强直性脊柱炎患者骨代谢水平与中医证型的相关性研究

发布时间：2018-01-09 05:16

  本文关键词：强直性脊柱炎患者骨代谢水平与中医证型的相关性研究　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 强直性脊柱炎 骨代谢 骨密度 疾病活动度 辨证分型

【摘要】：目的:强直性脊柱炎(Ankylosing Spondylitis,AS)是一种主要累及中轴关节,尤其是腰椎、骶髂关节的慢性脊柱关节炎性疾病。现代研究表明,部分患者有骨量减少、骨代谢水平异常的情况,提示存在骨折风险。本研究立足于观察AS患者中医证型与骨代谢、骨密度水平之间的相关性,AS患者中医证型与疾病活动度之间的相关性,以及AS患者疾病活动度与骨代谢、骨密度水平之间的相关性,为进一步行中西医结合治疗,有效防治骨质疏松,降低AS患者骨折风险提供一定的依据。方法:依据纳入标准,收集中国人民解放军陆军总医院风湿免疫科2016年7月到11月住院及门诊AS患者126例,记录其一般临床相关数据包括:性别、年龄、病程长短等。应用双能X线吸收法测量其骨密度水平,并记录右侧股骨颈Z值及腰椎L1-L4的Z值。依凭中国人民解放军陆军总医院检验科实验室,检测并记录患者骨钙素(Bone Gla Protein,BGP)、I型原胶原N-端前肽(Procollagen type I N-terminal propeptide,PINP)、甲状旁腺素(Parathyroid Hormone,PTH)、血钙(Serum Calcium,Ca)、碱性磷酸酶(Alkaline Phosphatase,ALP)、红细胞沉降率(Erythrocyte Sedimentation Rate,ESR)、C 反应蛋白(C-reactive Protein,CRP)水平。收集相关病情活动数据,通过ASDAS法(ASAS-endorsed disease activity score,ASDAS)计算患疾病活动度评分。依据《中药新药临床研究指导原则(最新)》,对处于病情活动期的AS患者进行科学的中医辨证分型,共分为:湿热痹阻证、寒湿痹阻证、瘀血痹阻证、肝肾亏虚证、肾阳亏虚证5个证型组。应用SPSS19.0软件对收集的AS患者中医证型、骨密度及骨代谢水平、疾病活动度ASDAS评分三者的数据结果进行统计分析,主要研究上述三者之间的相关性联系。结果:共收集AS患者126例,男性111例,女性15例,男女比例为7.4:1,骨量异常者78例,占总人数的61.9%。患者股骨颈及L1-L4腰椎的骨密度Z值:1.均与Ca水平呈正相关;2.与ALP、PTH相关性尚不能认为有统计学意义(P0.05);3.股骨颈Z值与BGP相关性均尚不能认为有统计学意义(P0.05)、与PINP水平呈负相关,腰椎Z值与BGP、PINP呈负相关;4.均与CRP、ESR呈负相关;5.与ASDAS-CRP、ASDAS-ESR的相关性尚不能认为有统计学意义(P0.05)。中医五个证型组的骨密度和骨代谢水平方面:与其他三组相比,肾阳亏虚证组和肝肾不足证组骨密度水平较低,Ca水平偏低,PINP和BGP水平较高。中医五个证型组的炎症因子和疾病活动度方面:肾阳亏虚证组在ESR和CRP方面均最高;瘀血痹阻证AS患者病情活动较为突出。结论:1.本次研究中骨密度水平减低的AS患者,Ca水平降低,BGP、PINP增加,此两者参与的骨生成水平提高,ALP和PTH参与的骨代谢环节可能并无异常。炎症因子活动与AS患者骨密度减低相关,但疾病活动情况与骨密度水平尚未发现有相关性。应是有更加剧烈的骨破坏因素打破了骨生成与骨吸收之间的动态平衡,造成AS患者骨代谢紊乱,骨密度减低。2.本次研究中肾阳亏虚证组和肝肾不足证组骨密度水平均明显低于其他三组,骨代谢异常较其他三组更为明显,要明确检查,及早防治骨量减少、骨质疏松。
[Abstract]:Objective: ankylosing spondylitis (Ankylosing Spondylitis AS) is a major involvement of axial joints, especially the lumbar spine, sacroiliac joint chronic spinal arthritis disease. Modern research shows that some patients with osteopenia, bone metabolism abnormalities, suggesting that in fracture risk. This research is based on the observation of AS patients TCM syndrome type and the correlation between bone metabolism, bone mineral density level, the correlation between AS patients with TCM syndrome type and disease activity, and disease activity in patients with AS and bone metabolism, the correlation between bone mineral density level, combined with western medicine for further treatment, effective prevention and treatment of osteoporosis in patients with AS, reduce the risk of fractures provide certain basis. Methods: according to the inclusion criteria, collected China people's Liberation Army General Hospital Department of Rheumatology in July 2016 to November 126 cases of inpatient and outpatient AS patients, record the general clinical correlation Including: gender, age, according to the length of the course. The level of bone mineral density measurement of dual energy X-ray absorptiometry application, and record the right femoral neck and lumbar spine Z value L1-L4 Z value. China depend on the people's Liberation Army General Hospital clinical laboratories, detect and record the patients (Bone Gla Protein BGP, osteocalcin, I) procollagen terminal propeptide (N- Procollagen type I N-terminal propeptide, PINP), parathyroid hormone (Parathyroid Hormone, PTH), serum