补肾强督方对强直性脊柱炎患者骨质疏松及骨量减少的影响

Effect of Bushen Qiangdu Recipe on Osteoporosis and Bone Loss of Patients with Ankylosing Spondylitis

目的观察补肾强督方对强直性脊柱炎患者骨质疏松和骨量减少的治疗作用。方法采用随机分组法将强直性脊柱炎患者分为2组,治疗组(288例)采用补肾强督方(由金狗脊、鹿角、熟地黄、淫羊藿、骨碎补、川续断、杜仲、穿山甲等组成)治疗,每日l剂,分2次早晚服。对照组(72例)采用补肾强督方加柳氮磺胺吡啶治疗。两组疗程均为6个月。观察两组治疗前后临床症状、枕墙距、指地距、颌柄距、胸廓活动度、Schober试验、脊柱活动度等体征,疾病活动性指标(ESR、CRP)的变化,并进行了腰椎、股骨、前臂、足跟等部位的骨密度检测,以及骨钙素(BGP)、降钙素、甲状旁腺激素(PTH)等骨代谢指标的检测。结果治疗组运用补肾强督方治疗后,BASFI、BASDAI、患者对疾病的总体评价、脊柱痛、枕墙距、指地距、颌柄距、胸廓活动度、Schober试验、脊柱活动度等均有不同程度改善,与治疗前比较,差异有统计学意义(P<0.05);患者的ESR、CRP有不同程度下降,与治疗前比较,差异有统计学意义(P<0.01);患者的骨代谢指标BGP较治疗前增高,PTH较治疗前下降,差异有统计学意义(P<0.05);患者的腰椎、股骨颈、Ward's三角区、股骨粗隆的骨密度值均有不同程度升高,足跟骨强度指数、BUA和SOS值亦较治疗前增加,差异有统计学意义(P<0.05)。长期服用补肾强督方,未见明显的不良反应。结论补肾强督方治疗AS疗效显著,能够调节患者的骨代谢水平,减轻免疫炎症反应,改善AS患者的脊柱、关节活动功能,增加骨生成,减少骨吸收,从而提高AS患者的骨密度,对AS患者的骨质疏松症有显著的治疗作用。

Objective To observe the therapeutic effect of Bushen Qiangdu Recipe（BSQDR） on osteoporosis and bone loss in patients with ankylosing spondylitis（AS）.Methods Patients with AS were randomally assigned to two groups.The 288 patients in the treatment group received BSQDR（consisting of cibotii rhizoma,antler,prepared rehmannia root,epimedium herb,rhizoma drynariae,teasel root,eucommia bark,pangolin scales,etc.,one dose daily,taken in two portions,once in the morning and once in the evening）.The 72 patients in the control group received SIDSM and sulfasalazine.The therapeutic course for both was six months.Clinical symptoms,pillow distance from the wall,hand distance from the ground,jaw distance from the handle,chest mobility,Schober test,spinal mobility and other signs of disease activity indices（ESR and CRP） were observed in patients before and after treatment.The bone mineral density（BMD） testing was performed in the lumbar spine,the femur,the forearm,and the heels,etc.Osteocalcin（BGP）,calcitonin,parathyroid hormone（PTH）,etc.bone metabolic indices were detected.Results BASFI,BASDAI,the overall assessment,the spinal pain,pillow distance from the wall,hand distance from the ground,jaw distance from the handle,chest mobility,Schober test,spinal mobility,and so on were all improved to some extent when compared with before treatment in the treatment group（P0.05）.The ESR and CRP decreased to various degrees,showing statistical significance when compared with before treatment（P0.01）.BGP increased and PTH decreased,showing statistical difference when compared with before treatment（P0.05）.The BMD in patients＇ lumbar spine,femoral neck,Ward＇s triangle,femoral trochanter increased to various degrees.The calcaneal intensity index,blood uric acid（BUA） and SOS values also increased more than before treatment,showing statistical significance（P0.05）.Long-term oral administration of BSQDR was safe,with no obvious adverse reaction.Conclusions BSQDR showed significant effect in treatment of AS.It could regulate the bone metabolic level in patients,attenuate the immune inflammatory response,improve the spine and joint activities functions,increase bone formation,reduce bone resorption,thereby,enhancing the BMD,showing significant therapeutic effect on osteoporosis in AS patients.