强直性脊柱炎寒、热不同证型的骨密度与疾病活动度特点

The relationship of TCM syndrome and disease activity,bone mineral density in patients with ankylosing spondylitis

目的:探讨强直性脊柱炎(AS)寒、热不同辨证分型的骨密度、疾病活动度特点。方法:依据纳入标准选择45例肾虚督寒证、45例肾虚湿热证的AS患者为研究对象,检测ESR、CRP、BASDAI、BASFI、枕墙距、颌柄距、指地距、胸廓活动度、Schober征。应用双能X法检测腰椎、股骨骨密度(BMD),超声法检测双侧足跟BMD,分析寒热证型之间以上指标的差异,及寒热证型患者骨密度与其他指标的相关性。结果:寒热两组的ESR、CRP、BASDAI、腰椎BMD、股骨颈BMD、左跟骨BMD存在显著差异(P<0.05);肾虚督寒证组左跟骨BMD与年龄、指地距呈负相关(P<0.01);肾虚湿热证组股骨颈BMD与ESR、CRP、指地距呈负相关(P<0.05),左跟骨T值与枕墙距、指地距、颌柄距呈负相关(P<0.01)。结论:肾虚督寒证AS患者的骨密度、疾病活动度较肾虚湿热证患者减低,提示肾虚督寒证患者治疗上要注重扶正药物的应用,肾虚湿热证患者治疗上要注重祛邪。

Objective：To study the relationship of TCM syndrome and disease activity,bone mineral density （BMD）in patients with ankylosing spondylitis.Methods：According to the classification standard,45 patients of kidney deficiency and Du-meridian cold syndrome （cold syndrome）and 45 patients of kidney deficiency and damp heat syndrome （heat syndrome）were selected.ESR, CRP, BASFI, BASDAI,the occiput-wall distance, the fin- ger-floor distance,the stem-jaw distance,Schober test,thoracic activity level were observed.BMDs of the lumbar spine,femoral neck and the femoral tuberosity were measured using DXEA.BMDs of bilateral heels were mea- sured using ultrasonic testing.Results：There were significant differences between the two groups of ESR, CRP,BASDAI,lumbar spine BMD,femoral neck BMD,left heels BMD （P〈0.05）.In the cold syndrome group, BMDs of the left heels was negatively correlated to age and the finger-floor distance （P〈0.01）.In the heat syndrome group,BMDs of the femoral neck was negatively correlated to ESR,CRP,and the finger-floor dis- tance （P〈0.05）.BMDs of the left heels was negatively correlated to occiput-wall distance,the finger-floor dis- tance,and the stem-jaw distance （P〈0.01）.Conclusion：BMDs and disease activity in the patients of cold syn- drome were lower than the other group.So in the treatment of patients with cold syndrome ,strengthening body defensiveness is the point.While in the patients of heat syndrome,eliminating pathogenic qi is the point.