伴神经症状的骨质疏松症的中医证型研究

发布时间：2018-06-01 09:57

  本文选题：骨质疏松症 + 腰椎退行性变　； 参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:本研究试图通过采用聚类分析等统计学方法来观察骨质疏松症(Osteoporosis,OP)合并下肢神经症状患者的中医证型分布规律,以期为该疾病的更精确的辨证施治及提高临床疗效提供理论依据。本研究还对骨质疏松症患者之腰椎退行性改变特点进行观察,以进一步探讨骨质疏松症与腰腿痛的关系。方法:收集在广州中医药大学第三附属医院就诊并确诊为骨质疏松症的患者120例,根据患者是否伴有下肢神经症状,分为A组(同时符合骨质疏松症与下肢神经症状的诊断标准)和B组(符合骨质疏松症诊断标准),对两组患者的一般资料、腰椎骨密度(L1、L2、L3和L4)、股骨颈骨密度、腰椎间隙高度、腰椎椎体高度、腰椎骨赘程度等资料进行收集,采用相关中医证候学调查表,对两组患者就诊时的四诊资料进行搜集,最后运用SPSS 19.0版统计软件中的相关统计学方法对所有数据进行分析。结果:1、OP患者多见于女性,但两组间的性别构成比经统计学检验无显著的统计学意义(P0.05)。2、两组之间的年龄比较:A组患者平均年龄为70.86±4.90岁,B组患者平均年龄为60.16±5.58岁,两组之间的年龄差异经统计学检验有显著统计学差异(P0.01)。3、两组之间的身高比较:A组患者平均身高157.31 ±5.53cm,B组患者平均身高158.70±5.69cm,两组之间的身高差异经统计学检验未见显著统计学差异(P0.05)。4、两组之间的体重比较:A组患者平均体重50.20±5.48kg,B组患者平均体重51.97±4.57kg,两组之间的体重差异经统计学检验未见显著统计学差异(P0.05)。5、中医证候聚类分析及证型分布:两组患者的四诊资料经聚类分析后,可将A组60例患者的中医证候聚为四类,其具体分布情况如下:肾阳亏虚型共有15例,所占比例为25%;寒湿阻络型共有13例,所占比例为21.7%;湿热阻络型共有12例,所占比例为20%;气滞血瘀型共有20例,所占比例为33.3%。B组患者的四诊资料经聚类分析后,将60例患者的中医证候聚为三类,其具体分布情况如下:脾肾阳虚型共有28例,所占比例为46.7%;肝肾阴虚型共有20例,所占比例为33.3%;气滞血瘀型为12例,所占比例为20%。6、腰椎及股骨颈骨密度的测量:在A组中:腰1骨密度平均值为0.75±0.07 g/cm2,腰2骨密度平均值为0.82±0.10g/cm2,腰3骨密度平均值为0.85 ± 0.08g/cm2,腰4骨密度平均值为0.91±0.08g/cm2;而在B组中:腰1骨密度平均值为0.61±0.09 g/cm2,腰2骨密度平均值为0.64±0.11g/cm2,腰3骨密度平均值为0.60±0.10g/cm2,腰4骨密度平均值为0.70±0.09g/cm2。二组间相对应的腰椎节段的骨密度值差异经统计学检验后均具有显著统计学差异(P0.01),即A组患者各节段的腰椎骨密度均值要高于B组;A组股骨颈的骨密度平均值为:0.50±0.06 g/cm2,B组股骨颈的骨密度平均值为:0.58±0.07 g/cm2,两组之间的差异经统计学检验后均具有显著统计学差异(P0.01),即A组患者股骨颈骨密度均值要低于B组。7、两组腰椎间隙高度(SLIH)、椎体高度(LVH)、腰椎骨赘程度(SL0D)的比较。对两组患者各相应节段SLIH进行两两比较,采用独立样本t检验,发现A组各节段的SLIH均小于B组,差异均存在统计学意义(p0.01)。对两组患者各节相应LVH进行两两比较,采用独立样本t检验,其结果提示A组LVH低于B组,差异有统计学意义(P0.01);其高度差异主要表现为Ha/Hp比值,其次为Hm/Hp比值,而两组Hp/Hpi+1比值未见明显差异。对两组患者各节段腰椎骨赘程度进行比较,采用秩和检验,发现A组与B组之间的骨赘程度差异有统计学意义(p0.01),A组的腰椎骨赘程度分级主要集中于ⅣV度,而B组的腰椎骨赘程度分级主要集中于Ⅰ度和Ⅱ度,即A组的腰椎骨赘严重程度要大于B组。结论:1、伴神经症状的骨质疏松症的中医证型可分为气滞血瘀型、肾阳亏虚型、寒湿阻络型和湿热阻络型,气滞血瘀是伴下肢神经症状的骨质疏松症患者中最常见的中医证型,在临床治疗中应多注重活血化瘀、通络止痛等治疗方法;骨质疏松症的中医证型可分为脾肾阳虚型、肝肾阴虚型和气滞血瘀型,脾肾阳虚是骨质疏松症患者中最常见的中医类型,在临床治疗中应注重补益脾肾两阳。2、骨质疏松症患者出现下肢神经症状往往是骨质疏松症病情进展的一种表现形式,提示腰椎及椎管的骨质、形态发生了更严重的病变。3、出现下肢神经症状的骨质疏松症患者其腰椎骨密度未必出现明显的下降,此时应注意观察股骨近端骨密度加以甄别。
[Abstract]:Objective: This study attempts to observe the pattern of TCM Syndrome Distribution in patients with Osteoporosis (OP) with lower extremity nerve symptoms by using statistical methods such as cluster analysis, in order to provide a theoretical basis for the more accurate diagnosis and treatment of the disease and to improve the clinical efficacy of the disease. The characteristics of sexual change were observed to further explore the relationship between osteoporosis and lumbago and leg pain. Methods: 120 cases of osteoporosis in Third Affiliated Hospitals of Guangzhou University of Chinese Medicine were collected. According to whether the patients were accompanied with lower extremity nerve symptoms, the patients were divided into A group (in the same time the diagnosis of osteoporosis and the diagnosis of lower extremity neurosis). Standard) and group B (in accordance with the diagnostic criteria for osteoporosis), the general data of two groups of patients, lumbar