长期使用糖皮质激素绝经后骨质疏松症中医证型分布及动物实验研究
发布时间：2019-03-30 11:46
【摘要】：第一部分长期服用糖皮质激素绝经后骨质疏松症的中医证型分布特点目的：统计长期使用糖皮质激素绝经后骨质疏松症患者的中医证型分布特点方法：收集我院2013年1月1日至2015年12月31日之间住院的患者,设置诊断条件为“肾病综合征”、“肾小球肾炎”、“肾小球硬化症”、“系统性红斑狼疮”、“类风湿性关节炎”、“支气管哮喘”、“慢性阻塞性肺病”、“干燥综合征”及“多发性肌炎”,查看患者病史,糖皮质激素治疗超过12周,根据纳入标准及排除标准纳入合适病例,随访获得患者症状,参照中医证型相关标准对纳入的病例进行中医辨证分型。结果：总共纳入例数共83例,其中肾阳虚证在所有证型中所占比例最大为39.76%(33例),其后依次为肝肾阴虚证25.30%(21例),脾肾阳虚证18.07%(15例),气滞血瘀型9.63%(8例),阴阳两虚证7.23%(6例)结论：妇女长期使用GC绝经后骨质疏松症,肾虚为基础,其中肾阳虚更为常见,肝肾阴虚次之,继而是脾肾阳虚、气滞血瘀甚至阴阳两虚的证型。第二部分去卵巢联合糖皮质激素干预的骨质疏松动物模型的特点目的：研究去卵巢联合糖皮质激素(GC)干预的小鼠骨质疏松模型与激素性骨质疏松、去卵巢骨质疏松模型的差异,并探讨其可能的病理机制。方法：3月龄SD雌性大鼠52只,随机分为空白组、地米组、去卵巢组、复合组,每组14只。地米组给予皮下注射盐酸地塞米松注射液,0.3 mg/kg/d,连续12周；去卵巢组于实验开始时手术摘除双侧卵巢；复合组于摘除双侧卵巢一周后开始皮下注射地塞米松注射液,0.3 mg/kg/d,连续12周；各组分别于干预第4、8、12周时进行取材,分别检测腰椎骨密度、骨微细结构、生物力学、血清雌激素、PINP、βCTX水平及Runx2, OPG, Sclerostin, cathepsink基因的表达水平。结果：复合组与地米组骨密度(BMD)及骨矿物含量(BMC)明显低于去卵巢组；Micro-CT检测发现,复合组骨小梁数量明显低于其它组,复合组骨小梁分离度明显高于其它组；腰椎生物力学发现在第12周时,复合组腰椎骨强度及能量吸收值明显低于去卵巢组。复合组雌激素水平在第12周时明显低于其它组；复合组血清中PINP、β-CTX水平在第12周时明显高于去卵巢组。地米组、去卵巢组、复合组三组之间Runx2, OPG表达较空白组均下调,Cathepsin k表达上调,且复合组表达量最高；复合组sclerostin表达明显高于去卵巢组与地米组。结论：去卵巢与GC联合干预比单纯去卵巢或糖皮质激素干预对骨骼的破坏更明显。
[Abstract]:Part one: distribution characteristics of TCM Syndrome types in Postmenopausal Osteoporosis after long-term use of glucocorticoid objective: to investigate the distribution characteristics of TCM syndrome types in postmenopausal osteoporosis patients with long-term use of glucocorticoids: methods: to collect the methods of TCM syndrome distribution in our hospital. Patients hospitalized between 1 January 2013 and 31 December 2015, The diagnostic conditions were "nephrotic syndrome", "glomerulonephritis", "glomerulosclerosis", "systemic lupus erythematosus", "rheumatoid arthritis", "bronchial asthma", "chronic obstructive pulmonary disease". "Sjogren's syndrome" and "polymyositis", check the patient history, glucocorticoid treatment for more than 12 weeks, according to the inclusion criteria and exclusion criteria into the appropriate cases, follow-up to obtain the symptoms of the patients, Referring to the relevant standards of TCM syndrome types, the included cases were classified according to TCM syndrome differentiation. Results: a total of 83 cases were included, among which the proportion of kidney-yang deficiency syndrome in all syndrome types was 39.76% (33 cases), followed by liver-kidney yin deficiency syndrome (25.30%), spleen-kidney yang deficiency syndrome (18.07%), and spleen-kidney yang deficiency syndrome (18.07%), followed by liver-kidney yin deficiency syndrome (25.30%) and spleen-kidney yang deficiency syndrome (18.07%). 9.63% (8 cases) of qi stagnation and blood stasis type, 7.23% (6 cases) of yin-yang deficiency syndrome. Conclusion: long-term use of GC postmenopausal osteoporosis is based on kidney deficiency, in which kidney yang deficiency is more common, liver-kidney yin deficiency is the second, and spleen-kidney yang deficiency is followed by spleen-kidney yang deficiency. Qi stagnation blood stasis and even yin-yang deficiency syndrome. Objective: to study the osteoporosis model and hormone-induced osteoporosis in ovariectomized and glucocorticoid-induced osteoporosis (GC)-induced ovariectomized and glucocorticoid-induced osteoporosis in mice. The difference of ovariectomized osteoporosis model and its possible pathological mechanism. Methods: 52 3-month-old female SD rats were randomly divided into blank group, rice group, ovariectomized group and compound group with 14 rats in each group. Dexamethasone Hydrochloride injection was injected subcutaneously into the rice group for 12 weeks, and bilateral ovaries were removed at the beginning of the experiment in the ovariectomized group. The compound group received subcutaneous injection of dexamethasone one week after bilateral ovariectomy, 0.3 mg/kg/d, for 12 weeks. Bone mineral density (BMD), bone microstructure, biomechanics, serum estrogens, PINP, 尾 CTX levels and the expression of Runx2, OPG, Sclerostin, cathepsink gene were measured in each group at 4,8 and 12 weeks after intervention respectively. Results: the bone mineral density (BMD) and bone mineral content (BMC) of the composite group and the ground rice group were significantly lower than those of the ovariectomized group, and the number of trabecular bone in the composite group was significantly lower than that of the other groups, and the trabecular separation degree of the composite group was significantly higher than that of the other groups. Lumbar biomechanical findings showed that the lumbar bone strength and energy absorption in the composite group were significantly lower than those in the ovariectomized group at the 12th week. The serum level of PINP, 尾-CTX in the composite group was significantly higher than that in the ovariectomized group at the 12th week, and the estrogen level in the composite group was significantly lower than that in the other groups at the 12th week. Compared with the blank group, the expression of Runx2, OPG in the rice group, ovariectomized group and compound group were up-regulated, and the expression of sclerostin in the composite group was the highest, and the expression of sclerostin in the composite group was significantly higher than that in the ovariectomized group and the rice group. Conclusion: the combined intervention of ovariectomy and GC is more obvious than that of ovariectomy or glucocorticoid alone.
