中药增骨汤序贯疗法治疗绝经后骨质疏松症—附120例临床观察

A SEQUENTIAL THERAPY WITH TCD “ZENGGU” Ⅰ, Ⅱ, AND Ⅲ FOR POSTMENOPAUSAL OSTEOPOROSIS

应用中药增骨汤Ⅰ～Ⅲ号序贯疗法治疗骨质疏松症５１８例。经严格筛选，按所制定的诊断标准，选择在同一时间内（１９９２年４月～１９９３年４月）治疗的１２０例患者，按单盲随机分组法原则分为序贯组及验方组，每组６０例，经ｔ检验有可比性（Ｐ＞０．０５）。经过３～６个月治疗和６个月～５年，平均３．８年随访。在改善症状与体征、反映骨形成指标及成骨细胞活性的血ＡＬＰ、反映骨吸收指标及破骨细胞活性的尿Ｃａ／Ｃｒ比值与ＨＹＰ／Ｃｒ比值、以及骨密度等方面，组间治疗前后比较均有显著性差异（Ｐ＜０．０５）。两组比较序贯组比验方组疗效更好（Ｐ＜０．０５），提示序贯疗法及验方治疗绝经后骨质疏松症均有效，但序贯疗法更具优势。分析其原因，序贯疗法是根据骨重建理论设立的，在激发骨重建启动后，及时地抑制骨吸收，进而促进骨形成，对骨重建各阶段使用有针对性的药物，使骨重建始终处于正性骨平衡状态，增加了骨量，并防止出现高骨转换及低骨转换而引起的骨量丢失，因而临床取得了较好效果。

Five hundred and eighteen cases of osteoporosis were treated by TCD sequential therapy with “ZENGGU” Ⅰ, Ⅱ and Ⅲ (TCD preparations for Increasing Bone Mineral Density). Through strict screening according to the diagnostic criteria, 120 cases admitted in April 1992-April 1993 were selected and single blindly and randomly divided into two groups (60 cases for each): sequential (S) and proved recipe (PR) groups, which had a comparability (P < 0.05) shown through t tests. The patients of the two groups were treated for 3-6 months and followed up for 6-60 months (Mean: 45.6 months). The results showed that S group had an advantage over PR group in the improvement of symptoms and signs, blood ALP reflecting bone formation and osteoblast activity, urine Ca/Cr and Hyp/Cr reflecting bone resorption and osteoclast activity, and bone mineral density, and it had better therapeutic effects than PR group (P < 0.05) though both S and PR therapies could produce therapeutic effects on postmenopausal osteoporosis (P < 0.05). Based on the bone remodeling theory, S therapy could in time inhibit bone resorption after bone remodeling starting, and thus stimulate bone formation. In addition, the corresponding effective TCD were used for bone remodeling at various stages so that bone remodeling could from beginning to end lie in a positive bone balance, bone mineral density could be increased, the bone loss from high and low bone turnover avoided, and therefore better clinical results obtained in S group.