traditional medicine and pharmacy No 41 2014
Bang 3.2. Ket qua thay doi huyet ap (n=47) Thdi gian dieu tri
X
Trudc dieu trj
Sau dieu trj
To(l) TlO (2)
T2o(3)
T3o(4)
HATT (mmHg) (X±SD) 153,6 ±2,5 145,4 ±5,3
136,9 ±6,7
126,9 ±6,1
P2-3<0,01
HATTr (mmHg) (X±SD) 88,4 ±3,8 82,6 ± 4,3
80,9 ± 3,9
77,3 ± 4,2
HATB (mmHg) (X ± SD) 110,2 ±2,5 103,7 ±4,1
99,5 ± 3,9
93,9 ± 4,2 P
^ triro'c - sau
P2-I
<0,01 P3-1
<0,01 P4.1
<0,01 P3.4<0,01
_ _ _ _ _ X '
Nhan xet: HATT, HATTr va HATB cua nhom nghien ciiu giam dan cho den hit qua trinh dieu trj nhung khdng cd benh nhan nao ha huyet ap qua miic. Sir khac biet giiia cac tdi dilm TlO, T20, T30 so vdi TO, T20 so vdi TO, T20 so vdi TlO va T30 so vdi T20 cd y nghia thing ke vdi p<0,01
Bang 3.3. Muc do lam thay doi huylt ap (n=47) cua thuoc
^^^^^Muc do HA ^ " ^ - ^ ^ ^ HATT
HATTr
Khdng thay doi n
0 7
% 0 14,89
Tang len n
0 0
% 0 0
Giam n
47 40
% 100 85,11 Nhan xet: 100% benh nhan trong nhdm nghien ciiu cd HATT giam; 14,89% s6 benh nhan cd HATTr khdng thay ddi, 85,11% s l benh nhan co HATTr giam
Bang 4.3. Danh gia tac dung ha huyet ap chung Ket qua
n
%
Tdt 33 70,21
Kha 12 25,53
Trung binh
4.26
Kem 0 0
Tong so 47 100 Nhan xet: Phin Idn cac benh nhan c6 miic ha HATB dat loai tot (70,21%).
Khdng cd benh nhan nao dap ling kem vdi thudc
Bang 5.3. Tac dung lam thay ddi cac chi so trung binh lipid mau (n=47) cua thuoc
—~--___Thdi gian dieu tri Thanh phan lipid^^~~~~~~~~~~--~----__^
CT (mmol/l) TG (mmol/l) LDL-C (mmol/l) HDL-C (mmol/1)
To (X ± SD) 4,97 ± 0,68 2,25 ± 0,53 2,75 ± 0,60 1,04 ±0,13
T30
(X±SD) 4,28 ± 0,52
1,71 ±0,29 2,19 ±0,56 1,22 ±0,19
P
<0,05
<0,05
<0,05
<0,05 Nhan xet: Thuoc cd tac dung lam giam CT, TG, LDL-C va lam tang HDL-C vdi p<0,05
Bang 6.3. Tac dung lam thay doi chi so huyet hgc (n=47) ciia thuoc
^^~~~~~~-~---.-_Jlidi gian dieu tri Chi so huyet hgc ^~~~~~~~--~.-___^
H6ng cau (G/1) Bach ciu (T/1) Tieu cau (T/l)
To (X ± SD) 4,13 ±0,27 7,18 ±0,12 260,02 ±9,56
T30
(X ± SD) 4,28 ± 0,30 7,06 ± 0,20 260,25 ± 9,49
P
>0,05
>0,05
>0,05 Nhan xet: Sau thdi gian dieu trj cac chi sd huyet hgc thay ddi khdng dang ke.
