运动疗法改善肺结核合并骨质疏松症患者骨密度及腰背痛的作用

Therapeutic effect of exercise therapy on bone mineral density and low back pain in pulmonary tuberculosis patients with osteoporosis

目的:观察运动疗法对肺结核合并骨质疏松症患者的骨密度及腰背痛改善情况。方法:选择2002-01/2004-12于洪区结核病防治所收治的浸润性肺结核合并骨质疏松症患者72例。随机分为运动组和对照组,每组36例。患者主要表现腰背痛及胸椎和腰椎正侧位X射线显示的骨质稀疏,椎体变形。两组患者进行相同的抗痨及补钙等药物治疗,运动组同时采取步行有氧耐力运动干预,速度80～100步/min,行走距离1.0～5.0km,时间15～20min/次,2～4周运动时间可逐渐增加,最长60min。运动频度3次/周。自觉运动强度在12～13运动当量范围,锻炼时间6个月。疗效评估:①于治疗前后测定患者腰椎椎体前后位骨密度,采用双能X射线骨密度仪测定(骨密度<正常值25%以上,为诊断骨质疏松金标准。骨质疏松的X射线特征根据骨小梁形态分度法由轻到重分为4度。初期:整个骨密度减低,骨小梁细。Ⅰ度:横行骨小梁减少,纵行骨小梁明显。Ⅱ度:横行骨小梁进一步减少,纵行骨小梁变粗。Ⅲ度:横行骨小梁几乎消失,纵行骨小梁也不明显)。②腰背痛评分标准:疼痛持续而明显1.5分;疼痛时轻时重1.0分;劳累后疼痛或轻微疼痛0.5分;无疼痛0分。两组患者均于治疗前后进行测评。③根据腰背痛和脊柱X射线骨质稀疏分度法及骨密度,运动组患者于运动后进行疗效测评。疗效评估标准:症状消失(腰背痛完全消失,脊柱X射线片显示正常至Ⅰ度改变,或骨密度无异常),好转(腰背痛症状基本消失,但脊柱X射线片显示Ⅱ度以上无改变,或骨密度由中重度变为正常或轻度)无效(腰背痛无改变,脊柱X射线片或骨密度测定无变化)。用t检验行组间显著性测试。结果:纳入72例,无1例脱落,均进入结果分析。①运动组治疗后腰椎骨密度显著高于对照组(0.87±0.16,0.68±0.15g/cm2,t=5.198,P<0.05);腰背痛症状较对照组明显改善(0.565±0.15,0.395±0.11,t=5.484,P<0.05)。运动组患者运动后腰椎骨密度较运动前明显增加,腰背痛症状显著改善。②运动组患者运动6个月后症状消失占11%(4/36)、好转占36%(13/36)、无效占53%(19/36),总有效率47%(17/36)。结论:有氧运动疗法不仅有缓解骨丢失及增加骨密度作用,还可缓解患者腰背痛症状,能有效改善肺结核合并骨质疏松症患者临床症状。

AIM:To explore the effect of exercise therapy on the improvements of bone mineral density and low back pain in pulmonary tuberculosis patients with osteoporosis.METHODS:Seventy two patients with infiltrative pulmonary tuberculosis patients with osteoporosis,who were treated in Yuhong District Tuberculosis Dispensary from January 2002 and December 2004,were randomly divided into exercise group(n=36) and control group(n=36).The main manifestations of the patients were low lack pain,and osteoporosis in thoracic spine and lumbar spine and vertebral deformation shown by X ray from frontal and lateral positions.All the patients received drug therapy of anti tuberculosis and calcium supplement,besides those in the exercise group received walking intervention of aerobic endurance exercise,the velocity was 80 to 100 pace per minute,the walking distance was 1.0 to 5.0 km,15 to 20 minutes for each time and gradually increased after 2 to 4 weeks to the maximal time of 60 minutes,the frequency was 3 times a week.The aware exercise intensity ranged 12 to 13 exercise equivalent,the training lasted for 6 months.Evaluation of curative effects:① The lumbar bone mineral densities of anteroposterior position were detected before and after treatment with dual energy X ray absorptiometry(the golden diagnostic standard of osteoporosis was bone mineral density < 25% of the normal value and above;The X ray characteristics of osteoporosis was divided into 4 grades according to the form of bone trabecula;Primary period:total bone mineral density was decreased,bone trabecula was thin;gradeⅠ :transverse bone trabecula was reduced,vertical bone trabecula was obvious;grade Ⅱ :transverse bone trabecula was further reduced,vertical bone trabecula became wider;grade Ⅲ :transverse bone trabecula almost disappeared,vertical bone trabecula was also not obvious).② Scoring standards for low back pain:pain was lasting and obvious as 1.5 points;pain was sometimes mild and sometimes severe as 1.0 point;feeling pain or slight pain after tiredness as 0.5 point;no pain as 0 point;All the patients in both groups were assessed before and after treatment respectively.③ According to the degree of low back pain and osteoporosis and bone mineral density,the curative effect in the exercise group was evaluated after exercise;The evaluation standards of curative effects:disappearance of symptoms(low back pain disappeared completely;spinal X ray showed normal to changes of grade Ⅰ ,or no abnormality of bone mineral density),turn better(the symptom of low back pain almost disappeared,but spinal X ray showed no changes of grade Ⅱ and above,or bone mineral density turned from moderate and severe to normal or mild),invalid(no changes in low back pain,spinal X ray and determination of bone mineral density).The t test was used for the analysis of the intergroup significant difference.RESULTS:All the 72 cases were involved in the analysis of results without deletion.① The lumbar bone mineral density in the exercise group after treatment was significantly higher than that in the control group[(0.87 ± 0.16),(0.68± 0.15) g/cm2,t=5.198,P< 0.05];The symptom of low back pain in the exercise group after treatment was obviously ameliorated as compared with that in the control group(0.565± 0.15,0.395± 0.11,t=5.484,P< 0.05);Compared with before treatment,the lumbar bone mineral density after treatment was markedly increased,and the symptom of low back pain was significantly ameliorated in the exercise group.② After 6 month training in the exercise group, the symptom disappeared in 11% (4/36) of the patients,turned better in 36% (13/36),and invalid in 53% (19/36),the total effective rate was 47% (17/36).CONCLUSION:Aerobic exercise therapy can not only relieve bone loss and increase bone mineral density,but also ameliorate the symptom of low back pain in the patients,it can effectively improve the clinical symptoms in pulmonary tuberculosis patients with osteoporosis.