中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (8): 1155-1160.doi: 10.12307/2023.870

• 骨组织构建 bone tissue construction • 上一篇    下一篇

益肾固疏方干预老年性骨质疏松症患者骨代谢标志物的变化及临床疗效

章晓云,刘  桦,柴  源,陈  锋,曾  浩,高振罡,黄有荣   

  1. 广西中医药大学附属瑞康医院,广西壮族自治区南宁市  530011
  • 收稿日期:2022-11-26 接受日期:2023-01-04 出版日期:2024-03-18 发布日期:2023-07-18
  • 通讯作者: 黄有荣,主任医师,教授,全国名老中医、全国中医骨伤名师,广西中医药大学附属瑞康医院,广西壮族自治区南宁市 530011
  • 作者简介:章晓云,男,1986年生,江西省九江市人,汉族,博士,副主任医师,硕士导师,主要从事骨伤科疾病的中医药临床与基础研究。
  • 基金资助:
    广西中医药适宜技术开发与推广项目(GZSY22-36),项目负责人:章晓云;广西自然科学基金青年基金(2020GXNSFBA159053),项目负责人:章晓云;广西中医药大学青年创新研究团队项目(2021TD001),项目负责人:章晓云;国家自然科学基金资助项目(81960803),项目参与人:章晓云;黄有荣桂派中医大师培养项目(桂中医药科教发[2022]6号),项目负责人:黄有荣;广西中医药大学桂派中医药传承创新团队(项目编号2022A004),项目参与人:章晓云

Effect of Yishen Gushu Formula on bone metabolic markers and clinical efficacyn in patients with osteoporosis of kidney deficiency and blood stasis type

Zhang Xiaoyun, Liu Hua, Chai Yuan, Chen Feng, Zeng Hao, Gao Zhengang, Huang Yourong   

  1. Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine, Nanning 530011, Guangxi Zhuang Autonomous Region, China
  • Received:2022-11-26 Accepted:2023-01-04 Online:2024-03-18 Published:2023-07-18
  • Contact: Huang Yourong, Chief physician, Professor, Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine, Nanning 530011, Guangxi Zhuang Autonomous Region, China
  • About author:Zhang Xiaoyun, MD, Master’s supervisor, Associate chief physician, Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine, Nanning 530011, Guangxi Zhuang Autonomous Region, China
  • Supported by:
    Guangxi Appropriate Technology Development and Promotion Project of Traditional Chinese Medicine, No. GZSY22-36 (to ZXY); Guangxi Natural Science Foundation for the Youth, No. 2020GXNSFBA159053 (to ZXY); Guangxi University of Traditional Chinese Medicine Youth Innovation Research Team Project, No. 2021TD001 (to ZXY); National Natural Science Foundation of China, No. 81960803 (to ZXY [project participant]); Traditional Chinese Medicine Master Training Project for Huang Yourong Gui School, No. [2022]6 (to HYR); Traditional Chinese Medicine Inheritance Innovation Team of Guangxi University of Traditional Chinese Medicine, No. 2022A004 (to ZXY [project participant])

摘要:


文题释义:

骨质疏松症:是绝经后妇女和老年人中常见的代谢性骨病,表现为骨量减少、骨微结构破坏和骨脆性增加为特征,临床以疼痛、脊柱变形及易发生脆性骨折等为主要表现,其中低能量损伤导致的髋部骨折是骨质疏松症最严重的并发症,在某些情况下是致命的,且随着疾病的发展呈逐渐加重的趋势,严重影响患者的生活质量。

骨稳态:由成骨细胞诱导的骨形成与破骨细胞诱导的骨吸收之间的动态平衡,在维持骨骼结构和功能方面发挥重要作用。当破骨细胞活性超过成骨细胞活性时,导致骨代谢紊乱、机体骨重塑失衡,从而导致骨质疏松症的发生并增加骨折倾向。


背景:随着疾病治疗模式的改变及近年来对老年性骨质疏松症研究的深入,越来越多的研究证实中医药在防治老年性骨质疏松症方面的效果显著。
目的:探讨益肾固疏方对肾虚血瘀型老年性骨质疏松症患者骨代谢标志物的影响。
方法:选择2020年7月至2022年3月广西中医药大学附属瑞康医院收治的肾虚血瘀型老年性骨质疏松症患者102例,其中男32例,女70例,年龄71-93岁。采用随机数字表法将102例患者分为试验组及对照组,每组51例,对照组给予碳酸钙D3颗粒+阿仑磷酸钠片治疗,治疗组给予碳酸钙D3颗粒+阿仑磷酸钠片+益肾固疏方治疗,连续治疗3个月。治疗前及治疗3个月后,检测两组患者L1-4椎体与左侧股骨颈骨密度,评估目测类比评分,检测血清骨钙素、骨桥素、Ⅰ型胶原交联C-末端肽及抗酒石酸酸性磷酸酶水平,评估中医证候积分与治疗有效率。