calcium (Serum Calcium, Ca), alkaline phosphatase (Alkaline Phosphatase, ALP), erythrocyte sedimentation rate (Erythrocyte Sedimentation, Rate, ESR), C reactive protein (C-reactive Protein, CRP) level collect the relevant data. The activity of disease, by the method of ASDAS (ASAS-endorsed disease activity score, ASDAS) calculate the disease activity score. On the basis of clinical research on new drugs of traditional Chinese medicine "guiding principle (the latest) >, in disease activity in AS TCM scientific classification, is divided into: dampness heat blockage syndrome, cold dampness syndrome, blood stasis syndrome, liver and kidney deficiency, kidney yang deficiency syndrome type 5 group. The application of SPSS19.0 software to collect the TCM syndrome in patients with type AS, bone mineral density and bone metabolism, disease activity score three ASDAS the results of statistical analysis, the correlation between the three main research subjects. Results: a total of 126 AS patients, 111 were male, 15 were female, male to female ratio was 7.4:1, 78 cases of abnormal bone mass, bone mineral density accounted for Z of the total number of 61.9%. patients with femoral neck and lumbar spine L1-L4 value: 1. and the Ca level was positively correlated with ALP; 2., PTH correlation is not considered statistically significant (P0.05); 3. femoral neck Z value and BGP correlation were not considered statistically significant (P0.05), and negatively correlated with the level of PINP, BGP and Z value of lumbar spine, PINP was negatively correlated with CRP; 4. 5., ESR was negatively correlated; With ASDAS-CRP, the correlation between ASDAS-ESR is not considered statistically significant (P0.05). Five TCM Syndromes of bone mineral density and bone metabolism: compared with the other three groups, kidney yang deficiency syndrome group and deficiency of liver and kidney. The BMD level is low, low levels of Ca, PINP and BGP five. Higher levels of TCM a group of syndromes of inflammation and disease activity: kidney yang deficiency syndrome group in ESR and CRP were the highest; blood stasis syndrome in patients with AS disease activity is more prominent. Conclusion: 1. the study of bone mineral density decreased level of AS patients, lower levels of Ca, BGP, PINP increased, the level of both bone formation participate in improving bone metabolism, ALP and PTH may participate in the process. No abnormal inflammatory factors in patients with AS activity and decreased bone density, but the disease activity and bone density level has not yet been found. The correlation should be more severe bone destruction factors break The bone formation and bone resorption caused by the dynamic balance between the AS patients, bone metabolism, bone mineral density decreased.2. in the research of kidney yang deficiency syndrome group and deficiency of liver and kidney. The BMD levels were significantly lower than those of the other three groups, abnormal bone metabolism is more obvious than the other three groups, to clear the check, reduce, as soon as possible prevention and treatment of bone osteoporosis.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.23
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本文编号：1400132