穴位注射鲑鱼降钙素治疗老年性骨质疏松症的临床疗效观察

Clinieal effect of acupoint injection of salmon calcitonin in the treatment of senile osteoporosis

目的观察穴位注射鲑鱼降钙素治疗老年性骨质疏松症的临床疗效。方法选择2016年2月至2017年7月在温州市中医院就诊且符合纳入标准的老年性骨质疏松症患者136例,采用随机数字表法分为两组,每组68例。穴位注射组:鲑鱼降钙素第1天50IU,第2天开始100IU,用0.9%氯化钠注射液稀释至2mL,取双侧肾俞、足三里穴位注射,每穴注射0.5mL,1次/d,连续治疗15d为1个疗程,间隔90d重复1个疗程。肌内注射组:相同剂量的鲑鱼降钙素臀大肌肌内注射,疗程同穴位注射组。两组均给予碳酸钙D3片口服每天1片;阿仑膦酸钠70mg空腹口服,每周1次。观察两组治疗前后Ⅰ型胶原羧基端肽β特殊序列(β-CTx)、Ⅰ型前胶原N-端前肽(PINP)、骨源性碱性磷酸酶(NBAP),股骨颈、股骨粗隆和腰椎(L1-L4)骨密度值(BMD)及骨质疏松症症状评分的变化。结果两组患者治疗后NBAP、BMD均高于治疗前(均P<0.05),β-CTx、PINP及症状评分均低于治疗前(均P<0.05)。治疗后,穴位注射组NBAP为(32.36±3.03)μg/L,高于肌内注射组的(29.66±3.20)μg/L(t=10.477,P<0.05);穴位注射组β-CTx为(0.10±0.05)μg/L,PINP为(28.78±5.23)μg/L,两者均明显低于肌内注射组[β-CTx(0.20±0.05)μg/L、PINP(35.77±6.49)μg/L](t=5.983、2.662,均P<0.05);治疗后,穴位注射组股骨颈、股骨粗隆和腰椎(L1-L4)BMD分别为(0.690±0.032)g/m^2、(0.620±0.010)g/m^2、(0.822±0.012)g/m^2,均高于肌内注射组的(0.652±0.012)g/m^2、(0.572±0.022)g/m^2、(0.801±0.011)g/m^2(t=5.055、6.133、1.956,均P<0.05);治疗后,穴位注射组腰膝酸软、耳鸣耳聋、发脱齿松、两足痿软、舌淡、脉虚无力等中医证候评分均优于肌内注射组(均P<0.05)。结论足三里、肾俞穴注射鲑鱼降钙素治疗老年性骨质疏松症比肌内注射疗效显著,能显著提高血清NBAP值,降低血清β-CTx、PINP水平,改善患者骨密度值,改善患者的临床症状,是治疗老年性骨质疏松症的有效方法。

Objective To observe the clinical effect of acupoint injection of salmon calcitonin in the treatment of senile osteoporosis. Methods From February 2016 to July 2017, 136 elderly patients with osteoporosis admitted to Wenzhou Hospital of Traditional Chinese Medicine were included.The patients were randomly divided into two groups, with 68 cases in each group.The acupoint-injection group was given 50IU salmon calcitonin on day 1, day 2 100IU, one time per day, continuously used for 15 days for a course of treatment, and with an interval of 90 days, and repeat the course of treatment.The patients were given 0.9% sodium chloride diluted to 2mL, inject 0.5mL into bilateral Shenshu and Zusanli these two points.The intramuscular injection group was given the same dose of salmon calcitonin gluteus maximus injected intramuscularly.At the same time, both two groups were given calcium Erqi D tablets one tablet a day, alendronate once a week, each time 70mg fasting taken orally.The type Ⅰ collagen β-CTx, PINP, NBAP, femoral neck, femur trochanter, lumbar (L1-L4) lumbar BMD and osteoporosis symptom score before and after treatment were compared. Results After treatment, the NBAP and BMD of the two groups were significantly higher than those before treatment (all P<0.05), and the β-CTx, PINP and symptoms scores were lower than before treatment (P<0.05). After treatment, NBAP in the acupoint injection group was (32.36±3.03)μg/L, which was higher than (29.66±3.20)μg/L in the intramuscular injection group(t=10.477, P<0.05). The β-CTx and PINP in the acupoint injection group were decreased to (0.10±0.05)μg/L and (28.78±5.23)μg/L, which were significantly lower than those in the intramuscular injection group[β-CTx(0.20±0.05)μg/L, PINP(35.77±6.49)μg/L(t=5.983, 2.662, all P<0.05)]. After treatment, the BMD of the femoral neck, femur trochanter and lumbar vertebra (L1-L4) in the acupoint injection group were (0.690±0.032)g/m^2, (0.620±0.010)g/m^2 and (0.822±0.012)g/m^2, respectively, which were higher than those in the intramuscular injection group[(0.652±0.012)g/m^2, (0.572±0.022)g/m2 and (0.801±0.011)g/m^2(t=5.055, 6.133, 1.956, all P<0.05)]. After treatment, the improvements of TCM syndromes such as weakness in the waist and knees, tinnitus and deafness, loss of appetite, release of teeth, relaxation of two feet, weak tongue, weak pulse in the acupoint injection group were better than those in the intramuscular injection group (all P<0.05). Conclusion The acupoint injection of salmon calcitonin at Zusanli and Shenshu points is more effective than the intramuscular injection in the treatment of senile osteoporosis.It can significantly increase the serum NBAP, decrease the serum β-CTx, PINP, improve the BMD and improve the patients' clinical symptoms, which means acupoint injection is a safe and effective way to treat senile osteoporosis.