围绝经期女性雌激素水平与骨质疏松发病机制的临床研究

发布时间：2018-09-04 19:00

【摘要】：目的与背景：从中医角度，围绝经期女性气血不足，周身脏腑经络因气虚、血虚而失养，，导致血行迟缓，脉道枯萎，血液淤积现象，出现“血瘀”证。西医认为，绝经期女性因卵巢功能的退化，体内雌激素水平下降，表现出一系列内分泌障碍性疾病，影响脂类代谢，导致血管内皮细胞破坏，激活血小板凝血系统及各种细胞因子的活性，导致红细胞聚集、血流缓慢、血粘度增加，形成“血瘀”。绝经后骨质疏松是绝经期女性常见的代谢性骨病，主要是因为雌激素缺乏，导致成骨细胞和破骨细胞活性下降，骨吸收与骨重建失衡所致。历代医家认为，女性绝经后肾元虚衰，进而导致气血衰弱，不能营养筋骨，导致骨枯髓减，引发“骨瘘”，认为“肾虚血瘀”是导致骨质疏松的主要病机。由此我们推断，雌激素水平下降是导致围绝经期女性出现“血瘀证”，进而肾精亏虚引起骨代谢障碍，最终导致骨质疏松发生。本研究主要目的是探讨围绝经期女性雌激素水平下降导致血瘀证病理变化的原因，及肾虚血瘀证引起骨量减少进而导致骨质疏松症的发病机制。方法：选取围绝经期女性83例，年龄41-60岁，按年龄每10岁一组分为41-50岁组34例和51-60岁组49例，分别检测两组患者雌二醇水平（E2）、血液流变学指标、骨代谢指标水平，骨代谢指标包括I型羧基末端肽（CTX）、氨基酸中段骨钙素（NMID）、I型前胶原氨基端前肽（PINP），同时将两组患者中医临床证候量化评分，比较各组患者雌激素水平、骨代谢指标、“血瘀”量化评分及血液流变学指标的差异，评价雌二醇水平与“血瘀”证及骨代谢的相关性。结果：1、两组患者雌二醇水平及骨代谢指标比较：随着年龄的增长女性雌二醇水平呈下降趋势，骨代谢指标CTX、PINP水平呈升高趋势，NMID水平呈下降趋势，两组E2、NMID、PINP、CTX比较差异有统计学意义（P＜0.05）。2、两组患者血瘀量化评分及血流变指标比较：随着女性雌二醇水平的下降，血瘀量化评分呈上升趋势，两年龄段女性血瘀量化评分比较差异显著（P＜0.05），51-60岁年龄段女性血流变大部分指标显著高于41-50岁年龄段的女性（P＜0.05），提示围绝经期女性存在凝、黏、浓、聚等血瘀的病理基础，并且年龄越大的患者血瘀程度越严重。3、雌二醇和骨代谢指标与血瘀量化评分、血流变指标间的相关性：（1） E2与CTX、NMID、PINP、血瘀量化评分、全血高切粘度、全血低切粘度、全血中切粘度、全血高切还原粘度、全血中切还原粘度、全血低切还原粘度、红细胞刚性指数呈负相关，与红细胞电泳时间呈正相关；说明随着年龄的症状，E2水平降低，导致骨代谢发生变化和血流动力学发生改变，呈现血瘀的病理改变。（2）血瘀量化评分与全血粘度高切、全血粘度中切、全血粘度低切、全血高切还原粘度呈正相关，提示围绝经期女性血液流变学改变存在血瘀证表现。（3）CTX与血瘀量化评分正相关，与红细胞电泳时间负相关， NMID和PINP指标与血瘀量化评分、全血高切粘度、全血低切粘度、全血中切粘度存在正相关，提示围绝经期女性血瘀证与骨合成速度相关，血瘀越严重成骨细胞活性越强，骨更新的速率越快，骨转换越高，说明血瘀的病理改变导致骨代谢异常。结论：围绝经期女性雌二醇水平与血瘀证、标志骨形成的指标NMID、PINP和标志骨吸收的指标CTX成负相关性，提示围绝经期女性雌激素水平与骨代谢和肾精亏虚密切相关，雌激素水平下降导致血液流变学指标的变化，引起“血瘀”的症候，从而引起骨代谢异常，骨吸收增加明显，骨形成相对减少，进而导致骨质疏松。因此，“肾虚血瘀”是导致骨质疏松的主要病机。
[Abstract]:Objective and BACKGROUND: From the perspective of traditional Chinese medicine, perimenopausal women with insufficient Qi and blood, the body viscera and meridians due to Qi deficiency, blood deficiency and loss of nourishment, resulting in blood flow retardation, atrophy, blood stasis, the emergence of "blood stasis" syndrome. Diseases affect lipid metabolism, cause vascular endothelial cell destruction, activate platelet coagulation system and various cytokine activities, lead to red blood cell aggregation, slow blood flow, increased blood viscosity, the formation of "blood stasis." Postmenopausal osteoporosis is a common metabolic osteopathy in menopausal women, mainly due to estrogen deficiency, resulting in osteoblasts. It is believed that the decrease of estrogen level is the main pathogenesis of osteoporosis. The purpose of this study was to investigate the pathogenesis of osteoporosis caused by the decrease of estrogen level in perimenopausal women and the pathological changes of blood stasis syndrome.
Methods: 83 perimenopausal women aged 41-60 years were divided into 41-50 age group (34 cases) and 51-60 age group (49 cases). The levels of estradiol (E2), hemorheology, bone metabolism, bone metabolism, including type I carboxyl terminal peptide (CTX), mid-amino acid osteocalcin (NMID) and type I procollagen were measured. Amino-terminal pro-peptide (PINP) was used to evaluate the correlation between estradiol level and blood stasis syndrome and bone metabolism.
