基于“肾主骨”理论探讨穴位针灸对肾阴亏虚型骨质疏松患者骨代谢及生活质量的影响

发布时间：2018-01-01 23:19

本文关键词：基于“肾主骨”理论探讨穴位针灸对肾阴亏虚型骨质疏松患者骨代谢及生活质量的影响　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：[目的]通过对骨质疏松的病人行针灸治疗,观察其骨密度、骨代谢指标变化及疼痛、生活质量和中医证候的改善等,探索印证针灸疗法是否可以对骨质疏松症产生治疗作用,为该疗法找寻科学依据。[方法]采用随机对照研究方法,方案经伦理委员会审核通过。招募符合纳入标准,并签署知情同意书的受试者60名。依据随机序号入组,设立基础治疗下的试验与空白对照,试验组口服钙尔奇D600mg/日,依据补肾填髓选穴针刺治疗,对照组仅给予口服钙尔奇D600mg/日。试验周期3个月。观察指标包括:双能X线骨密度测定和血清骨代谢指标PINP\CTX\OP值测定(试验前后);视觉疼痛评分、生活质量量表评分和中医证候改善评分(试验前及试验开始后每1、2、3月末)。[结果]本研究入组60例绝经后骨质疏松妇女受试者,完成试验48例。其中针灸组23例,对照组25例,不符合纳入标准被剔除5例,未完成治疗失联7例。治疗前两组观察指标基线值比较无显著差异,具有可比性。通过正态性检验,分别使用t检验和非参数检验对治疗后得出结论:1、腰椎骨密度、股骨颈骨密度、全髋骨密度进行数据统计分析,腰椎骨密度针灸组治疗后为0.88590±10920,对照组治疗后为0.8754±0.22384;股骨颈骨密度针灸组治疗后为0.7413±0.09068,对照组治疗后为0.7612±0.09043;全髋骨密度针灸组治疗后为0.7921 ±0.07705,对照组治疗后为0.8096±0.09850。结果显示两组经过治疗后针灸组和对照组骨密度指标无统计学差异(P0.05)。2、骨代谢指标中,PINP针灸组治疗后为52.2146± 19.45078,对照组治疗后52.7904±23.15097;CTX针灸组治疗后为458.5417±201.57402,对照组治疗后为457.2083±211.93415;0C针灸组治疗后为20.4992±5.17352,对照组治疗后为20.9108±7.71508。通过正态性检验,使用t检验对PINP、CTX、0P进行数据统计分析,结果显示两组经过治疗后针灸组和对照组上述各项指标仍然无统计学差异(P0.05)。3、治疗1月后针灸组疼痛评分为5.1667±0.70196,对照组评分为5.7917±0.72106;治疗2月后针灸组疼痛评分为4.7083±0.55003,对照组评分为5.7083±0.85867;治疗3月后针灸组疼痛评分为4.2917±0.55003,对照组评分为5.6250±0.85867;经过重复测量方差分析检验,两组组内分别比较治疗后VAS评分比前一个月均有好转(F=26.788,P=0.0000.05),针灸组及对照组治疗后的每个月的时间节点进行比较发现两组间VAS评分有统计学差异(F=18.252,P=0.0000.05)。针灸组优于对照组。4、治疗1月后针灸组躯体健康总测量评分为44.7500±5.73509,对照组评分为44.3750±5.24042;治疗2月后针灸组躯体健康总测量评分为48.1667±7.53927,对照组评分为44.3750±5.31183;治疗3月后针灸组躯体健康总测量评分为58.4583± 10.99399,对照组评分为47.5000±5.80105;经过重复测量方差分析检验,结果表明针灸组及对照组在治疗后PCS每个月相比均有差异,治疗后PCS评分比前一个月均有好转(F=52.159,P=0.0000.05)。将针灸组及对照组治疗后的每个月的时间节点进行比较发现两组间PCS评分有统计学意义(F=4.072,P=0.0490.05)。针灸组优于对照组。5、治疗1月后针灸组心理健康总测量评分为63.7083±7.07709,对照组评分为60.5417±7.07709;治疗2月后针灸组心理健康总测量评分为66.7083±6.36894,对照组评分为60.4583±7.26504;治疗3月后针灸组心理健康总测量评分为70.4583±5.91960,对照组评分为60.7083±6.60355;经过重复测量方差分析检验,结果表明针灸组及对照组在治疗后MCS每个月相比均有差异,治疗后MCS评分比前一个月均有好转(F=54.506,P=0.0000.05),针灸组及对照组治疗后的每个月的时间节点进行比较发现两组间MCS评分有统计学差异(F=8.993,P=0.0040.05)。针灸组优于对照组。6、治疗1月后针灸组中医证候评分为5.3333±0.96309,对照组评分为5.1667±0.96309;治疗2月后针灸组中医证候评分为4.7917±0.72106,对照组评分为5.5417±0.88363;治疗3月后针灸组中医证候评分为4.2500±0.94409,对照组评分为5.4167±0.97431;经过重复测量方差分析检验,结果表明针灸组及对照组在治疗后中医证候评分每个月相比均有差异,治疗后中医证候评分比前一个月均有好转(F=25.379,P=0.0000.05)。将针灸组及对照组治疗后的每个月的时间节点进行比较发现两组间中医证候评分有差异(F=3.250,p=0.0480.05)。针灸组优于对照组。[结论]针灸治疗能够较好地改善患者疼痛症状,并提高患者生存质量,可以作为骨质疏松症患者的基础治疗选择。其作用机制还有待进一步深入研究。本次研究反映的BMD\PINP\CTX\OP值治疗前后无显著差异,一方面可能与试验周期较短,尚不能产生骨质量影像学的改变有关;另一方面骨质疏松代谢表现可以是高转换型,也可以是低转换型,本次研究未能细化分组,因此不能准确反映试验结果。这也有待进一步深入研究。
[Abstract]:[Objective] by patients with acupuncture on the treatment of osteoporosis, observe the changes of bone mineral density and bone metabolism index, pain, quality of life and the improvement of TCM, to explore whether acupuncture can produce that effect on the treatment of osteoporosis, for the therapy for scientific basis. Methods: a randomized controlled study method that scheme by the ethics committee approval. Who met the inclusion criteria of the subjects, and signed informed consent 60. According to the random number into the group, set up the test and blank treatment control, the experimental group was treated with Caltrate D600mg/, according to supplement the kidney acupoint acupuncture treatment, control group was given