Thudc khdng lam anh hudng den chiic nang tao mau ciia benh nhan vdi p>0,05 Bang 7.3. Tac dung lam thay doi mdt sd chi tieu sinh hda mau (n=47)
^^~~~~~-~-~-,,_Thdi gian dieu tri Chi sd sinh hda ^^~~~~-~~~-~-,__^^
ALT (U/I - 37°C) AST (U/I - 37°C) Ure (mmol/l) Creatinin (pmol/l)
To (X ± SD) 37,30 ±15,63 39,85 ± 35,50 5,96 ±1,22 84,28 ±13,20
T30
(X±SD) 34,14 ±9,38 36,80 ±21,45
5,78 ± 0,97 86,35 ± 12,80
P
>0,05
>0,05
>0,05
>0,05 Nhan xet: Sau lieu trinh dieu trj 30 ngay, cac chi sd sinh hda tren thay d6i kh6ng cd y nghia th6ng ke vdi p>0,05. Thudc khdng lam anh hudng din chire nang gan va than. Tren lam sang khdng cd benh nhan nao bj dj ling vdi thudc gay man ngiia, ndn, ia chay...
rnal of research in viet nam traditional medicine and pharmacy No 41 2014
Ket qua theo ddi sau nghien cuu:
^ F
Bang 8.3. Ket qua theo ddi sau nghien cuu ve huyet ap ciia 27 benh nhan sau khi dirng dieu tri 30 ngay (n=27)
Thdi diem theo ddi
To(l) T3o(2) Sau
nghien ciiu
T45 (3) T6o(4)
HATT (mmHg) (X ± SD) 153,33 ±2,77 125,37 ±6,03 130,19 ±5,80 134,81 ±5,80 P2-3 <o,oi
HATTr (mmHg) ( X ± S D ) 87,59 ± 4,25 76,11 ±4,67 77,96 ± 2,86 79,26 ± 2,67
HATB (mmHg) (X ± SD) 109,56 ±2,78
92,53 ±4,51 95,43 ± 3,35 97,78 ± 3,33
P
Pl.2<0,01 Pi-3<0,01 P,.4<0,01 P2.4<0,01
Nhan xet: Ket qua cho thay trung
F
binh huyet ap cua 27 benh nhan dugc theo ddi sau khi dirng thudc da tang din trd lai d cac thdi diem ngay thii 45 va 60 tuy nhien cac chi sd: HATT, HATTr va HATB diu thap hon so vdi thdi diem TQ va deu nam trong gidi ban binh thudng.
IV. B A N L U A N :
> F
4.1. Ban ve tac dung ha huyet
F F X
ap cua nude sac nam Hdng chi
Nghien ciin tren 47 benh nhan tang huylt ap nguyen phat do I, sau 30 ngay dilu trj da cho mdt ket qua kha quan, do la: chi sd HATT trudc dilu trj cua nhdm nghien ciiu la 153,6
± 2,5 mmHg, sau lieu trinh dilu trj
cdn 126,9 ± 6,1 mmHg. Chi s6 HATTr trudc dieu trj ciia nhom nghien ciiu la 88,4 ± 3,8 mmHg, sau lieu trinh dieu trj con 77,3 ± 4,2 mmHg. Chi sd HATB trudc dieu trj ciia nhom nghien ciiu la 110,2 ± 2,5 mmHg, sau lieu trinh dieu trj con 93,9 ± 4,2 mmHg va kh6ng c6 benh nhan nao ha HA qua miic. Sir khac biet trudc va sau dieu trj c6 y nghia thing ke vdi p<0,01. Dac biet sau khi dimg thuoc 30 ngay da kiem tra lai
F
dugc 27 benh nhan trong sd 47 benh nhan nghien ciiu vdi 2 thdi diem danh gia la sau 15 ngay va 30 ngay thi thiy chi sl huylt ap cd tang dan trd lai, nhung van thap ban so vdi
thdi dilm TQ va van trong gidi ban binh thudng.
Nim Hong chi nim trong ddng Nim Linh chi bao gdm 6 chiing loai
quy la: Thanh chi. Hong chi, Hoang chi. Bach chj, Hic chi va Tir chi (Luc bao linh chi) trong dd Hdng chi theo y ly YHCT cd vj ding, tinh binh, khdng ddc, vdi tac dung tang tri nhd, bl tang tam, trj dam thip... Tang tam chii vl huylt mach, dam thap gan vdi benh vira xo ddng mach cua YHHD.
Nen viec nghien ciiu nam Hdng chi va minh chiing nam Hdng chi cd tac dung ha huyet ap la gdp phan lam sang td y ly ciia YHCT.