bone mineral density (L1, L2, L3 and L4), femoral neck bone density, lumbar intervertebral height, lumbar vertebra height, and lumbar osteophyte degree were collected, and the related TCM Syndrome questionnaire was used to collect the four diagnosis data of the two groups of patients. Finally, all data were analyzed with statistical methods in the SPSS 19 edition. Results: 1, OP patients were mostly seen in women, but the gender composition between the two groups was not statistically significant (P0.05).2, the age of the two groups was compared: the average age of the A group was 70.86 + 4.90 years, and the average age of the group B patients. For 60.16 + 5.58 years, the age difference between the two groups was statistically significant (P0.01).3, the height comparison between the two groups: the average height of the group A was 157.31 + 5.53cm, and the average height of the B group was 158.70 + 5.69cm. The height difference between the two groups was not statistically significant (P0.05).4, between the two groups. Weight comparison: the average weight of the A group was 50.20 + 5.48kg, and the average weight of the group B was 51.97 + 4.57kg. The weight difference between the two groups was not statistically significant (P0.05).5, TCM syndrome clustering analysis and Syndrome Distribution: the four diagnosis data of the two groups of patients were analyzed by polyclass analysis, and the TCM Syndromes of the 60 patients in group A could be gathered to four The specific distribution is as follows: there are 15 cases of kidney yang deficiency syndrome, the proportion of which is 25%, the cold dampness obstructing collaterals in 13 cases, the proportion of 21.7%, the damp heat obstructing collaterals in 12 cases, the proportion of 20%, the qi stagnation and blood stasis type in 20 cases, and the proportion of the four diagnosis data of the group 33.3%.B patients after clustering analysis, the TCM Syndromes of 60 patients are gathered into the TCM syndrome. The three kind, its specific distribution is as follows: there are 28 cases of spleen kidney yang deficiency type, accounting for 46.7%, 20 cases of liver kidney yin deficiency, 33.3% and 12 cases of qi stagnation and blood stasis, the proportion of 20%.6, the measurement of lumbar and femoral neck bone density: in group A, the average density of the waist 1 bone density is 0.75 + 0.07 g/cm2, and the average waist 2 bone density is 0.82 + 0. 10g/cm2, the mean value of lumbar 3 bone density was 0.85 + 0.08g/cm2, and the mean value of lumbar 4 bone density was 0.91 + 0.08g/cm2, while in group B, the mean value of lumbar 1 bone density was 0.61 + 0.09 g/cm2, the average of the waist 2 bone density was 0.64 + 0.11g/cm2, the average of the waist 3 bone density was 0.60 + 0.10g/cm2, and the mean lumbar 4 bone density was the corresponding lumbar intervertebral body between the 0.70 + 0.09g/cm2. two groups. The bone mineral density of the segment had significant difference after statistical test (P0.01), that is, the mean value of lumbar bone