【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
本文编号：2450050
[Abstract]:Part one: distribution characteristics of TCM Syndrome types in Postmenopausal Osteoporosis after long-term use of glucocorticoid objective: to investigate the distribution characteristics of TCM syndrome types in postmenopausal osteoporosis patients with long-term use of glucocorticoids: methods: to collect the methods of TCM syndrome distribution in our hospital. Patients hospitalized between 1 January 2013 and 31 December 2015, The diagnostic conditions were "nephrotic syndrome", "glomerulonephritis", "glomerulosclerosis", "systemic lupus erythematosus", "rheumatoid arthritis", "bronchial asthma", "chronic obstructive pulmonary disease". "Sjogren's syndrome" and "polymyositis", check the patient history, glucocorticoid treatment for more than 12 weeks, according to the inclusion criteria and exclusion criteria into the appropriate cases, follow-up to obtain the symptoms of the patients, Referring to the relevant standards of TCM syndrome types, the included cases were classified according to TCM syndrome differentiation. Results: a total of 83 cases were included, among which the proportion of kidney-yang deficiency syndrome in all syndrome types was 39.76% (33 cases), followed by liver-kidney yin deficiency syndrome (25.30%), spleen-kidney yang deficiency syndrome (18.07%), and spleen-kidney yang deficiency syndrome (18.07%), followed by liver-kidney yin deficiency syndrome (25.30%) and spleen-kidney yang deficiency syndrome (18.07%). 9.63% (8 cases) of qi stagnation and blood stasis type, 7.23% (6 cases) of yin-yang deficiency syndrome. Conclusion: long-term use of GC postmenopausal osteoporosis is based on kidney deficiency, in which kidney yang deficiency is more common, liver-kidney yin deficiency is the second, and spleen-kidney yang deficiency is followed by spleen-kidney yang deficiency. Qi stagnation blood stasis and even yin-yang deficiency syndrome. Objective: to study the osteoporosis model and hormone-induced osteoporosis in ovariectomized and glucocorticoid-induced osteoporosis (GC)-induced ovariectomized and glucocorticoid-induced osteoporosis in mice. The difference of ovariectomized osteoporosis model and its possible pathological mechanism. Methods: 52 3-month-old female SD rats were randomly divided into blank group, rice group, ovariectomized group and compound group with 14 rats in each group. Dexamethasone Hydrochloride injection was injected subcutaneously into the rice group for 12 weeks, and bilateral ovaries were removed at the beginning of the experiment in the ovariectomized group. The compound group received subcutaneous injection of dexamethasone one week after bilateral ovariectomy, 0.3 mg/kg/d, for 12 weeks. Bone mineral density (BMD), bone microstructure, biomechanics, serum estrogens, PINP, 尾 CTX levels and the expression of Runx2, OPG, Sclerostin, cathepsink gene were measured in each group at 4,8 and 12 weeks after intervention respectively. Results: the bone mineral density (BMD) and bone mineral content (BMC) of the composite group and the ground rice group were significantly lower than those of the ovariectomized group, and the number of trabecular bone in the composite group was significantly lower than that of the other groups, and the trabecular separation degree of the composite group was significantly higher than that of the other groups. Lumbar biomechanical findings showed that the lumbar bone strength and energy absorption in the composite group were significantly lower than those in the ovariectomized group at the 12th week. The serum level of PINP, 尾-CTX in the composite group was significantly higher than that in the ovariectomized group at the 12th week, and the estrogen level in the composite group was significantly lower than that in the other groups at the 12th week. Compared with the blank group, the expression of Runx2, OPG in the rice group, ovariectomized group and compound group were up-regulated, and the expression of sclerostin in the composite group was the highest, and the expression of sclerostin in the composite group was significantly higher than that in the ovariectomized group and the rice group. Conclusion: the combined intervention of ovariectomy and GC is more obvious than that of ovariectomy or glucocorticoid alone.
【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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相关期刊论文 前2条
1 刘雷;塔拉;杨红云;陈平;崔秀梅;;骨质疏松症中医体质与辨证分型的相关性研究——附300例临床分析[J];中国骨质疏松杂志;2013年10期
2 徐祖健;汪付;尹思源;杨洪彬;马川;袁伟;陈巍;;绝经后妇女原发性骨质疏松症辨证分型与症候特征的探讨[J];中医正骨;2008年11期
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