肾虚量化评分在女性原发性骨质疏松症中临床运用的初步研究

发布时间：2018-05-04 18:39

本文选题：原发性骨质疏松症 + 肾虚量化评分　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:分析女性绝经后骨质疏松症肾虚量化评分、患者雌二醇(E2)与骨密度(BMD)的相关性,将肾虚量化评分与E2两者结合起来分析,揭示肾虚证候轻重程度与E2、骨密度水平的相关性;通过E2、肾虚量化评分与骨代谢标志物相相关性的分析,从骨代谢角度上探讨肾虚造成骨质疏松症的可能作用机制,从而更加客观的把握肾虚对骨代谢的影响,为临床补肾中药、肾虚量化评分的恰当使用提供较好的依据。方法:将41例符合本次研究要求的患者纳入研究中,每间隔10岁分为一组,共3组(A组:54-63y;B组:64-73y;C组:74-83y),统计整理纳入患者的年龄、身高、体重情况。检测所有纳入患者的E2、BMD(腰椎)、两种骨代谢标志物:PINP与β-CTx,分别为代表骨形成标志的Ⅰ型前胶原氨基端延长肽与骨破坏标志的Ⅰ型胶原羧基端肽β特殊序列,对每个患者进行肾虚量化评分,并且运用直线相关分析法对各个项目指标数值进行相应的统计和分析。结果:1、在三个组的患者基线特征(身体质量指数(Body Mass Index,BMI)、身高、体重)统计学比较结果中,任意两组间P值均大于0.05,无统计学差异,说明各组之间存在可比性。2、各组之间肾虚量化评分、骨代谢标志物、BMD、E2相比较:肾虚量化评分:A组和C组相比较,P0.01;A组和B组相比较,P0.01;B组和C组相比较,P0.01β-CTx和PINP:A组和C组相比较,P0.01;A组和B组相比较,P0.01;B组和C组相比较,P0.01;BMD:A组和B组相比较,P0.05;A组和组C相比较,P0.01;B组和组C相比较,P0.05;E2:A组和B组相比较,P0.05;A组和组C相比较,P0.01;B组和组C相比较,P0.05;3、肾虚量化评分与年龄、BMD、E2、β-CTx、PINP的相关性(r):肾虚量化评分与年龄呈高度正相关,r=0.937、P0.01;肾虚量化评分与BMD呈高度负相关,r=-0.962、P0.01;肾虚量化评分与E2呈高度负相关,r=-0.868、P0.01;肾虚量化评分与β-CTx呈高度正相关,r=0.935、P0.01;肾虚量化评分与PINP呈高度负相关,r=-0.958、P0.01;4、E2与BMD、年龄、β-CTx、PINP指标的相关性(r):E2与骨密度呈高度正相关,r=0.766,P0.01;E2与年龄呈高度负相关,r=-0.758,P0.01;E2 与 CTx 呈高度负相关,r=-0.727,P0.01;E2 与 PINP 呈高度正相关,r=0.745,P0.01;5、年龄与BMD、PINP、β-CTx指标的相关性(r):年龄与BMD呈高度负相关,r=-0.932,P0.01;年龄与PINP呈高度负相关,r=-0.931,P0.01;年龄与β-CTx呈高度正相关,r=0.907,P0.01;结论:女性原发性骨质疏松症患者,肾虚量化评分随着患者年龄的增加呈逐渐加重倾向,而雌激素水平则呈逐渐下降趋势,破骨细胞功能活动相对于成骨细胞逐渐增强。其机制可能是由于女性绝经后雌激素水平逐渐下降导致骨重建发生变化、骨代谢失常,骨吸收作用相对骨形成作用而言逐渐增强,进而形成骨质疏松。研究表明肾虚在女性原发性骨质疏松症发病过程中起着非常重要的作用,骨质疏松症肾虚量化评分可较好地运用于临床,为原发性骨质疏松症补肾中药的使用提供一定的参考和依据。
[Abstract]:Objective: to analyze the correlation between the quantitative score of kidney deficiency in postmenopausal women and the relationship between estradiol E _ 2 (E _ 2) and bone mineral density (BMD). To reveal the correlation between the severity of kidney deficiency syndrome and the level of E2 and bone mineral density, to explore the possible mechanism of osteoporosis caused by kidney deficiency from the perspective of bone metabolism through the analysis of the correlation between E2, quantitative score of kidney deficiency and the markers of bone metabolism. Therefore, it is more objective to grasp the effect of kidney deficiency on bone metabolism, and to provide a better basis for the proper use of clinical kidney tonifying Chinese medicine and the quantification score of kidney deficiency. Methods: 41 patients who met the requirements of this study were included in the study. Each 10 years old was divided into three groups: group A: 54-63yr, group B: 64-73yr, group C: 74-83yr. The age, height and weight of the patients were statistically analyzed. All the patients were included in the study to detect the specific sequences of E2P BMDs (lumbar vertebrae), two biomarkers of bone metabolism: 1 PINP and 尾 -CTX, which were the amino terminal lengthening peptide of type I procollagen and the carboxyl terminal peptide 尾 of type I collagen, respectively, which represented the marker of bone formation. Each patient was scored by kidney deficiency quantification, and each item index value was analyzed by linear correlation analysis. Results in the baseline characteristics (body Mass index, height, weight) of the three groups, the P value of any two groups was greater than 0.05, and there was no statistical difference between the two groups. The results showed that there was comparability between the groups, and the quantitative score of kidney deficiency among the