oral Caltrate D600mg/ day. 3 months test cycle. The observation indexes include: Determination of X-ray absorptiometry and serum markers of bone metabolism in PINPCTXOP dual energy (before and after test); visual pain scores, life quality scores and Medical syndromes score (before and in the test at the end of each 1,2,3). The results this study enrolled 60 cases of postmenopausal women with osteoporosis subjects completed the trial in 48 cases. The acupuncture group of 23 cases, 25 cases in the control group did not meet the inclusion criteria were excluded in 5 cases, did not complete the treatment lost in 7 cases. The two groups before treatment were observed at baseline showed no significant difference, comparable. Through the test of normality, respectively, using t test and non parametric test to draw the conclusion: 1 after treatment, bone mineral density, bone mineral density, statistical analysis of hip bone mineral density, bone mineral density of lumbar vertebra acupuncture group after treatment was 0.88590 + 10920, the control group after treatment was 0.8754 + 0.22384; femoral neck BMD acupuncture group after treatment was 0.7413 + 0.09068, the control group after treatment was 0.7612 + 0.09043; total hip bone density in acupuncture group after treatment was 0.7921 + 0.07705, the control group after treatment was 0.8096 + 0.09850 . the results showed that the two groups after the treatment of acupuncture group and control group were no significant differences in bone mineral density (P0.05) of.2, bone metabolism index, PINP acupuncture group after treatment was 52.2146 + 19.45078, 52.7904 + 23.15097 in the control group after treatment; CTX acupuncture group after treatment was 458.5417 + 201.57402, the control group after treatment was 457.2083. 211.93415; 0C acupuncture group after treatment was 20.4992 + 5.17352, the control group after treatment was 20.9108 + 7.71508. by the normality test, t test of PINP, CTX, 0P statistical data analysis, the results showed that the two groups after the treatment of acupuncture group and control group the above indexes still had no statistical difference (P0.05.3) in January, after the treatment of acupuncture group pain score was 5.1667 + 0.70196, the control group score was 5.7917 + 0.72106; February after treatment acupuncture group pain score was 4.7083 + 0.55003, the control group score was 5.7083 + 0.85867; acupuncture group pain score after treatment in March 4.2917 + 0.55003, the control group score was 5.6250 + 0.85867; after repeated measurement analysis of variance test, the two groups were compared after treatment VAS score than the previous month were improved (F=26.788, P=0.0000.05), acupuncture group and control group after treatment time each month, the comparison of VAS scores between the two groups there were significant differences (F=18.252, P=0.0000.05). The acupuncture group than the control group.4 acupuncture group after treatment in January physical health measurement score was 44.7500 + 5.73509, the control group score was 44.3750 + 5.24042; acupuncture group after treatment in February physical health measurement score was 48.1667 + 7.53927, the control group score was 44.3750 + 5.31183 in March; after