Results: 1. Comparison of estradiol level and bone metabolism index between the two groups: with the increase of age, estradiol level of female showed a downward trend, bone metabolism index CTX, PINP level showed an upward trend, NMID level showed a downward trend, two groups of E2, NMID, PINP, CTX difference was statistically significant (P < 0.05). Variable index comparison: With the decrease of female estradiol level, the quantitative score of blood stasis showed an upward trend. There was a significant difference in the quantitative score of blood stasis between two years old women (P The pathological basis of blood stasis and the severity of blood stasis in older patients. 3. The correlation between estradiol and bone metabolism index and blood stasis quantitative score, hemorheology index: (1) E2 and CTX, NMID, PINP, blood stasis quantitative score, whole blood high shear viscosity, whole blood low shear viscosity, whole blood middle shear viscosity, whole blood high shear reduction viscosity, whole blood middle shear reduction viscosity Viscosity, whole blood low shear reduction viscosity, erythrocyte rigidity index was negatively correlated with erythrocyte electrophoresis time was positively correlated; indicating that with age symptoms, E2 level decreased, resulting in changes in bone metabolism and hemodynamics, showing pathological changes of blood stasis. (2) Blood stasis quantitative score and whole blood viscosity high shear, whole blood viscosity medium shear, whole blood viscosity, blood stasis. There was a positive correlation between blood viscosity and reduction viscosity at high shear, suggesting that there was blood stasis syndrome in perimenopausal women. (3) CTX was positively correlated with blood stasis quantitative score, and negatively correlated with erythrocyte electrophoresis time. NMID and PINP indexes were positively correlated with blood stasis quantitative score, whole blood high shear viscosity, whole blood low shear viscosity, and whole blood middle shear viscosity. It is suggested that the blood stasis syndrome in perimenopausal women is related to the rate of bone synthesis. The more serious the blood stasis, the stronger the activity of osteoblasts, the faster the rate of bone regeneration, and the higher the bone turnover, indicating that the pathological changes of blood stasis lead to abnormal bone metabolism.
Conclusion: The level of estradiol in perimenopausal women is negatively correlated with blood stasis syndrome, NMID, PINP and CTX, indicating that the level of estrogen in perimenopausal women is closely related to bone metabolism and deficiency of kidney essence. Therefore, kidney deficiency and blood stasis are the main pathogenesis of 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】：2014
【分类号】：R711.51;R580

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