绝经后骨质疏松症中医辨证分型与骨代谢标志物关系的研究

发布时间：2018-03-20 22:35

本文选题：绝经后骨质疏松症　切入点：骨代谢指标　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对100例绝经后骨稀疏症患者、20例绝经后非骨松症患者及20例育龄期女性的研究,来探讨骨钙素、雌二醇、尿NTx在绝经后骨松症中的意义;并探究骨代谢指标在绝经后骨松症中医分型上是否存在差异,为骨松症的诊断和辨证提供一定的依据。方法:根据双光能X线骨密度仪测定的BMD数值,选取停经后骨质稀疏症(包括骨量减少者)100例,停经后非骨质松症(非骨松组)及育龄期骨密度正常女性(对照组)各20例。综合患者临床症状及体征,依照中华人民共和国国家标准制订的中医临床诊疗术语症候部分,以国内中医药治疗骨质疏松症文献复习为基础,参照诸多学者意见,采用中医基本证候独立诊断的方法,将纳入的100例停经后骨松症患者按照中医辨证分型分为肾虚血瘀、脾肾阳虚、肝肾阴虚、肾精不足,共4型,测定三组患者血清中骨钙素、雌二醇,尿NTx以及L2~L4椎体正位骨密度。结果:(1)骨松组、非骨松组骨钙素、尿NTx数值均显著高于正常育龄期女性,雌二醇水平明显低于正常育龄期女性,差异有统计学意义(P0.05);(2)绝经后骨质疏松症的主要证侯分别为:腰膝部酸困痛、眩晕耳鸣、五心烦热、盗汗颧红、舌紫暗有瘀斑、脉细数、弦涩等;(3)绝经后女性骨质疏松症的中医证型分布常见的有四种,其中最多的是:肾虚血瘀型,其次为:肝肾阴虚、脾肾两虚、肾精亏虚。(4)绝经后骨质疏松症各中医辨证分型在骨钙素、尿NTx、骨密度值之间的差异无统计学意义。结论:骨代谢指标具有较高的敏感性和特异性,因此在绝经后骨松症的早期,监测骨代谢指标能及早反映病情,因此在OP的早期诊断和药物疗效监测中具有重要临床应用价值。
[Abstract]:Objective: to investigate the significance of osteocalcin, estradiol and urinary NTx in postmenopausal osteopenia, 20 postmenopausal non-osteopenia patients and 20 women of childbearing age. To explore the difference of bone metabolism indexes in TCM classification of postmenopausal osteopenia, and to provide some basis for the diagnosis and differentiation of osteopenia. Methods: according to the BMD value measured by dual X-ray absorptiometry, We selected 100 cases of postmenopausal osteoporosis (including 100 cases of osteopenia), 20 cases of postmenopausal non-osteoporosis (non-osteoporosis group) and 20 cases of normal bone mineral density (control group). In accordance with the national standards of the people's Republic of China, the TCM clinical diagnosis and treatment term symptom part, based on the review of domestic literature on the treatment of osteoporosis with Chinese medicine, and referring to the opinions of many scholars, adopts the method of independent diagnosis of the basic syndromes of traditional Chinese medicine. The 100 postmenopausal patients with osteosarcoma were divided into 4 types according to TCM syndrome differentiation: kidney deficiency and blood stasis, spleen and kidney yang deficiency, liver and kidney yin deficiency, kidney essence deficiency, total 4 types. Serum osteocalcin and estradiol were measured in three groups. Results the bone mineral density (BMD) of NTx and L2 / L4 vertebrae were significantly higher in bone loose group and non osteosong group than in normal reproductive age group, and the level of estradiol was significantly lower than that in normal reproductive age group. The main symptoms of postmenopausal osteoporosis were: lumber and knee pain, vertigo tinnitus, five upset heat, night sweating zygomaticus red, tongue purple dark ecchymosis, fine pulse count. There are four common types of TCM syndrome in postmenopausal women with osteoporosis, the most common of which are deficiency of kidney and blood stasis, followed by deficiency of liver and kidney yin, deficiency of spleen and kidney, There was no significant difference in osteocalcin, urinary NTxand bone mineral density in postmenopausal osteoporosis. Conclusion: the indexes of bone metabolism have high sensitivity and specificity, so in the early stage of postmenopausal osteopenia, there is no significant difference in the differentiation of TCM syndromes in postmenopausal osteoporosis. The monitoring of bone metabolism can reflect the disease as early as possible, so it has important clinical application value in the early diagnosis of op and the monitoring of drug efficacy.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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