the acupuncture group total body health measurement score was 58.4583 + 10.99399, the control group score was 47.5000 + 5.80105; after repeated measurement analysis of variance test, results showed that acupuncture group and control group after treatment in each PCS The moon is that there were significant differences of PCS score after treatment were better than the previous month (F=52.159, P=0.0000.05). The acupuncture group and control group after treatment time each month, the comparison of PCS scores between the two groups was statistically significant (F=4.072, P=0.0490.05). The acupuncture group than in the control group.5, after the acupuncture treatment in January the mental health total measurement score was 63.7083 + 7.07709, the control group score was 60.5417 + 7.07709; acupuncture group mental health treatment in February after the total measurement score was 66.7083 + 6.36894, the control group score was 60.4583 + 7.26504; March after treatment acupuncture group mental health measuring total score was 70.4583 + 5.91960, the control group score was 60.7083 + 6.60355; after repeated measurement analysis of variance test, results showed that acupuncture group and control group after treatment MCS each month compared were different, the MCS score after treatment were better than the previous month (F= 54.506, P=0.0000.05), needle Moxibustion group and control group after treatment time each month, the comparison between the two groups of MCS score had significant difference (F=8.993, P=0.0040.05). The acupuncture group than in the control group.6 acupuncture, TCM syndrome treatment group in January after the score was 5.3333 + 0.96309, the control group score was 5.1667 + 0.96309; Acupuncture and TCM syndrome group in February after the score was 4.7917 + 0.72106, the control group score was 5.5417 + 0.88363; acupuncture and TCM syndrome treatment group in March after the score was 4.2500 + 0.94409, the control group score was 5.4167 + 0.97431; after repeated measurement analysis of variance test, results showed that acupuncture group and control group were compared in different traditional Chinese medicine syndrome score every month treatment later, after the treatment of TCM syndrome score were better than the previous month (F=25.379, P=0.0000.05). The acupuncture group and control group after treatment time each month, the comparison between the two groups of TCM syndrome score The difference (F=3.250, p=0.0480.05). The acupuncture group than the control group. Conclusion acupuncture treatment can improve the symptoms of pain, and improve the quality of life of patients, can be used as the basis for treatment of osteoporosis patients. The mechanism needs further research. This study reflects the BMDPINPCTXOP value was no significant difference before and after treatment. On the one hand and the test cycle is short, still can not produce the quality of bone imaging changes; on the other hand, osteoporosis metabolism can be high conversion type, can also be a low conversion type. This study can not refine the packet, which can not precisely reflect the test results. It also needs further study.

【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.1

【参考文献】