慢性阻塞性肺疾病稳定期患者肾虚证与骨密度的相关性研究

发布时间：2018-01-10 08:19

本文关键词：慢性阻塞性肺疾病稳定期患者肾虚证与骨密度的相关性研究　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：通过综合慢性阻塞性肺疾病及骨质疏松症目前的中西医研究结果,设计临床调查研究实验方案,探讨慢性阻塞性肺疾病稳定期患者肾虚证的严重程度同骨密度之间的相关性,为阐明中医学中“肾主骨”理论的科学性提供依据,并对运用补肾的中药进行防治骨质疏松症具有一定的指导意义。方法：根据病例纳入标准及排除标准,收集2015年9月至2016年3月在广州中医药大学第一附属医院呼吸科及门诊就诊的慢性阻塞性肺疾病稳定期且中医辨证为肾虚证的患者共118名,其中男性患者93名,女性患者25名。记录患者的一般资料,抽取静脉血检查血清钙、磷、碱性磷酸酶水平,测定肺功能指标,利用双能X线骨密度仪,测定患者第2、3、4腰椎正位的BMD和T值,统计慢性阻塞性肺疾病患者骨量减少、骨质疏松的检出率,并根据严石林等发表的《肾虚证辨证因子等级评判操作标准》对每例患者进行肾虚证症状积分,探讨年龄、体重指数、气流受限程度对骨密度的影响,并利用Pearson相关分析探讨患者肾虚证积分与骨密度的相关性。结果：本次研究结果显示慢阻肺患者合并骨质疏松症的总体检出率为25.4%,男性检出率为26.9%,女性检出率为20.0%。慢阻肺合并骨质疏松症患者的平均年龄慢阻肺合并骨量减少患者慢阻肺且骨量正常患者,而且患者年龄与骨密度呈明显负相关(r=-0.458,P=0.000,0.01)。不同骨量变化程度患者体重指数的差异无统计学意义(P=0.644,0.05),并且体重指数与骨密度未见相关性(r=-0.047,P=0.613,0.05)。骨密度与气流受限程度(FEVl%pred)显著相关(r=0.376,P=0.000,0.01),随着气流受限程度的加重,骨密度也呈现出逐渐下降的趋势。骨代谢指标方面,不同骨量变化程度组患者的血清钙、磷水平的差异无统计学意义(P＞0.05),骨量正常的患者钙磷乘积与骨质疏松患者相比具有统计学意义(P＜0.05)。骨量正常组的碱性磷酸酶骨量减少组骨质疏松组(P＜0.05),且碱性磷酸酶与骨密度呈负相关(r=-0.459,P=0.000,0.01)。骨量正常组与骨量减少组、骨量减少组与骨质疏松组的肾虚证积分的差异无统计学意义(P＞0.05),但骨量正常组的肾虚证积分骨质疏松组(P0.05)。骨密度T值与肾虚证积分显著相关(r=-0.254,P=0.005,0.01)。肾虚证积分与年龄、体重指数、气流受限程度及碱性磷酸酶均未见相关性(均P＞0.05)。结论：本次研究结果显示慢阻肺患者合并骨质疏松症的检出率高于普通人群。而且随着气流受限程度的加重,患者的骨密度也随之下降。患者肾虚证与骨密度呈现显著相关性,骨质疏松越严重,肾虚证积分也越高。这为证明中医学“肾主骨”理论的科学性提供了依据,并且也提示了我们在临床治疗方面,要重视患者肾虚证的严重程度,进行早期筛查,进行早期干预,绐予“补肾”治疗,对于避免因骨质疏松症引起骨折导致患者病情加重,影响生存质量具有一定意义。
[Abstract]:Objective: to design a clinical investigation scheme by synthesizing the current research results of chronic obstructive pulmonary disease (COPD) and osteoporosis. To explore the correlation between the severity of kidney deficiency syndrome and bone mineral density in patients with chronic obstructive pulmonary disease at stable stage, and to provide scientific basis for elucidating the theory of "kidney dominating bone" in traditional Chinese medicine. It has certain guiding significance for the prevention and treatment of osteoporosis by using traditional Chinese medicine to tonify the kidney. Methods: according to the standard of inclusion and exclusion of the cases. From September 2015 to March 2016, 118 patients with chronic obstructive pulmonary disease (COPD) in respiratory department and outpatient department of the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine who were diagnosed as kidney deficiency syndrome by TCM syndrome differentiation were collected. Among them 93 male patients and 25 female patients. The general data of the patients were recorded, the serum calcium, phosphorus and alkaline phosphatase levels were collected from venous blood samples, lung function indexes were measured, and dual energy X-ray absorptiometry was used. The BMD and T values of the lumbar vertebrae were measured in the 3rd and 4th lumbar vertebrae of the patients. The bone mass of the patients with chronic obstructive pulmonary disease (COPD) was decreased and the detection rate of osteoporosis was detected. And according to Yan Shilin published "Kidney deficiency Syndrome differentiation Factor Grade Evaluation Standard" for each patient kidney deficiency syndrome symptom score, to explore the age, body mass index, airflow limitation degree of the impact on bone mineral density. Pearson correlation analysis was used to explore the correlation between kidney deficiency syndrome score and bone mineral density. Results: this study showed that the overall detection rate of osteoporosis in patients with chronic obstructive pulmonary disease was 25.4%. The detection rate of male was 26.9 and that of female was 20.0. The average age of patients with chronic obstructive pulmonary disease combined with osteoporosis was decreased in patients with chronic obstructive lung and normal bone mass. There was a negative correlation between age and bone mineral density (BMD). There was no significant difference in body mass index (BMI) between the patients with different bone mass change degrees, and there was no correlation between BMI and bone mineral density (BMD). The bone mineral density (BMD) was significantly correlated with the degree of airflow limitation (FEVlpred). With the severity of airflow limitation, bone mineral density (BMD) also showed a decreasing trend. In terms of bone metabolism index, serum calcium of patients with different bone mass changes. There was no significant difference in phosphorus level (P > 0.05). The calcium and phosphorus product of the patients with normal bone mass was significantly higher than that of the patients with osteoporosis (P < 0.05), and that of the patients with normal bone mass of alkaline phosphatase (ALP) was significantly lower than that of the patients with osteoporosis (P < 0.05). There was a negative correlation between alkaline phosphatase and bone mineral density (BMD). There was no significant difference in the score of kidney deficiency between the osteopenia group and the osteoporosis group (P > 0.05). But the integral of kidney deficiency syndrome and osteoporosis group in normal bone mass group was P0.050.The T value of bone mineral density was significantly correlated with the integral of kidney deficiency syndrome. The score of kidney deficiency syndrome and age, body mass index. There was no correlation between the degree of airflow limitation and alkaline phosphatase (all P > 0.05). Conclusion: the results of this study showed that the prevalence of osteoporosis in patients with COPD was higher than that in the general population. The more serious osteoporosis, the higher the score of kidney deficiency syndrome. This provides a scientific basis to prove the theory of "kidney dominating bone" in traditional Chinese medicine. And it also indicates that we should pay attention to the severity of kidney deficiency syndrome in clinical treatment, early screening, early intervention, and give "kidney tonifying" treatment. It is significant to avoid the exacerbation of the patient's condition and to affect the quality of life because of the fracture caused by 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】：2016
【分类号】：R259

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