density in each segment of group A was higher than that of group B; the average value of bone mineral density of the femoral neck in group A was 0.50 + 0.06 g/cm2, and the average value of bone mineral density in group B was 0.58 + 0.07 g/cm2, and the difference between the two groups was examined by statistical test. There were significant statistical differences (P0.01), that is, the femoral neck bone density in group A was lower than that of group B.7, two groups of lumbar intervertebral height (SLIH), vertebral height (LVH), and lumbar osteophyte degree (SL0D). 22 comparison of the corresponding segment SLIH in the two groups was compared, and the independent sample t test was used to find that SLIH of each segment of the A group was smaller than that of the B group. There were statistical significance (P0.01). 22 comparison of the corresponding LVH in each group of the two groups was compared with the independent sample t test. The results suggested that the LVH in the group A was lower than the B group (P0.01), and the difference was mainly shown as the ratio of Ha/Hp, followed by the ratio of Hm/Hp, while the ratio of Hp/Hpi+1 in the two groups was not significantly different. The degree of lumbar vertebrae osteophyte was compared. The difference of osteophyte between group A and group B was statistically significant (P0.01). The grade of lumbar osteophyte in group A was mainly concentrated on the degree of IV V, and the degree of lumbar osteophyte in group B mainly concentrated on degree I and II degree, that is, the severity of lumbar osteophyte in group A was greater than that of group B. Conclusion: 1, 1, Syndrome types of osteoporosis associated with neurological symptoms can be divided into qi stagnation and blood stasis type, kidney yang deficiency type, cold dampness obstructing collaterals and damp heat obstructing collaterals, qi stagnation and blood stasis is the most common TCM syndrome type of osteoporosis patients with lower extremity neurosis. In clinical treatment, more attention should be paid to the treatment of activating blood and removing stasis, dredging collaterals and relieving pain and so on; The TCM syndrome type can be divided into spleen kidney yang deficiency type, liver kidney yin deficiency type and qi stagnation blood stasis type, spleen kidney yang deficiency is the most common type of Chinese medicine in osteoporosis patients. In clinical treatment, we should pay attention to tonifying the spleen and kidney of two Yang.2. The symptoms of the lower limbs of the patients with osteoporosis are often a form of expression of the progress of osteoporosis. The bone of vertebra and spinal canal has a more serious form of.3, and the bone density of the lumbar vertebrae in the patients with the symptoms of lower extremity may not be significantly reduced. At this time, attention should be paid to the screening of the bone density near the femur.
【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】：R259
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本文编号：1963778