结果与结论:①两组治疗3个月后的L1-4椎体与左侧股骨颈骨密度均高于治疗前(P < 0.05),试验组治疗3个月后的L1-4椎体与左侧股骨颈骨密度均高于对照组(P < 0.05);②两组治疗3个月后的目测类比评分均低于治疗前(P < 0.05),试验组治疗3个月后的目测类比评分低于对照组(P < 0.05);③两组治疗3个月后的血清骨钙素、骨桥素、Ⅰ型胶原交联C-末端肽及抗酒石酸酸性磷酸酶水平均较治疗前明显改善(P < 0.05),试验组治疗3个月后的血清骨钙素、骨桥素水平高于对照组(P < 0.05),Ⅰ型胶原交联C-末端肽及抗酒石酸酸性磷酸酶水平低于对照组(P < 0.05);④两组治疗3个月后的中医证候总评分均低于治疗前,试验组治疗3个月后的中医证候总评分低于对照组;治疗3个月后,两组均未发生明显不良反应,试验组于对照组治疗总有效率分别为88.2%,70.6%,组间比较差异有显著性意义(P < 0.05);⑤结果显示,益肾固疏方联合抗骨质疏松药物可通过调节骨代谢、提高骨密度、减轻患者病痛来显著改善肾虚血瘀型老年性骨质疏松症患者的临床症状,阻止疾病的进一步发展。

https://orcid.org/0000-0002-2572-0229(章晓云)

中国组织工程研究杂志出版内容重点:组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程

关键词: 骨质疏松症, 骨代谢标志物, 益肾固疏方, 中医药, 临床疗效, 随机对照试验

Abstract: BACKGROUND: With the variation of disease treatment modes and the in-depth research on senile osteoporosis in recent years, increasing studies have confirmed that traditional Chinese medicine has a significant effect on the prevention and treatment of senile osteoporosis.
OBJECTIVE: To investigate the effect of Yishen Gushu Formula on bone metabolic markers in patients with osteoporosis of kidney deficiency and blood stasis type.
METHODS: 102 patients with senile osteoporosis of kidney deficiency and blood stasis type who were treated at Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine from July 2020 to March 2022 were enrolled, including 32 males and 70 females, aged 71-93 years. All patients were randomly divided into two groups, with 51 patients in each group. The control group was treated with calcium carbonate D3 granules and sodium alendronate tablets, while the treatment group was treated with Yishen Gushu Formula beyond the control group. Treatments in each group lasted 3 months. Bone mineral density of the L1-4 lumbar vertebrae and left femoral neck, visual analog scale score, and serum levels of osteocalcin, osteopontin, type I collagen cross-linked C-terminal peptide and tartrate resistant acid phosphatase were measured before and 3 months after treatment. Traditional Chinese medicine syndrome score and therapeutic efficiency were also assessed.
RESULTS AND CONCLUSION: After 3 months of treatment, the bone mineral density of the lumbar vertebrae (L1-4) and left femoral neck was significantly increased in both two groups (P < 0.05), and the bone mineral density of the lumbar vertebrae (L1-4) and left femoral neck was significantly higher in the treatment group than the control group (P < 0.05). The visual analog scale scores of both groups after 3 months of treatment were lower than those before treatment (P < 0.05), and the visual analog scores of the treatment group after 3 months of treatment were lower than those of the control group (P < 0.05). After 3 months of treatment, the serum levels of osteocalcin, osteopontin, type I collagen cross-linked C-terminal peptide and tartrate resistant acid phosphatase were significantly improved in both two groups, while compared with the control group, the serum levels of osteocalcin and osteopontin were significantly higher (P < 0.05) and the serum levels of type I collagen cross-linked C-terminal peptide and tartrate resistant acid phosphatase were significantly lower in the treatment group (P < 0.05). After 3 months of treatment, the Traditional Chinese medicine syndrome scores were decreased in both two groups, while the Traditional Chinese medicine syndrome scores in the treatment group were lower than those in the control group. After 3 months of treatment, no significant adverse reactions occurred in both groups. The total effective rate was 88.2% and 70.6% in the treatment and control groups respectively, and there was a significant difference between the two groups (P < 0.05). To conclude, Yishen Gushu Formula combined with anti-osteoporosis drugs can significantly improve the clinical symptoms of patients with senile osteoporosis of kidney deficiency and blood stasis type and prevent disease progression by regulating bone metabolism, increasing bone mineral density, and relieving pain.

Key words: osteoporosis, bone metabolic marker, Yishen Gushu Formula, traditional Chinese medicine, clinical efficacy, randomized controlled trial

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