XI 'X
4.2. Ban ve tac dung dieu chinh
F r
roi loan lipid mau cua nude sac
F ^
nam Hdng chi
F F
Ket qua nghien ciiu cdn cho thay
F F X
nude sac nam Hdng chi cd tac dung dieu chinh rdi loan lipid mau d nhiing benh nhan tang huyet ap cdn kem theo rdi loan lipid mau vdi ket qua la lam giam 13,88% ddi vdi Cholesterol toan phan, giam dugc 24%) ddi vdi Triglycerit, giam 20,36% doi vdi LDL-C va lam tang dugc 14,75% doi
vdi HDL-C, Su thay doi trudc va sau dieu trj cd y nghia thong ke vdi p<0,01, Nim Hdng chi cd tac dung dieu trj chiing dam thip trong YHCT, mdt chiing benh cd bieu hien lam sang nhu xo vira ddng mach ciia YHHD, Nghien ciiu ciia Pham Thj Bach Yin nam 2009 cho thay nude sic Hdng chi Da Lat cd tac dung ban
F F F
che rd ret rdi loan ca 4 chi sd lipid mau tuong duong vdi Lipanthyl
F
200mg/24 gid, Ket qua nghien ciiu
F
Ciia chiing tdi tuong duong vdi ket qua nghien ciin ciia Pham Thj Bach Yin [5],
4.3. Tinh an toan ciia nude sac
F ^
nam Hdng chi tren lam sang
X t k
Sau 30 ngay dieu trj, cac chi so huyet hgc va sinh hda ciia benh nhan nghien ciiu thay ddi khdng dang ke.
F F
Thudc khdng lam anh hudng den chiic nang tao mau, chiic nang gan- than va khdng cd benh nhan nao dj ling vdi thudc tren lam sang. Nghien
X F
Ciiu ve ddc tinh cap va ban trudng diln ciia nim Hdng chi Da Lat nam 2009 ciia Pham Thj Bach Yin cho thiy khdng xac djnh dugc LD50 va
Journal of research in viet nam traditional medicine and pharmacy No 41 2014
thudc khdng anh hudng din chiic nang sinh hda va tao mau ciing nhu tren md benh hgc ciia gan va than [5]
ddng vat nghien ciin V. KET LUAN:
5.1. Nam Hdng chi cd tac dung
F X
lam giam huyet ap vdi lieu 15g/ngay tren 47 benh nhan tang huyet ap do 1.
Sau 30 ngay dieu trj vdi 70,21% dat loai tdt, 25,35% dat loai kha va
4,26%) dat loai trung binh. Su thay
•» X
ddi trudc va sau dieu trj co y nghia thdng ke vdi p<0,01
- Nam Hdng chi cd tac dung dieu chinh rdi loan lipid mau. Sir thay d6i trudc va sau dieu trj co y nghia thdng kevdip<0,01.
5.2. Kh6ng thay tac dung kh6ng mong mu6n ciia thu6c tren lam sang va can lam sang
TAI LIEU THAM KHAO 1. Dd Duy Bich, Dd Trung
Dam, Doan Thi Nhu va cs (2004),
"Linh chi Ganoderma Lucidum W.Curt, cay thuoc vd dong vat ldm thuoc a Viet Nam " tap II. NXB Khoa hgc ky thuat. tr.60
2. Nguyen Hiru Ddng, Dinh Xuan Linh, Nguyen Thi Son (2005): "Ky thuat trdng ndm Linh chi, ndm dn, ca sa khoa hoc vd cong nghiep nudi trong" NXB Ndng nghiep, tr. 108-133
3. Vu Dinh Hai (2002), "Cap nhat vi tdng huyet dp " Tap chi thdng tin Y Dugc so 2/3/2002
4. Bui Chi Hieu, Nguyen Minh Luan va cs (1993): "Tim hieu tdc diing cua ndm Linh chi (Gonoderma Lucidum) " Tai lieu phuc vu Hoi thao vl YHCT lin thii III tai Thanh phi HCM 8/1993
5. Pham Thi Bach Yen, Nguyen Nhugc Kim (2009). "Nghien cuu tdc
F X
dung hg lipid mdu cua ndm Hong chi Dd Lat (Gonoderma lucidum) tren ldm sdng" Tap chi Y hgc Viet Nam, s6 1,tap356,tr.44-48