groups. Comparison of bone metabolism marker BMD-E _ 2: comparison of kidney deficiency quantification score between group A and group C: comparison of P0.01 尾 -CTx and P0.01 尾 -CTx in group B and group C; comparison of group A and group B in comparison of P0.01 尾 -CTx and group B; comparison of group B and group C of P0.01A and group C Group B: comparison of P0.05A and Group C; comparison of Group B and Group C; comparison of Group A and Group B; comparison of Group A and Group C; comparison of Group B and Group C; comparison of Group C and Group C; correlation of Kidney deficiency Quantification score with Age of BMDE2, 尾 -CTxPINP: correlation of Kidney deficiency Quantification score and Age There was a high positive correlation between kidney deficiency and 尾 -CTx, a high positive correlation between kidney deficiency score and PINP, a high negative correlation between kidney deficiency score and BMD, a high negative correlation between kidney deficiency score and E2, a high positive correlation between kidney deficiency quantification score and 尾 -CTx, and a high negative correlation between kidney deficiency quantification score and PINP, a significant negative correlation between E2 and BMD-0.95% P0.014, and a negative correlation between kidney deficiency quantification score and PINP, and a high negative correlation between kidney deficiency quantification score and BMD, and a high negative correlation between kidney deficiency quantification score and E 2 and BMD-0.868 P0.01; a high positive correlation between kidney deficiency quantification score and 尾 -CTx P0.01; a high negative correlation between kidney deficiency quantification score and PINP. Age, correlation between 尾 -CTxPINP and BMD: r: E2 is highly positively correlated with bone mineral density; r-0.758P0.01E _ 2 is highly negatively correlated with age; r-0.727; P0.01E _ 2 is highly positively correlated with PINP; age is highly correlated with BMD-PINP, 尾 -CTx; age is highly negative with BMD; and age is highly negatively correlated with BMD-PINP, 尾 -CTx. There was a highly negative correlation between age and PINP, and a high positive correlation between age and 尾 -CTX. Conclusion: the age of female patients with primary osteoporosis is 0.907 and 0.907P0.01.Conclusion: there is no significant correlation between age and PINP, and there is a significant correlation between age and 尾 -CTX. Conclusion: there is a significant correlation between age and 尾 -CTX in female patients with primary osteoporosis. The quantitative score of kidney deficiency increased gradually with the increase of age, while the level of estrogen decreased gradually, and the function of osteoclasts was gradually enhanced compared with osteoblasts. The mechanism may be that the decline of estrogen level in postmenopausal women may lead to changes in bone remodeling and bone metabolism, and bone resorption is gradually enhanced in relation to bone formation, resulting in osteoporosis. Studies have shown that kidney deficiency plays a very important role in the pathogenesis of primary osteoporosis in women. The quantitative score of kidney deficiency in osteoporosis can be used in clinical practice. To provide certain reference and basis for the use of traditional Chinese medicine for tonifying kidney in primary osteoporosis.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R580

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